453-04-6390-m5
DECISION AND ORDER I. DISCUSSION Texas Mutual Insurance Company (TMIC), Petitioner, requested a hearing to contest the Findings and Decision of the Texas Workers’ Compensation Commission (Commission) acting through Ziroc, an Independent Review Organization (IRO).[1] By letter issued on April 12, 2004, the IRO disagreed with TMIC’s prior adverse decision to deny reimbursement to Jack […]
453-04-6625-m5
DECISION AND ORDER I. INTRODUCTION Mega Rehab (Provider) disputes a decision of an independent review organization (IRO) on behalf of the Texas Workers= Compensation Commission (TWCC) Medical Review Division (MRD) regarding medical services that the Provider furnished to ___ (Claimant). Liberty Mutual Insurance Company (Carrier) contends, and the IRO agreed, that the services were not […]
453-04-5077-m5
DECISION AND ORDER Petitioner, San Antonio Accident Injury Care (Provider), appealed the Findings and Decision of the Medical Review Division (MRD) of the Texas Workers’ Compensation Commission (TWCC) denying reimbursement from Via Metropolitan Transit (Carrier) for medical services provided to an injured worker (Claimant). Provider disputes the conclusion of the Independent Review Organization (IRO) that […]
453-04-6066-m5
DECISION AND ORDER American Casualty Company of Reading PA (American Casualty) requested a hearing to contest an Independent Review Organization (IRO) determination, made on behalf of the Texas Workers= Compensation Commission (Commission) Medical Review Division, that electrodiagnostic testing and other services provided by Advanced Medical Associates (Advanced Medical) to an injured worker (Claimant) on October […]
453-05-0970-m5
DECISION AND ORDER Health Ready Physical Therapy (Health Ready) seeks review of a decision of the Texas Workers’ Compensation Commission’s (Commission’s)[1] Medical Review Division (MRD) based on the opinion of an independent review organization (IRO). The decision denied reimbursement for work hardening treatment provided to Claimant__. The Administrative Law Judge (ALJ) finds that the work […]
453-04-1841-m5
DECISION AND ORDER I. DISCUSSION The University of Texas System (Petitioner) requested a hearing to contest the November 14, 2003 Findings and Decision of the Texas Workers’ Compensation Commission (Commission) allowing reimbursement for (1) office visits with manipulations,[1] joint mobilization,[2] traction,[3] therapeutic procedures,[4] muscle testing,[5] myofacial release,[6] and work hardening[7] from March 19, 2001, through […]
453-04-5767-m5
DECISION AND ORDER I. INTRODUCTION Texas Mutual Insurance Company (Carrier) disputes several decisions of an independent review organization (IRO) and the Texas Workers’ Compensation Commission (TWCC) Medical Review Division (MRD) regarding medical services for ___ (Claimant). The disputes concern services that SCD Back & Joint (Provider) furnished to the Claimant. The Provider also disputes a […]
453-04-7168-m5
DECISION AND ORDER EZ RX Pharmacy (Provider) challenges the decision of the Independent Review Organization (IRO) denying reimbursement for prescription medication provided to injured worker ___ (Claimant). After considering the evidence and arguments of the parties, the Administrative Law Judge (ALJ) concludes that Republic Franklin Insurance Company (Carrier) is not liable for reimbursing Petitioner any […]
453-04-3712-m5
DECISION AND ORDER Petitioner, Eric A. Vanderwerff, D.C., (Provider), requested a hearing from the Findings and Decision of the Medical Review Division (MRD) of the Texas Workers’ Compensation Commission (TWCC) denying reimbursement from Fireman’s Fund Insurance Co. (Carrier) for medical services provided to an injured worker (Claimant). The MRD ordered Carrier to pay for a […]
453-04-5858-m5
DECISION AND ORDER I. INTRODUCTION Mega Rehab (Provider) contested the decision of the Texas Workers= Compensation Commission’s Medical Review Division (MRD)denying reimbursementof$794.39for services provided to Claimant from December 6, 2002, through April 17, 2003.[1]The Administrative Law Judge (ALJ) finds thatProvider did not prove the disputed treatments were reasonable or medically necessary, and that reimbursement for […]