453-05-0211-m5
DECISION AND ORDER Texas Mutual Insurance Company (TMIC) seeks review of a decision by the Texas Workers’ Compensation Commission (Commission), acting through an independent review organization (IRO), in a dispute regarding the medical necessity of physical medicine treatments provided to Claimant ___ This decision finds that MTR Management (MTR) should be reimbursed $1008.50 for 11 […]
453-04-4687-m5
DECISION AND ORDER Texas Mutual Insurance Company (Carrier) requested a hearing on a decision by an Independent Review Organization (IRO) granting reimbursement to Syzygy Associates, L.P. (Provider) for work hardening provided to injured worker (Claimant). After considering the evidence and arguments, the Administrative Law Judge (ALJ) concludes that Carrier has shown that the treatments in […]
453-05-0078-m5
DECISION AND ORDER Texas Mutual Insurance Company (Carrier) requested a hearing on a decision of an independent review organization (IRO) on behalf of the Texas Workers’ Compensation Commission (Commission) in a dispute regarding medical necessity for physical therapy. The IRO found that the insurer, Liberty Mutual Fire Insurance Company (Carrier), improperly denied reimbursement for physical […]
453-05-0858-m5
DECISION AND ORDER MedPro Clinics (Provider), challenges the decision of an Independent Review Organization (IRO) upholding the denial of reimbursement for a physical therapy program rendered to Claimant from March 8, 2004, through May 7, 2004. In this decision, the Administrative Law Judge (ALJ) finds that Provider met its burden of showing that the treatment […]
453-04-8210-m5
DECISION AND ORDER This case is an appeal by Pain & Recovery Clinic (Petitioner or Provider) from a decision of an independent review organization (IRO) on behalf of the Texas Workers’ Compensation Commission (Commission) in a dispute regarding medical necessity for chiropractic treatment. The IRO found that the insurer, ZNAT Insurance Company (Respondent or Carrier), […]
453-04-4212-m5
DECISION AND ORDER Texas Mutual Insurance Company (Carrier) contested the decision of the Medical Review Division (MRD) of the Texas Workers’ Compensation Commission (the Commission) ordering reimbursement for physical therapy and office visits provided to Claimant on 15 dates of service from July 25 through October 25, 2002, following a three-level lumbar fusion on February […]
453-05-3082-m5
DECISION AND ORDER I. INTRODUCTION ___ (Claimant) disputes a decision of the Texas Workers’ Compensation Commission (TWCC) Medical Review Division (MRD) regarding alleged medical services for which he alleges that North American Specialty Services (Carrier) failed to pay. As set out below, the Administrative Law Judge (ALJ) finds that the Claimant has failed to submit […]
453-04-0679-m5
DECISION AND ORDER Texas Mutual Insurance Company (Carrier) contested the decision of the Medical Review Division (MRD) of the Texas Workers’ Compensation Commission (the Commission) ordering reimbursement for physical therapy and office visits that were provided to Claimant on 39 dates of service between September 11, 2002, and January 9, 2003. Carrier denied reimbursement on […]
453-04-5713-m5
DECISION AND ORDER Texas Mutual Insurance Company (Carrier) challenges the decision of the Medical Review Division (MRD) of the Texas Workers’ Compensation Commission (Commission) ordering reimbursement for certain treatments provided to injured worker (Claimant). After considering the evidence and arguments presented, the Administrative Law Judge (ALJ) concludes that Carrier is liable for reimbursing Richard Taylor, […]
453-05-0209-m5
DECISION AND ORDER This case is an appeal by Orthopaedic Institute Pharmacy (Petitioner) from a decision of an independent review organization (IRO) on behalf of the Texas Workers’ Compensation Commission (Commission) in a dispute regarding medical necessity for prescription medicine. The IRO found that the insurer, Liberty Mutual Fire Insurance Company (Respondent), properly denied reimbursement […]