453-04-7158-m5
DECISION AND ORDER The worker’s compensation claimant (Claimant) in this case sustained compensable injuries to her right knee and lower back. She underwent approximately two months of work hardening administered by Main Rehab & Diagnostic (Provider). The carrier, Liberty Mutual Insurance Corporation (Carrier), paid for the first month of the work hardening program. However, citing […]
453-04-5344-m5
DECISION AND ORDER I. DISCUSSION In SOAH Docket No. 453-04-5766.M5, Texas Mutual Insurance Company (TMIC) requested a hearing following an April 5, 2004 Amended Findings and Decision of the Texas Workers’ Compensation Commission (Commission). The Commission’s April 5, 2004 Amended Findings and Decision (April Decision), relied upon a decision of an Independent Review Organization (IRO), […]
453-04-5766-m5
DECISION AND ORDER I. DISCUSSION In SOAH Docket No. 453-04-5766.M5, Texas Mutual Insurance Company (TMIC) requested a hearing following an April 5, 2004 Amended Findings and Decision of the Texas Workers’ Compensation Commission (Commission). The Commission’s April 5, 2004 Amended Findings and Decision (April Decision), relied upon a decision of an Independent Review Organization (IRO), […]
453-04-6345-m5
DECISION AND ORDER I. DISCUSSION In SOAH Docket No. 453-04-5766.M5, Texas Mutual Insurance Company (TMIC) requested a hearing following an April 5, 2004 Amended Findings and Decision of the Texas Workers’ Compensation Commission (Commission). The Commission’s April 5, 2004 Amended Findings and Decision (April Decision), relied upon a decision of an Independent Review Organization (IRO), […]
453-04-6347-m5
DECISION AND ORDER Pain & Recovery Clinic (Petitioner) appealed the decision of the Texas Workers’ Compensation Commission’s (Commission) Medical Review Division (MRD) to the findings of its designee, an independent review organization (IRO). The decision upheld United States Fidelity & Guaranty Company’s (Carrier) denial of reimbursement for services provided a workers’ compensation claimant (Claimant) on […]
453-04-7780-m5
DECISION AND ORDER I. INTRODUCTION Pain and Recovery Clinic North (Provider) appealed the Findings and Decision of the Texas Workers’ Compensation Commission (Commission) denying reimbursement to Petitioner for chiropractic treatments and office visits provided to Claimant from March 10, 2003 through April 17, 2003, on the grounds that the services were not medically necessary. This […]
453-05-2977-m5
DECISION AND ORDER I. DISCUSSION Maximum Therapeutic Initiative (Petitioner) requested a hearing to contest the September 22, 2004 Findings and Decision of the Texas Workers’ Compensation Commission (Commission) denying reimbursement for treatment services provided to ___ (Claimant) from July 7, 2003, through July 11, 2003, because they were not medically necessary.[1] The Commission also reviewed […]
453-04-7320-m5
DECISION AND ORDER I. INTRODUCTION Shaub Family Chiropractic Center (Provider) disputes a decision of the Texas Workers’ Compensation Commission (TWCC) Medical Review Division (MRD) regarding medical services that the Provider furnished to ___ (Claimant). Atlantic Mutual Insurance Company (Carrier) contends that the services were not shown to be reasonably medically necessary due to the Claimant’s […]
453-05-1609-m5
DECISION AND ORDER First Rio Valley Medical, P.A., (Provider) appealed the decision of the Independent Review Organization (IRO) denying reimbursement for services provided to an injured worker (Claimant). After considering the evidence and arguments of the parties, the Administrative Law Judge (ALJ) concludes that Provider failed to show by a preponderance of the evidence that […]
453-04-5116-m5
DECISION AND ORDER I. DISCUSSION Texas Mutual Insurance Company (TMIC) requested a hearing to contest the March 1, 2004 Findings and Decision of the Texas Workers’ Compensation Commission (Commission) acting through MAXIMUS, an Independent Review Organization (IRO), allowing Craig A. Thiry, D.C. (Respondent), reimbursement, on the basis of medical necessity, for a sensory nerve conduction […]