453-04-5201-m5
DECISION AND ORDER I. PROCEDURAL HISTORY ____ (Claimant) appealed the decision of the Medical Review of Texas, an independent review organization certified by the Texas Department of Insurance, in Texas Workers= Compensation Commission (TWCC) Medical Review Division tracking number M5-04-1037-01 denying reimbursement for the prescription drug hydrocodone[1] in the amount of $61.69. The Administrative Law […]
453-04-2824-m5
DECISION AND ORDER I. INTRODUCTION Russell Baker, D.C. (Dr. Baker) has appealed a decision of the Texas Workers’ Compensation Commission’s (TWCC) Medical Review Division (MRD) regarding medical services he provided ___ (Claimant) from August 12, 2002, to December 18, 2002, but for which ACIG Insurance Company (Carrier) denied reimbursement. MRD, relying on a determination of […]
453-04-3737-m5
DECISION AND ORDER I. DISCUSSION Integrative Medical Clinics (Petitioner) requested a hearing following a February 3, 2004, Decision of the Texas Workers’ Compensation Commission (Commission). The Commission, relying upon a January 30, 2004, decision of Maximus, an Independent Review Organization (IRO), denied reimbursement for chiropractic services Petitioner provided to injured worker ___ (Claimant) from September […]
453-04-4288-m5
DECISION AND ORDER Texas Mutual Insurance Company (Carrier) has appealed the decision of the Independent Review Organization (IRO) granting reimbursement for physical therapy treatments provided to injured worker ____ (Claimant). After considering the evidence and arguments of the parties, the Administrative Law Judge (ALJ) concludes that Carrier has shown by a preponderance of the evidence […]
453-04-4718-m5
DECISION AND ORDER Petitioner, Liberty Mutual Insurance Company (Carrier), appealed the Findings and Decision of the Medical Review Division (MRD) of the Texas Workers’ Compensation Commission (TWCC) ordering reimbursement to Jeffrey S. Standifer, D.C., (Provider) for medical services provided to ____, (Claimant). Carrier disputes the IRO’s conclusion that these services were medically necessary.[1] The Administrative […]
453-04-4570-m5
DECISION AND ORDER Kevin Strathdee, D.C. (Provider) appeals from a decision by an independent review organization (IRO) regarding medical necessity for chiropractic treatment. The IRO found that Liberty Mutual Insurance Company (Carrier) properly denied reimbursement based on lack of medical necessity for therapy administered by Provider during February 10B28, 2003, to a claimant suffering from […]
453-04-3781-m5-etal
DECISION AND ORDER I. DISCUSSION The dockets in this matter were administratively joined by the State Office of Administrative Hearings (SOAH) for purposes of administrative economy. The parties and the Claimant (___) are the same in each case. The hearings on the two dockets were held on the same date, and the evidence in the […]
453-04-3601-m5
DECISION AND ORDER After an Independent Review Organization (IRO) determined that its treatment of Claimant after July 25, 2002, was not medically necessary and denied reimbursement, Central Dallas Rehab (Provider) requested a hearing. Provider seeks reimbursement of approximately $9,000 for services rendered. This decision finds that Provider proved that services for which it charged $554 […]
453-04-5982-m5
DECISION AND ORDER Hatfield Chiropractic, Inc. (Hatfield) requested a hearing to contest a Texas Workers’ Compensation Commission (Commission) Medical Review Division (MRD) decision that its documentation was inadequate to support the delivery of certain services to an injured worker and that its claim should therefore be denied. This order denies the claim because Hatfield failed […]
453-04-5080-m5
DECISION AND ORDER This case involves a dispute over whether the State Office of Risk Management (Carrier) should reimburse VONO (Petitioner) for prescription medications provided to Claimant from December 27, 2004, through April 16, 2003. The medical necessity of the medications is the only issue to be resolved. The Administrative Law Judge (ALJ) concludes that […]