453-04-5710-m5
DECISION AND ORDER The issue involved is whether Liberty Mutual Fire Insurance Company (Carrier) correctly denied payment of $3,410 billed by Jerry L. Orsburn, D.C. (Provider) for therapeutic procedures, myofascial release, and office visits provided to an injured worker (Claimant) from April 28 through May 21, 2003. Carrier challenged the medical necessity of the treatment, […]
453-04-4339-m5
DECISION AND ORDER Texas Mutual Insurance Co. (“Carrier”) has challenged a decision of an independent review organization (“IRO”) on behalf of the Texas Workers’ Compensation Commission (”Commission”) in a dispute regarding the medical necessity of chiropractic therapy services. The IRO found that Carrier improperly denied reimbursement for care that Eric A. Vanderwerff, D.C., (“Provider”) administered […]
453-04-0042-m5
DECISIONAND ORDER Texas Mutual Insurance Company (TMIC) and SCD Back & Joint Clinic (Clinic) seek 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 lower back injury. […]
453-04-5712-m5
DECISION AND ORDER Medpro Clinics (Provider) seeks reimbursement for passive physical therapy modalities provided to an injured worker. As reflected in the Findings of Fact and Conclusions of Law, the Administrative Law Judge concludes reimbursement is not warranted because Provider failed to prove the services were medically necessary for the treatment of the injured worker. […]
453-04-5926-m5
DECISION AND ORDER Neuromuscular Institute of Texas, PA (“Provider”) has challenged a decision of an independent review organization (“IRO”), acting on behalf of the Texas Workers’ Compensation Commission (“Commission”), in a dispute regarding medical necessity for chiropractic treatment. The IRO found that Southwestern Bell Telephone Co. (“Carrier”), the self-insured employer of a claimant suffering from […]
453-04-5356-m5
DECISION AND ORDER I. SUMMARY This case involves challenges by Texas Mutual Insurance Company (Carrier) from decisions of Independent Review Organizations (IROs) on behalf of Texas Workers’ Compensation Commission (Commission) in a dispute regarding the medical necessity for physical therapy/chiropractic treatment by Central Dallas Rehab (Provider). The disputed services,[1] including muscle testing, joint mobilization, manual […]
453-04-5895-m5
DECISION AND ORDER Texas Mutual Insurance Company (TMI or Petitioner) appealed the findings and decision of the Texas Workers’ Compensation Commission’s Medical Review Division, which adopted the decision of its designee, an independent review organization (IRO), granting reimbursement to Cross Timbers Physical Therapy (Respondent) for physical therapy provided to a workers’ compensation claimant (Claimant). This […]
453-04-6068-m5
DECISION AND ORDER Texas Mutual Insurance Co. (“Carrier”) challenged the decision of an independent review organization (“IRO”) on behalf of the Texas Workers’ Compensation Commission (“Commission”) in a dispute regarding the medical necessity of physical therapy services. The IRO found that Carrier improperly denied reimbursement for physical therapy that Elisa Miranda, P.T., (“Provider”) administered between […]
453-04-4750-m5
DECISION AND ORDER Texas Mutual Insurance Company (Petitioner) requested a hearing on the findings and decision of the Texas Workers’ Compensation Commission’s designee, an independent review organization (IRO), in MDR Docket Nos. M5-04-0188-01 and M5-04-0138-01 (consolidated), that granted certain reimbursement to Central Dallas Rehabilitation (Respondent) for physical therapy services and office visits provided to workers’ […]
453-04-5357-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 and adequately documented for a workers’ compensation claimant, Texas Mutual Insurance Company (Carrier) appealed.[1] In this Decision and Order, the Administrative Law Judge (ALJ) finds the Carrier failed to […]