453-04-8368-m5
DECISION AND ORDER Texas Mutual Insurance Company (Carrier) requested a hearing to contest the July 16, 2004, Findings and Decision of the Texas Workers= Compensation Commission (Commission) authorizing reimbursement in the amount of $2,603.59 to First Rio Valley Medical, P.A., (Provider) for aquatic therapy,[1] massage therapy,[2] and therapeutic exercises,[3] from December 10, 2003, through February […]
453-05-3649-m5
DECISION AND ORDER Texas Mutual Insurance Company (Provider) requested a hearing to contest the May 1, 2003, Findings and Decision of the Texas Workers’ Compensation Commission (Commission) authorizing reimbursement in the amount of $2,214.00, for patient focused office visits,[1] aquatic therapy,[2] therapeutic exercises,[3] and copies of medical records[4] from October 21, 2002, through November 7, […]
453-04-8260-m5
DECISION AND ORDER I. INTRODUCTION Texas Mutual Insurance Co. (Carrier) disputes a decision of an independent review organization (IRO) regarding medical services for ___ (Claimant). Carrier had denied reimbursement to Pain & Recovery Clinic North (Provider) for certain services provided to the Claimant between April 15, 2003, and July 10, 2003. The IRO and MRD […]
453-03-3230-m5
DECISION AND ORDER Texas Mutual Insurance Company (Carrier) requested a hearing to contest the April 3, 2003, Findings and Decision of the Texas Workers’ Compensation Commission (Commission) authorizing reimbursement to First Rio Valley Medical, P.A. (Provider) for patient focused office visits,[1] expanded problem office visits,[2] one-on-one aquatic therapy,[3] spray and stretch,[4] attended electrical stimulation, [5]and […]
453-04-2849-m5
DECISION AND ORDER I. INTRODUCTION American Home Assurance Company (Carrier) contests the decision of the Texas Workers” Compensation Commission’s Medical Review Division (MRD) ordering reimbursement of $3,108 for services provided to Claimant from April 28, 2003, through May 21, 2003, by Community Rehab & Work Conditioning (Provider). The Administrative Law Judge (ALJ) finds that Carrier […]
453-04-4214-m5
DECISION AND ORDER Texas Mutual Insurance Company (Carrier) requested a hearing to contest the January 30, 2004, Findings and Decision of the Texas Workers’ Compensation Commission (Commission) authorizing reimbursement of $8,836.00, to First Rio Valley Medical, P.A., (Provider) for aquatic therapy (CPT Code 97113), electrical stimulation (CPT Code 97032), massage therapy (CPT Code 97124), therapeutic […]
453-05-3042-m5
DECISION AND ORDER The State Office of Risk Management (SORM) appeals a decision by the Texas Workers’ Compensation Commission’s Medical Review Division (MRD) regarding the medical necessity and documentation of chiropractic services for a workers’ compensation claimant. MRD referred the medical necessity issue to an independent review organization (IRO), which found the services medically reasonable […]
453-04-1330-m5
DECISION AND ORDER This case is an appeal by Vladimir Redko, M.D. from a decision by an Independent Review Organization (IRO) in a medical necessity dispute initiated before the Texas Workers’ Compensation Commission (Commission). Dr. Redko requested reimbursement for services provided to a Claimant from August 16, 2002, through January 2, 2003. The IRO determined […]
453-04-4682-m5
DECISION AND ORDER Petitioner Kevin Strathdee, D.C., (Dr. Strathdee) appealed a determination by an Independent Review Organization (IRO) that certain post-operative therapies and durable medical equipment (DME) Dr. Strathdee provided to Claimant ___ were not medically necessary. The amount in dispute is $6,062.00. In this Decision and Order, the Administrative Law Judge (ALJ) finds that […]
453-05-0541-m5
DECISION AND ORDER Highpoint Pharmacy (Petitioner) appealed the findings and decision of the Texas Workers’ Compensation Commission’s designee, an independent review organization (IRO), which found that prescriptions that Petitioner provided a workers’ compensation claimant (Claimant) were not medically necessary healthcare. The IRO’s decision upheld a denial of reimbursement by the American Home Assurance Company (Carrier). […]