453-04-7664-m5
DECISION AND ORDER I. DISCUSSION Mega Rehab (Petitioner) sought review of the Findings and Decision of the Texas Workers§ Compensation Commission (Commission) acting through Forte, an Independent Review Organization (IRO). The IRO denied Petitioner’s request for reimbursement for $653.54 from American Home Assurance Co. (Respondent) for four sessions of aquatic therapy rendered to S.W. (Claimant).[1] […]
453-04-8288-m5
DECISION AND ORDER The Insurance Company of the State of Pennsylvania (ICSP) denied ___ reimbursement of $370.95 for four prescription drugs he purchased between July – December 2003. The drugs were Promethazine, Alprazolam, Sonata, and Hydrocodone. ___ appealed the denial to the Texas Workers’ Compensation Commission (TWCC), which referred the matter to an Independent Review […]
453-05-1232-m5-etal
DECISION AND ORDER Church Mutual Insurance Company (Carrier) is challenging the determination of the independent review organization (IRO) that Carrier should pay for preauthorized health care provided by First Rio Valley Medical, P.A. (Provider). Carrier argues that Provider’s pain management program is an unacceptable program, which was not preapproved. The Administrative Law Judge (ALJ) concludes […]
453-04-7661-m5
DECISION AND ORDER Eric Vanderwerff, D.C., (Petitioner) challenged the Findings and Decision of the Texas Workers’ Compensation Commission (Commission) acting through Independent Review Incorporated, an Independent Review Organization (IRO), finding physical therapy treatments were not medically necessary for the treatment of injured worker ___ (Claimant). After considering the evidence and arguments of the parties, the […]
453-04-0137-m5
DECISION AND ORDER First Rio Valley Medical, P.A., (Provider) challenged the decision of an 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 […]
453-04-5984-m5
DECISION AND ORDER The issue involved is whether American Home Assurance Company (Carrier) correctly denied payment of $9,381 billed by Troy M. Hurst, D.C. (Provider) for chiropractic services provided to an injured worker (Claimant) between July 1, 2002, and February 2, 2003. Carrier challenged the medical necessity of the treatment, but Provider contended Claimant’s pain […]
453-04-7172-m5
DECISION AND ORDER This case is a dispute over whether Lumbermens Underwriting Alliance (Respondent) should reimburse VONO (Petitioner) the sum of $520.71 for prescription medications provided to an injured worker (Claimant) from February 21, 2003, until May 23, 2003. The Administrative Law Judge (ALJ) concludes that Petitioner has not met its burden of proving that […]
453-04-8917-m5
DECISION AND ORDER ___,[1] (Claimant) contested a Texas Workers’ Compensation Commission (Commission) Medical Review Division (MRD) decision, concluding that certain prescription medications he purchased were medically unnecessary. Liberty Mutual Insurance Company (Carrier) contended the Claimant is not entitled to medical dispute resolution because he did not comply with a Commission rule requiring him to submit […]
453-03-3605-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 […]
453-04-5801-m5
DECISION AND ORDER SCD Back & Joint Clinic, Ltd. (Provider) challenged the decision of the Medical Review Division (MRD) of the Texas Workers’ Compensation Commission denying reimbursement to it for one-on-one physical therapy (PT), for other physical medicine treatments, and for related office visits that Provider administered to Claimant from July 23, 2002, through October […]