453-05-2806-m5
DECISION AND ORDER I. SUMMARY DECISION East Texas Chiropractic, Petitioner, requested a hearing following the issuance on October 22, 2004, of the Findings and Decision of the Medical Review Division (MRD) Texas Workers’Compensation Commission (Commission). The Commission’s Findings and Decision relied upon a decision of an Independent Review Organization (IRO) that Petitioner’s treatments rendered to […]
453-05-4539-m5
DECISION AND ORDER SCD Back & Joint Clinic, Inc. (Provider) requested a hearing to contest the decision of the Medical Review Division (MRD) of the Texas Workers’ Compensation Commission (TWCC)[1] denying reimbursement for office visits, therapeutic exercises, group therapeutic procedures, electrical stimulation, massage and chiropractic manipulation provided to Claimant from December 23, 2003,[2] through August […]
453-05-1697-m5
DECISION AND ORDER South Coast Spine & Rehab, P.A. (Petitioner) requested a hearing to contest independent review organization (IRO) and Texas Workers’ Compensation Commission (Commission)[1] Medical Review Division (MRD) determinations that certain services it provided to an injured worker (Claimant) from April 13, 2004, through May 13, 2004, were not medically necessary. This decision concludes […]
453-05-4328-m5
DECISION AND ORDER I. DISCUSSION Liberty Mutual Fire Insurance Company (Liberty Mutual) requested a hearing to contest the decision requiring Liberty Mutual to reimburse Pain & Recovery Clinic North and Nestor Martinez, D.C. (Respondent) for services including office visits, therapeutic procedures, myofascial release, joint mobilization, and neuromuscular reeducation from May 14, 2003, through June 30, […]
453-05-4909-m5
DECISION AND ORDER Texas Mutual Insurance Company (Carrier) appealed the decision of the Medical Review Division (MRD) of the Texas Workers= Compensation Commission (TWCC)[1] ordering reimbursement for electrical stimulation, ultrasound, therapeutic exercises, massage therapy, chiropractic manipulative treatment, office visits, and a thoracic rib belt provided to Claimant from August 4, 2003, through May 3, 2004. […]
453-05-1996-m5
DECISION AND ORDER Petitioner Waco Ortho Rehab (Provider) disagrees with the decision of an independent review organization (IRO) issued on behalf of the Texas Workers’ Compensation Commission (Commission)/Medical Review Division (MRD)[1] finding that the medical services provided to Claimant from September 10, 2003, to November 17, 2003, were not medically necessary. These services included office […]
453-05-9356-m5
DECISION AND ORDER Mark Sherrod, D.C., requested a hearing to contest an independent review organization (IRO) opinion and Texas Workers’ Compensation Commission[1] Medical Review Division decision that certain services he provided to an injured worker (Claimant) from May 12, 2004, through November 4, 2004, were not medically necessary. This decision concludes that Dr. Sherrod proved […]
453-05-1549-m5-etal
DECISION AND ORDER VONO and ReCept Pharmacy (Providers) challenged the decisions of two Independent Review Organization (IRO) decisions denying reimbursement for prescription medication provided to two injured workers, ___and __ (Claimants). After considering the evidence and arguments of the parties, the Administrative Law Judge (ALJ) concludes that the Providers met their burden of showing that […]
453-05-7332-m5
DECISION AND ORDER An Independent Review Organization (IRO) determined that various chiropractic services rendered by Summit Rehabilitation Centers (Provider) to an injured worker (Claimant) for his compensable injury were medically necessary. The Medical Review Division (MRD) of the Texas Workers’ Compensation Commission (Commission)[1] ordered Cornerstone Mutual Insurance Company (Carrier) to reimburse Provider $1,509.34 for all […]
453-05-7364-m5
DECISION AND ORDER Petitioner Carl M. Naehritz III, D.C. & Associates, P.C. (Provider) disagrees with the decision of an independent review organization (IRO) issued on behalf of the Texas Workers’ Compensation Commission (Commission) Medical Review Division (MRD)[1] finding that medical services provided to Claimant from December 12, 2003, through May 21, 2004, were not medically […]