453-04-8342-m5
DECISION AND ORDER Pedro Nosnik, M.D. (Provider) appealed the decision of the Texas Workers’ Compensation Commission (Commission) designee, an Independent Review Organization (IRO), which denied his request for reimbursement for consultation/office visit (CPT Code 99244), electromyography (EMG) (CPT Code 95861), nerve conduction (NCV) (CPT Codes 95900 and 95904), and H or F reflex study (CPT […]
453-04-7288-m5
DECISION AND ORDER Kiest Park Medical (Provider) challenged the decision of an Independent Review Organization (IRO) upholding the denial of treatment rendered to ___ (Claimant) between May 28, 2003, through September 2, 2003. In this decision, the Administrative Law Judge (ALJ) finds that Provider met its burden of showing that the treatment rendered was reasonable […]
453-04-7779-m5
DECISION AND ORDER ___ (Claimant) challenges the decision by an Independent Review Organization (IRO) denying her request to reimburse her for prescription medications provided to her from December 23, 2003, until March 9, 2004, in the amount of $155.60. Travelers Indemnity Company of Connecticut (Carrier) denied the request as not medically necessary and the IRO […]
453-04-8655-m5
DECISION AND ORDER SLT Chiropractic Associates (Provider) appealed the findings and decision of the Texas Workers’ Compensation Commission’s (Commission’s) designee, an independent review organization (IRO), which found that the treatments provided to ___a workers’ compensation claimant (Claimant), were not medically necessary health care. This decision finds that the treatments provided Claimant were not medically necessary. […]
453-05-2759-m5
DECISION AND ORDER I. DISCUSSION South Coast Spine and Rehab, P.A. (South Coast) requested a hearing to contest the denial for reimbursement of services including office visits, massage, aquatic therapy, and therapeutic exercises from March 25, 2004, through April 20, 2004. This decision GRANTS the relief sought by South Coast and requires reimbursement for the […]
453-04-2827-m5
DECISION AND ORDER I. INTRODUCTION Ace American Insurance Company (Petitioner) requested a hearing to contest the January 6, 2004, Findings and Decision of the Texas Workers’ Compensation Commission (Commission) authorizing reimbursement to First Rio Valley Medical, P.A. (Respondent) for chiropractic treatments provided to __ (Claimant) on June 10, 11, 12, and 23, 2003 (Disputed Services). […]
453-04-6623-m5
DECISION AND ORDER Santiago Guajardo, D. C. (Provider), challenged the decision of the Medical Review Division (MRD) of the Texas Workers’ Compensation Commission (Commission) denying reimbursement for office visits, physical therapy, and sessions of physical medicine provided to ___ (Claimant) from April 14, 2003, through October 2, 2003. Zurich American Insurance Company (Carrier) is the […]
453-04-7573-m5
DECISION AND ORDER Irving Imaging (Provider) appealed the decision of the Texas Workers’ Compensation Commission (Commission) designee, an Independent Review Organization (IRO), which denied its request for reimbursement for an MRI of the lumbar spine and an MRI of the brain as not medically necessary. The Administrative Law Judge (ALJ) finds that Provider did not […]
453-04-3594-m5
DECISION AND ORDER I. INTRODUCTION Ace American Insurance Company (Petitioner) requested a hearing to contest the January 27, 2004, Findings and Decision of the Texas Workers’ Compensation Commission (Commission) authorizing reimbursement to First Rio Valley Medical, P.A. (Respondent) for chiropractic treatments provided to ___ (Claimant) from September 18, 2002, through October 18, 2002 (Disputed Services). […]
453-05-1630-m5
DECISION AND ORDER I. INTRODUCTION Ace American Insurance Company (Petitioner) requested a hearing to contest the October 7, 2004, Findings and Decision of the Texas Workers’ Compensation Commission (Commission) authorizing reimbursement to First Rio Valley Medical, P.A. (Respondent) for chiropractic treatments provided to ___ (Claimant) on January 9, 12, 14, 15, 19, 21, and 23, […]