453-04-3739-m5
DECISION AND ORDER This is a dispute over reimbursement for medical services provided by Richard Guerrero, D.C., to workers’ compensation claimant ___ (Claimant). The Administrative Law Judge (ALJ) concludes the services should be reimbursed. I. HISTORY The Claimant suffered a crushing injury to her right forearm on ___, when it was caught in machinery at […]
453-04-4231-m5
DECISION AND ORDER Odessa Physical Therapy (Provider) challenges an Independent Review Organization (IRO) decision confirming the denial of reimbursement for physical therapy services provided to an injured worker (Claimant). The Administrative Law Judge (ALJ) concludes the disputed services were not shown to be medically necessary to treat Claimant’s injury. Consequently, reimbursement should be denied. I. […]
453-04-4340-m5
DECISION AND ORDER This case is an appeal by Texas Mutual Insurance Co. (Petitioner) from 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 physical therapy services. The IRO found that Petitioner improperly denied reimbursement for physical therapy that […]
453-02-2731-m5
DECISION AND ORDER E.R.P. (Provider) appealed the decision by the Medical Review Division (MRD) of the Texas Workers’ Compensation Commission (Commission) in a medical fee dispute. The MRD found that The University of Texas System (Carrier) properly denied reimbursement of $749.00[1] to Provider for Claimant’s prescriptions of hydrocodone (November 20, 2000, and January 16, 2001) […]
453-04-4480-m5
DECISION AND ORDER I. DISCUSSION Neuromuscular Institute of Texas (Petitioner) requested a hearing to contest the Findings and Decision of the Texas Workers’ Compensation Commission (Commission) acting through Independent Review Incorporated, an Independent Review Organization (IRO), denying Petitioner reimbursement for therapeutic procedures and exercises, hot and cold pack therapy, electrical stimulation, functional capacity evaluation (FCE), […]
453-04-0996-m5
DECISION AND ORDER Petitioner, Texas Mutual Insurance Company (Carrier), requested a hearing following the Findings and Decision of the Medical Review Division (MRD) of the Texas Workers’ Compensation Commission (TWCC), acting through Texas Medical Foundation, an Independent Review Organization, ordering reimbursement to SCD Back and Joint Clinic (Provider) for medical services provided to ____ (Claimant). […]
453-04-4599-m5
DECISION AND ORDER After an Independent Review Organization (IRO) determined that its treatment of Claimant from January 27 through June 9, 2003, was not medically necessary, Alamo Health Care (Provider) requested a hearing. This decision finds that the first 24 therapy sessions were medically necessary, except that therapeutic exercises billed under 97110 should be billed […]
453-04-5896-m5
DECISION AND ORDER I. INTRODUCTION Texas Mutual Insurance Co. (Carrier) disputes a decision of an independent review organization (IRO) on behalf of the Texas Workers’ Compensation Commission (TWCC) and a separate Medical Review Division (MRD) decision, both regarding medical services for ____ (Claimant). The Carrier had denied Southeast Health Services, Inc. (Provider) reimbursement for certain […]
453-04-5253-m5
DECISION AND ORDER Texas Mutual Insurance Company (Carrier) appealed the findings and decision of the Texas Workers’ Compensation Commission’s (Commission’s) designee, an independent review organization that found that the office visits and physical medicine treatment that Central Dallas Rehab (Provider) provided to ___, a workers’ compensation claimant (Claimant), were medically necessary health care. This decision […]
453-04-1515-m5
DECISION AND ORDER East Harris County Orthopedic Associates, P.A. (Provider) appealed the findings and decision of the Texas Workers’ Compensation Commission’s (Commission) Medical Review Division (MRD), which denied additional reimbursement for spinal surgery that was performed on Claimant ____ (Claimant). The Administrative Law Judge (ALJ) finds Provider is not entitled to additional reimbursement of $13,295 […]