453-04-4645-m5
DECISION AND ORDER I. INTRODUCTION After an Independent Review Organization (IRO) reviewer and the Commission’s Medical Review Division (MRD) determined physical-medicine treatment was medically necessary for a workers’ compensation claimant, Texas Mutual Insurance Company (Carrier) appealed. In this Decision and Order, the Administrative Law Judge (ALJ) sustains the Carrier’s appeal as to $2,415 in charges […]
453-04-6344-m5
DECISION AND ORDER Main Rehab and Diagnostic (Provider) challenged the decision of the Medical Review Division (MRD) of the Texas Workers’ Compensation Commission denying reimbursement to it for sessions of physical therapy and work hardening that Provider administered to ___ (Claimant) from March 13, 2003, through June 9, 2003. Dallas Fire Insurance Company (Carrier) appealed […]
453-04-6342-m5
DECISION AND ORDER I. DISCUSSION Insurance Company of Pennsylvania (Petitioner or Carrier) requested a hearing before the State Office of Administrative Hearings (SOAH) following the decision of April 23, 2004, by the Texas Workers’ Compensation Commission (Commission) acting through Medical Review of Texas, an Independent Review Organization (IRO). The Commission’s Order found that the request […]
453-04-6501-m5
DECISION AND ORDER I. DISCUSSION Highpoint Pharmacy (Petitioner) requested a hearing before the State Office of Administrative Hearings (SOAH) following a decision of the Texas Workers’ Compensation Commission (Commission or TWCC) acting through Forté, an Independent Review Organization (IRO). The Commission’s Order denied Petitioner’s request for reimbursement of medications for ___ (Claimant). This decision grants […]
453-04-8086-m5
DECISION AND ORDER I. DISCUSSION First Rio Valley Medical, P.A. (Petitioner), requested a hearing to contest the June 23, 2004 Findings and Decision of the Texas Workers’ Compensation Commission (Commission) denying reimbursement for (1) office visits with manipulations,[1] aquatic therapy,[2] special reports,[3] and massage therapy[4] from December 12, 2003, through January 7, 2004 (Disputed Services).[5] […]
453-04-5927-m5
DECISION AND ORDER Neuromuscular Institute of Texas (Petitioner) seeks reimbursement of $788 for seven sessions of physical therapy following trigger point injections provided to injured worker ___ (Claimant). The Texas Workers’ Compensation Commission (Commission), acting through an independent review organization (IRO) denied reimbursement on the basis that the services were not medically necessary. This decision […]
453-04-2304-m5
DECISION AND ORDER I. INTRODUCTION After an Independent Review Organization (IRO) reviewer and the Commission’s Medical Review Division (MRD) determined physical-medicine treatment was medically necessary for a workers’ compensation claimant, Liberty Mutual Fire Insurance Company (Carrier) appealed. In this Decision and Order, the Administrative Law Judge (ALJ) finds that charges for traction should not be […]
453-04-4178-m5
DECISION AND ORDER I. INTRODUCTION Eric Vanderwerff, D.C. (Petitioner) seeks reimbursement for 42 physical medicine sessions he provided to the Claimant from July 2, 2002, through February 19, 2003. Mid-Century Insurance Company (Carrier or Respondent) opposes reimbursement on the grounds that the sessions were not properly documented or reasonable and medically necessary to treat the […]
453-04-5929-m5
DECISION AND ORDER SCD Back & Joint Clinic (Clinic) 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 provided to Claimant ___, who suffered from a compensable lower back injury. The amount in controversy […]
453-04-5894-m5
DECISION AND ORDER Texas Mutual Insurance Company (Carrier) appealed in part the decision of the Medical Review Division (MRD) of the Texas Workers’ Compensation Commission (the Commission) ordering reimbursement to Abilene Healthcare and Injury Clinic (Provider) for manual tractionand myofascial releasethat were provided to Claimant between March 28, 2003, and July 1, 2003. Provider appealed […]