453-04-2026-m5
DECISION AND ORDER I. DISCUSSION Central Dallas Rehab (Petitioner) requested a hearing following a November 25, 2003 Decision of the Texas Workers’ Compensation Commission (Commission). The Commission, relied, in part, upon a June 27, 2003 decision of Envoy Medical Systems, LLC., an Independent Review Organization (IRO). The Commission denied reimbursement for chiropractic services provided by […]
453-04-0801-m5
DECISION AND ORDER I. SUMMARY Waco Ortho Rehab (Provider) appealed the decision of Ziroc, an independent review organization (IRO) certified by the Texas Department of Insurance, in Texas Workers’ Compensation Commission (TWCC) Medical Review Division (MRD) tracking number M5-03-0955-01, denying reimbursement for medical services provided to the Claimant. Additionally, the Provider appealed the MRD’s decision […]
453-04-4643-m5
DECISION AND ORDER I. SUMMARY Central Dallas Rehab (Provider) sought reimbursement for work hardening services, physical therapy services, and office visits provided to Claimant ____ Liberty Mutual Fire Insurance Company (Carrier) denied payment for all treatments as medically unnecessary. The Independent Review Incorporated, an Independent Review Organization (IRO), reviewed the claim. The IRO denied reimbursement […]
453-03-4464-m5
DECISION AND ORDER Health & Medical Practices Associates (Provider) rendered various services, including ultrasound and physical exercise/activities, to an injured worker (Claimant). Texas Mutual Insurance Company (Carrier) denied payment for all services provided from July 12, 2002, through September 27, 2002. Through an Independent Review Organization (IRO), the Texas Workers= Compensation Commission’s Medical Review Division […]
453-04-4569-m5
DECISION AND ORDER I. INTRODUCTION After an Independent Review Organization (IRO) reviewer determined chiropractic and physical medicine treatment was not medically necessary for a workers= compensation claimant, Don A. Sayler, D.C. (Provider) appealed. Based on the record, the Administrative Law Judge (ALJ) finds the evidence did not establish the medical necessity of services provided from […]
453-04-6506-m5
DECISION AND ORDER American Home Assurance Company (American Home) requested a hearing to contest an independent review organization (IRO) decision that an office visit for the evaluation and management of a new patient provided to an injured worker (Claimant) by First Rio Valley Medical, P.A. (First Rio), and an attendant work-status report submitted to the […]
453-04-4215-m5
DECISION AND ORDER Alliance Pain Centers, P.C. (Provider), appealed the decision of an Independent Review Organization (IRO) upholding the denial of therapeutic activities administered to Claimant from August 27, 2002, through September 27, 2002. In this decision, the Administrative Law Judge (ALJ) finds that Provider failed to meet its burden of showing that the treatment […]
453-04-4598-m5
DECISION AND ORDER I. INTRODUCTION After an Independent Review Organization (IRO) reviewer determined various chiropractic and other physical medicine treatments were medically necessary for a workers= compensation claimant, Southwestern Bell Telephone Company (the Carrier) appealed. At issue are services provided by Neuromuscular Institute of Texas, PA (the Provider) which totaled $5,012. In this decision, the […]
453-04-4596-m5
DECISION AND ORDER Petitioner Neuromuscular Institute of Texas (Provider) appealed the findings and decision of the Texas Workers= Compensation Commission’s (TWCC=s) designee, an independent review organization (IRO), which found that the office visits, hot/cold packs, electrical stimulation, ultrasound, myofascial release, and electrodes provided between January 13, 2004, and March 21, 2003, to ____, a workers= […]
453-04-2736-m5
DECISION AND ORDER Employers Insurance Company of Wausau (Carrier or Petitioner) is contesting charges for ten prescriptions filled for an injured worker by Highpoint Pharmacy (Respondent) between June 5, 2002, and February 4, 2003, in the amount of $1,251.35.[1] The Administrative Law Judge (ALJ) concludes that these medications were not medically necessary for the compensable […]