453-04-6480-m5
DECISION AND ORDER This case involves medical treatments and testing provided by Results Rehab to workers’ compensation claimant ____ (the Claimant) from December 11, 2002, through April 16, 2003. The Administrative Law Judge (ALJ) concludes the workers’ compensation carrier, Texas Mutual Insurance Company (TMIC), proved the disputed treatments were not medically necessary and that reimbursement […]
453-04-1166-m5
DECISION AND ORDER I. SUMMARY Texas Mutual Insurance Company (Carrier) appealed the decisions of two independent review organizations (IROs) in Texas Workers’ Compensation Commission (TWCC) Medical Review Division (MRD) tracking numbers M5-03-1014-01 and M5-03-1987-01, granting reimbursement for medical services provided to the Claimant. Additionally, the Carrier appealed the MRD’s decision denying reimbursement for services not […]
453-04-3076-m5
DECISION AND ORDER I. SUMMARY Texas Mutual Insurance Company (Carrier) appealed the decisions of two independent review organizations (IROs) in Texas Workers’ Compensation Commission (TWCC) Medical Review Division (MRD) tracking numbers M5-03-1014-01 and M5-03-1987-01, granting reimbursement for medical services provided to the Claimant. Additionally, the Carrier appealed the MRD’s decision denying reimbursement for services not […]
453-04-6356-m5-etal
DECISION AND ORDER This proceeding concerns appeals from two decisions by Independent Review Organizations (IROs) that were joined for hearing at the State Office of Administrative Hearings (SOAH). At issue in both cases is the medical necessity of services Main Rehab and Diagnostic (Provider) rendered to Claimant ___ The first dispute, SOAH Docket No. 453-04-6356.M5, […]
453-04-5764-m5
DECISION AND ORDER I. INTRODUCTION After an Independent Review Organization (IRO) reviewer and the Commission’s Medical Review Division determined that physical-medicine treatment was unnecessary for a workers’ compensation claimant, Brian Randall, D. C. (Provider) appealed. The amount in dispute is $4,539.00 for 22 physical-medicine sessions. In this Decision and Order, the Administrative Law Judge (ALJ) […]
453-04-5800-m5
DECISION AND ORDER Texas Mutual Insurance Company (Texas Mutual) and Main Rehab & Diagnostic (Main Rehab) each requested a hearing to contest an Independent Review Organization (IRO) decision, made on behalf of the Texas Workers= Compensation Commission (Commission), regarding certain treatments/services that Main Rehab provided to an injured worker (Claimant), including therapeutic exercise, office visit, […]
453-04-7294-m5
DECISION AND ORDER American Casualty Company of Reading, PA (Carrier) requested a hearing to contest a decision by Independent Review, Inc., an independent review organization (IRO), which found that an initial functional capacity evaluation or physical performance test was medically necessary for ___ (Claimant). The Administrative Law Judge (ALJ) holds that finds that Carrier met […]
453-04-7319-m5
DECISION AND ORDER Michael Bhatt, D.C., requested a hearing to contest determinations by an Independent Review Organization (IRO) and the Texas Workers= Compensation Commission (Commission) Medical Review Division (MRD), that certain therapeutic exercises and office visits he provided to an injured worker (Claimant) were medically unnecessary. The ALJ concludes that Dr. Bhatt proved the services […]
453-04-4186-m5
DECISION AND ORDER I. DISCUSSION Texas Mutual Insurance Company (TMIC) requested a hearing to contest the January 28, 2004 Findings and Decision of the Texas Workers’ Compensation Commission (Commission) allowing SCD Back and Joint Clinic, Ltd. (SCD), reimbursement, on the basis of medical necessity, for analgesic balm,[1] therapeutic exercises,[2] muscle testing,[3] office visits,[4] joint mobilization,[5] […]
453-04-6503-m5
DECISION AND ORDER Petitioner, JCMLR, P.A., (Provider) appealed the Findings and Decision of the Medical Review Division (MRD) of the Texas Workers’ Compensation Commission (TWCC) denying reimbursement from Texas Mutual Insurance Co. (Carrier) for medical services rendered to an injured worker (Claimant). Provider disputes the conclusion of the Independent Review Organization (IRO) that these services […]