453-04-3675-m5
DECISION AND ORDER El Paso Physical Therapy Services (Provider) challenges an Independent Review Organization (IRO) decision denying it 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 for the treatment of Claimant’s injury. Consequently, reimbursement should be […]
453-04-2739-m5
DECISION AND ORDER Roshan Sharma, M.D. (Provider), challenged the decision of an Independent Review Organization (IRO) upholding the denial of 16 separate electric stimulation procedures administered to Claimant from January 20, 2003, through February 21, 2003. In this decision, the Administrative Law Judge (ALJ) finds that Provider failed to meet its burden of showing that […]
453-04-5346-m5
DECISION AND ORDER VONO challenges the decision of the Independent Review Organization (IRO) denying reimbursement for prescription medication provided to injured worker ___ (Claimant). After considering the evidence and arguments of the parties, the Administrative Law Judge (ALJ) concludes that the State Office of Risk Management (SORM) is liable for reimbursing VONO the sum of […]
453-04-2025-m5
DECISION AND ORDER This is a dispute over services rendered to workers’ compensation claimant ___ (Claimant) from February 14, 2002, through July 31, 2002. The Administrative Law Judge (ALJ) concludes Petitioner Texas Mutual Insurance Company (TMIC) should reimburse Real Health Care for the disputed services rendered from February 14, 2002, through February 28, 2002. TMIC […]
453-04-3417-m5
DECISION AND ORDER This is a dispute over services rendered workers’ compensation claimant ___ (Claimant) from March 21, 2002 through July 12, 2002. The ALJ concludes TMIC should reimburse Real Health Care for the treatments provided from April 1 through May 1, 2002. In addition, TMIC should be required to provide reimbursement for one service […]
453-04-4486-m5
DECISION AND ORDER This is a dispute over services rendered to workers’ compensation claimant ____ (Claimant) from September 3, 2002, through March 14, 2003. The Administrative Law Judge (ALJ) concludes Petitioner Texas Mutual Insurance Company (TMIC) should reimburse Real Health Care for the disputed services rendered through September 6, 2002. TMIC proved the disputed services […]
453-04-3449-m5
DECISION AND ORDER Medway Health Centers (Medway) requested a hearing to contest a decision by an Independent Review Organization (IRO) that denied reimbursement for seven days of work-hardening services provided by Medway to a workers’ compensation claimant (Claimant) between April 30 and May 21, 2002. Medway contends the services were medically reasonable and necessary while […]
453-04-4719-m5
DECISION AND ORDER This case is a dispute over whether Dallas Independent School District (Respondent) should reimburse VONO (Petitioner) the sum of 1114.98 for prescription medications provided to an injured worker (Claimant) from December 2, 2002, until May 21, 2003. The Administrative Law Judge (ALJ) concludes that Petitioner met its burden of proving the medications […]
453-04-1809-m5
DECISION AND ORDER I. INTRODUCTION This cse presents a challenge by Waco Ortho Rehab (APetitioner) to a decision of an independent review organization (AIRO) on behalf of the Texas Workers’ Compensation Commission (ACommission or ATWCC) in a dispute regarding medical necessity for chiropractic treatment. The IRO found that the insurer, American Home Assurance Co. (ARespondent), […]
453-04-4184-m5
DECISION AND ORDER Texas Mutual Insurance Company (Carrier) appealed the findings and decision of the Texas Workers= Compensation Commission’s designee, an independent review organization (IRO), which found that physical therapy provided by Medical Center Rehab Clinics (Provider) to Claimant was medically necessary healthcare. This decision and order finds the physical therapy sessions in dispute, from […]