453-04-5183-m5
DECISION AND ORDER Claimant ___ injured his back on ___, when the front end of the heavy equipment he was operating dropped into a trench, causing him to be thrown forward and then backward. He began seeing Brad Cudnik, D.C., the following day, and began a program of physical therapy at Dr. Cudnik’s clinic. In […]
453-04-4528-m5
DECISION AND ORDER This case is a dispute over whether Employers Insurance Company of Wausau (Respondent) should reimburse VONO (Petitioner) the sum of $1,177.96 for prescription medications provided to an injured worker (Claimant) from January 8, 2003, until June 16, 2003. The Administrative Law Judge (ALJ) concludes that Petitioner met its burden of proving the […]
453-04-3741-m5
DECISION AND ORDER VONO (Petitioner) appealed the findings and decision of the Texas Workers= Compensation Commission’s designee, an independent review organization (IRO), which found that prescriptions that Petitioner provided a workers= compensation claimant (Claimant) were not medically necessary healthcare. The IRO’s decision upheld a denial of reimbursement by the Insurance Company of the State of […]
453-04-3603-m5
DECISION AND ORDER I. INTRODUCTION After an Independent Review Organization (IRO) reviewer determined chiropractic and physical medicine treatment was medically necessary for a workers= compensation claimant who was also receiving epidural steroid injections (ESIs), the Carrier, Liberty Insurance Corporation, requested a hearing. The Provider, Pain & Recovery Clinic-North, argued that the services were medically necessary. […]
453-04-4399-m5
DECISION AND ORDER American Home Assurance Company, (Petitioner) requested a hearing following a December 19, 2003, Decision of the Texas Workers’ Compensation Commission (Commission). The Commission, relying upon a November 25, 2003, decision of Ziroc, an Independent Review Organization (IRO), authorized reimbursement for chiropractic services[1] provided by SCD Back and Joint Clinic, Ltd. (Respondent) to […]
453-04-4337-m5
DECISION AND ORDER I. SUMMARY The Independent Review Organization (IRO) decision involved four disputed services B a clinical interview and evaluation (CPT Code 90801, performed on October 14, 2002), psychological testing (CPT Code 90830, performed on October 31, 2002), and psychophysiological profile assessment/biofeedback (CPT Codes 90900 and 90906, performed on October 31, 2002). The IRO […]
453-04-2319-m5
DECISION AND ORDER I. DISCUSSION Texas Mutual Insurance Company (Texas Mutual) requested a hearing to contest an Independent Review Organization (IRO) decision that certain physical medicine services provided by Health & Medical Practice Associates (HMPA) to an injured worker (Claimant) were medically necessary. The Administrative Law Judge (ALJ) concludes that most of the active therapy […]
453-04-4198-m5
DECISION AND ORDER Advanced Medical Associates (Provider) rendered various services to Claimant on January 30, 2003, including an office visit and various diagnostic tests. Lumbermens Mutual Casualty Company (Carrier) determined that all these services were not medically necessary and denied payment. Provider requested medical dispute resolution. An independent review organization (IRO) concluded that the services […]
453-04-4754-m5
DECISION AND ORDER The Insurance Company of the State of Pennsylvania (Carrier), requested a hearing to contest a decision by an Independent Review Organization (IRO) that granted reimbursement to Buena Vista Workskills for eight weeks of work-hardening services provided to Claimant ____between October 3 and December 2, 2002. Carrier contends the services were not medically […]
453-05-3359-m5
DECISION AND ORDER American Casualty Company of Reading, Pa. (Carrier ) appealed the decision of the Texas Workers= Compensation Commission’s (Commission) Medical Review Division (MRD) to adopt the decision of its designee, an independent review organization (IRO), which granted reimbursement for services provided a workers= compensation claimant (Claimant) by Jack Barnett, D.C. (Provider). Carrier claimed […]