453-04-6069-m5-etal
DECISION AND ORDER I. INTRODUCTION Texas Mutual Insurance Company (Carrier) disputes the decisions of two independent review organizations (IROs) and the Texas Workers’ Compensation Commission (TWCC) Medical Review Division (MRD) regarding medical services for ____ (Claimant). Carrier disputes that it should be required to reimburse Main Rehab and Diagnostic (Provider) $6,833.55 for those services. As […]
453-04-6389-m5
DECISION AND ORDER Petitioner, Texas Mutual Insurance Co. (Carrier), appealed the Findings and Decision of the Medical Review Division (MRD) of the Texas Workers’ Compensation Commission (TWCC) granting reimbursement to Brian Randall, D.C. (Provider) for medical services rendered to ___, (Claimant). Carrier disputes the conclusion of the Independent Review Organization (IRO) that these services were […]
453-04-7293-m5
DECISION AND ORDER I. INTRODUCTION ___ (Claimant) requested a hearing to contest a decision by the Texas Workers’ Compensation Commission (Commission) Medical Review Division (MRD) to dismiss his request for medical dispute resolution based on its conclusion that claims for his disputed medical bills had not been submitted to Valley Forge Insurance Company (Carrier) for […]
453-04-6385-m5
DECISION AND ORDER I. SUMMARY Main Rehab and Diagnostic (Provider) appealed the decision of Envoy Medical Systems, LP, an independent review organization (IRO) certified by the Texas Department of Insurance, in Texas Workers’ Compensation Commission (TWCC) Medical Review Division (MRD) tracking number M5-04-0470-01, denying reimbursement for medical services provided to the Claimant. Additionally, the Provider […]
453-04-3451-m5
DECISION AND ORDER Petitioner ___ (Claimant) appealed the decision of the Texas Workers’ Compensation Commission (the Commission/TWCC) to dismiss the medical dispute resolution. TWCC dismissed the appeal contending that: (1) Petitioner did not timely file the appeal, and (2) Petitioner failed to provide the documentation required by 28 Tex. Admin. Code (TAC) § 133.308(f). Consequently, […]
453-04-5123-m5
DECISION AND ORDER I. INTRODUCTION Mary C. Hodgkinson, P.T. (M.C.H.P. or Provider) has appealed a decision issued by the Texas Workers’ Compensation Commission’s (TWCC) Medical Review Division (MRD), which adopted an Independent Review Organization’s (IRO) determination that The Provider should be denied reimbursement for medical services she provided to ___ (Claimant). The only disputed issue […]
453-04-5737-m5
DECISION AND ORDER Texas Mutual Insurance Company (Carrier) challenges Independent Review Organization (IRO) and Medical Review Division (MRD) decisions granting reimbursement to Work Ready Rehab (Provider) for physical therapy services provided to an injured worker (Claimant). The Administrative Law Judge (ALJ) concludes, based on the evidence presented, that (1) the disputed services were not medically […]
453-04-6067-m5
I. Introduction Cotton D. Merritt, D.C. (Dr. Merritt) has appealed a decision of the Texas Workers’ Compensation Commission’s (TWCC) Medical Review Division (MRD) regarding medical services he provided ___ (Claimant) from March 18, 2003, through April 24, 2003, but for which National Fire Insurance Company of Hartford (Carrier) denied reimbursement. MRD, relying on a determination […]
453-04-3077-m5
DECISION AND ORDER Texas Mutual Insurance Company (TMIC) seeks review of a decision by the Texas Workers’ Compensation Commission (Commission), acting through an independent review organization (IRO), in a dispute regarding the medical necessity of physical medicine treatments that Southeast Health Services (Southeast) provided to Claimant___., who suffered from a lower back injury. This decision […]
453-04-3715-m5
DECISION AND ORDER Texas Mutual Insurance Company (TMIC) seeks review of a decision by the Texas Workers’ Compensation Commission (Commission), acting through an independent review organization (IRO), in a dispute regarding the medical necessity of physical medicine treatments that Southeast Health Services (Southeast) provided to Claimant ___, who suffered from a lower back injury. This […]