453-04-5200-m5
DECISION AND ORDER Continental Casualty Company (Carrier) contested the decision of the Medical Review Division (MRD) of the Texas Workers’ Compensation Commission (the Commission) ordering reimbursement of treatment provided to Claimant by Central Dallas Rehab (Provider) between November 20, 2002, and February 10, 2003. Following the hearing on the merits, the parties submitted an agreed […]
453-04-4531-m5
DECISION AND ORDER I. DISCUSSION Texas Mutual Insurance Company (Petitioner) requested a hearing to contest the Findings and Decision of the Texas Workers’ Compensation Commission (Commission) allowing Franklin Chiropractic and Accident Clinics, Inc. (Respondent), reimbursement for (1) office visits with manipulations[1] and therapeutic exercises[2] from June 27, 2002, through September 30, 2002, and (2) auto-traction/physical […]
453-04-5420-m5
DECISION AND ORDER I. DISCUSSION Texas Mutual Insurance Company (Petitioner) requested a hearing to contest the Findings and Decision of the Texas Workers’ Compensation Commission (Commission) allowing Central Dallas Rehab, (Respondent or Provider) reimbursement for muscle testing,[1] range of motion testing,[2] and joint mobilization,[3] (Disputed Services).[4] On March 31, 2004, the Commission issued an Order […]
453-04-5925-m5
DECISION AND ORDER Petitioner, Huffmeister Family Chiropractic Clinic (Provider), appealed the Findings and Decision of the Medical Review Division (MRD) of the Texas Workers’ Compensation Commission (TWCC) denying reimbursement from the City of Houston (City ) for medical services provided to ___, (Claimant). The City provided workers’ compensation coverage for its workers through a self-insurance […]
453-04-4446-m5
DECISION AND ORDER Dr. Suhail Al-Sahli (Provider) challenges an Independent Review Organization (IRO) decision confirming the denial of reimbursement for services provided to Claimant from September 13, 2001, through May 31, 2002. The Administrative Law Judge (ALJ) concludes the disputed services were not shown to be medically necessary to treat Claimant’s injury. Consequently, reimbursement should […]
453-04-4401-m5
DECISION AND ORDER Carl M. Naehritz, III, D.C. (Petitioner) challenged the Findings and Decision of the Texas Workers’ Compensation Commission (Commission) acting through Maximus, an Independent Review Organization (IRO), finding physical therapy treatments were not medically necessary for the treatment of injured worker ___ (Claimant). After considering the evidence and arguments of the parties, the […]
453-04-6406-m5
DECISION AND ORDER Neuromuscular Testing and Rehab Center (Provider) requested a hearing on the findings and decision of the Texas Workers’ Compensation Commission’s Medical Review Division in MDR Docket No. M5-03-0061-01 that denied certain reimbursements to Provider for physical therapy services provided to workers’ compensation claimant, ___ (Claimant). Liberty Mutual Fire Insurance Company (Carrier) denied […]
453-04-2694-m5
DECISION AND ORDER I. INTRODUCTION Texas Mutual Insurance Company (Carrier) has appealed a decision of an independent review organization (IRO) on behalf of the Texas Workers’ Compensation Commission (TWCC). The decision concerned the Carrier’s denial of Metroplex Diagnostics’ (Provider’s) request for reimbursement of medical services for ___ (Claimant). The IRO found that the motor nerve […]
453-04-5343-m5
DECISION AND ORDER Dana J. Santelli, D.C., Petitioner, sought reimbursement from American Home Assurance Co., Respondent, for office visits, myofacial release, hot/cold packs, electric stimulation, electric current therapy, durable medical equipment, and unattended electric stimulation delivered to the Claimant, B.M., during the dates October 17, 2002, through February 26, 2003, in the amount of $3,260.00. […]
453-04-5856-m5
DECISION AND ORDER I. SUMMARY American Home Assurance Company (Carrier) asserts that the disputed services, including office visits, therapeutic exercises, myofascial release, electrical stimulation, joint mobilization, and testing, performed from May 13, 2002, through August 16, 2002 (totaling $7,061.00) were not medically necessary. The Independent Review Organization (IRO) found that the disputed services were medically […]