453-04-0366-m5
DECISION AND ORDER Truman Davidson, D.C. (Provider) requested a hearing to contest an Independent Review Organization (IRO) decision that the aquatic therapy provided to an injured worker (Claimant) from July 22, 2002, through September 7, 2002, was medically unnecessary. Provider argued that the aquatic therapy was medically necessary because it provided the safest and quickest […]
453-04-3690-m5
DECISION AND ORDER I. DISCUSSION Main Rehab & Diagnostic (Main Rehab), Petitioner, sought reimbursement from Texas Mutual Insurance Company (TMIC), Respondent, for neurological procedures, therapeutic exercise, physical therapy sessions, office procedures, muscle testing, and range of motion testing. Medical Review of Texas, an Independent Review Organization (IRO), issued a letter dated August 20, 2003, in […]
453-04-4183-m5
DECISION AND ORDER I. DISCUSSION Texas Mutual Insurance Company (TMIC), Petitioner, appealed the Findings and Decision of the Texas Workers’ Compensation Commission (Commission) acting through the Texas Medical Foundation, an Independent Review Organization (IRO).[1] By letter issued on August 13, 2003, the IRO disagreed with TMIC’s prior adverse decision to deny reimbursement to Main Rehab […]
453-04-1215-m5
DECISION AND ORDER Petitioner, Texas 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 Julio Fajardo, D.C., (Provider) for medical services provided to N.C., (Claimant). Carrier disputes the IRO’s conclusion that these services were medically necessary. The Administrative Law […]
453-04-3418-m5
DECISION AND ORDER Petitioner, Texas 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 Therapy Works, Inc., (Provider) for medical services provided to___, (Claimant). Carrier disputes the IRO’s conclusion that these services were medically necessary. The Administrative Law Judge […]
453-04-1365-m5
DECISION AND ORDER Texas Mutual Insurance Company (Carrier) appealed the decision of an Independent Review Organization (IRO) upholding the reimbursement for myofacial release, electric stimulation, therapeutic exercises, and office visits administered to Claimant between March 5, 2003, and May 16, 2003. In this decision, the Administrative Law Judge (ALJ) finds that Carrier met its burden […]
453-04-4756-m5
DECISION AND ORDER Claimant ___ injured her back on ___, when she was involved in an automobile accident. She began receiving passive chiropractic care about a week following the accident. At issue in this case are office visits, hot/cold packs, electrical stimulation, joint mobilization, and traction administered by Southeast Health Services (SHS) from January 15, […]
453-04-5236-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 […]
453-04-4457-m5
DECISION AND ORDER After an Independent Review Organization (IRO) determined that his treatment of Claimant from October 4 through December 12, 2002, was not medically necessary, Charles A. Scott, D.C. (Provider) requested a hearing. This decision finds that Provider did not prove that the disputed services were medically necessary healthcare for Claimant. I. JURISDICTION, NOTICE, […]
453-03-1759-m5
DECISION AND ORDER St. Paul Mercury Insurance Company (Carrier) requested a hearing on the decision of the Independent Review Organization (IRO) granting reimbursement to Central Dallas Rehabilitation (Provider) for office visits, various passive modalities (including joint mobilization and myofascial release), chiropractic manipulations, range-of-motion treatments, muscle testing, and work hardening provided to injured worker ____ (Claimant). […]