453-05-2804-m5
DECISION AND ORDER NUNC PRO TUNC[1] Pacific Employers Insurance Company (Carrier) and Vista Medical Center Hospital (Provider) each requested a hearing on a decision by the Medical Review Division (MRD) of the Texas Department of Insurance, Division of Workers’ Compensation (Division),[2] ordering additional reimbursement, but less than Provider requested, for a hospital stay provided to […]
453-05-3226-m5
DECISION AND ORDER American Home Assurance Company (Carrier) requested a hearing on a decision by the Medical Review Division (MRD) of the Texas Department of Insurance, Division of Workers’ Compensation (Division)[1] ordering additional reimbursement to HCA Corpus Christi Medical Center (Provider) for a hospital stay provided to Claimant, an injured worker. Provider argued that reimbursement […]
453-04-4568-m5
DECISION AND ORDER Don A. Salyer, D.C. (Petitioner) seeks reimbursement for office visits, electrical stimulation, therapeutic procedures, mechanical traction, supplies/materials, and myofascial releases provided to a worker’s compensation claimant from September 27, 2002 through December 20, 2002. The Texas Workers’ Compensation Commission (Commission),[1] acting through an independent review organization (IRO), denied reimbursement on the basis […]
453-04-5186-m5
DECISION AND ORDER Zenith Insurance Company (Carrier) requested a hearing on a decision by the Medical Review Division (MRD) of the Texas Department of Insurance, Division of Workers’ Compensation (Division),[1] ordering additional reimbursement to Provider for a hospital stay provided to Claimant, an injured worker. Carrier argued that reimbursement for this admission should not be […]
453-05-0603-m5
DECISION AND ORDER I. INTRODUCTION Vista Healthcare, Inc. (Vista) requested a hearing to contest a decision by the Medical Review Division (MRD) of the Texas Workers’ Compensation Commission (Commission) denying additional payment for ambulatory surgical center services.[1] Vista operated ambulatory surgical centers (ASCs) in Texas, providing surgical services to patients not requiring in-patient hospitalization. Vista […]
453-05-0604-m5
DECISION AND ORDER I. INTRODUCTION Vista Healthcare, Inc. (Vista) requested a hearing to contest a decision by the Medical Review Division (MRD) of the Texas Workers’ Compensation Commission (Commission) denying additional payment for ambulatory surgical center services.[1] Vista operated ambulatory surgical centers (ASCs) in Texas, providing surgical services to patients not requiring in-patient hospitalization. Vista […]
453-05-4266-m5
DECISION AND ORDER Lawrence N. Smith, D.C. (Petitioner) requested a hearing to contest independent review organization (IRO) and Texas Workers’ Compensation Commission (Commission)[1] Medical Review Division (MRD) determinations that certain services he provided to an injured worker (Claimant) from March 15, 2004, through August 20, 2004, were medically unnecessary. This decision concludes the Petitioner proved […]
453-05-1995-m5
DECISION AND ORDER Waco Ortho Rehab. (Petitioner) requested a hearing to contest the Findings and Decision of the Texas Workers’ Compensation Commission (Commission) acting through Texas Medical Foundation, an Independent Review Organization (IRO), denying Petitioner reimbursement for therapeutic procedures and exercises, office visits, muscle testing, physical performance testing, range of motion testing, chiropractic manipulative treatment, […]
453-05-7235-m5
DECISION AND ORDER Petitioner, Chris G. Dalrymple, D.C. (Provider), challenged the Findings and Decision of the Medical Review Division (MRD) of the Texas Workers’ Compensation Commission, now the Texas Department of Insurance, Division of Workers’ Compensation, denying reimbursement from Insurance Company of the State of PA (Carrier) for medical services provided to an injured worker […]
453-05-9154-m5
DECISION AND ORDER An Independent Review Organization (IRO) determined that various chiropractic services rendered by Horizon Health (Provider) to Claimant for her compensable injury were not medically necessary. The Medical Review Division (MRD) of the Texas Workers’ Compensation Commission (Commission)[1] ordered that the City of Houston (Carrier) need not reimburse Provider for the disputed services. […]