453-04-1978-m5
DECISION AND ORDER This case is an appeal by Texas Mutual Insurance Co. (APetitioner) from a decision of an independent review organization (AIRO) on behalf of the Texas Workers= Compensation Commission (ACommission) in a dispute regarding the medical necessity of physical therapy services. The IRO found that Petitioner improperly denied reimbursement for physical therapy that […]
453-04-3780-m5
DECISION AND ORDER The issue in this case is whether certain chiropractic services rendered from January 27, 2003, through March 26, 2003, should have been reimbursed by the Insurance Company of the State of Pennsylvania (Carrier). The Administrative Law Judge finds Lawrence Neil Smith, D.C. (Provider) is entitled to $70 additional reimbursement. I. DISCUSSION The […]
453-04-0987-m5
DECISION AND ORDER SCD Back and Joint Clinic, Ltd. (Provider) contested the decision of the Medical Review Division (MRD) of the Texas Workers’ Compensation Commission (the Commission) declining to order reimbursement of $777.50 foroffice visits, joint mobilization, myofascial release, therapeutic exercises, and group exercises that were provided to Claimant on four dates of service between […]
453-04-1542-m5
DECISION AND ORDER SCD Back and Joint Clinic, Ltd. (Provider) contested the decision of the Medical Review Division (MRD) of the Texas Workers’ Compensation Commission (the Commission) declining to order reimbursement of $777.50 foroffice visits, joint mobilization, myofascial release, therapeutic exercises, and group exercises that were provided to Claimant on four dates of service between […]
453-04-4179-m5
DECISION AND ORDER I. SUMMARY Eric A. Vanderwerff, D.C., (Provider) appealed the decision of Independent Review Incorporated, an independent review organization (IRO) certified by the Texas Department of Insurance, in Texas Workers= Compensation Commission (TWCC) Medical Review Division (MRD) tracking number M5-03-2740-01, denying reimbursement for medical services provided to the Claimant. Additionally, the Provider appealed […]
453-04-1329-m5
DECISION AND ORDER The issue in this case is whether chiropractic services rendered between January 29, and March 29, 2003, were medically necessary to treat the Claimant’s compensable injury. The Administrative Law Judge finds they were not. I. DISCUSSION The Claimant injured his lower back and chest on ___ when the counter weight of a […]
453-04-0014-m5
DECISION AND ORDER American Protection Insurance Company (Carrier) appealed the decision of Maximus, an independent review organization certified by the Texas Department of Insurance, approving reimbursement for physical therapy services by Dr. Jack Barnett (Provider) from April 24 through September 17, 2002. Carrier contends that the services were not medically necessary. For the reasons set […]
453-04-2733-m5
DECISION AND ORDER I. Introduction Chad Wersell, D.C. (Provider) disputes a decision of an independent review organization (IRO) on behalf of the Texas Workers= Compensation Commission (TWCC). Hartford Underwriters Insurance Company (Carrier) had denied the Provider reimbursement for certain medical services that the Provider furnished to ___ (Claimant) from July 12, 2002, through September 6, […]
453-03-4448-m5
DECISION AND ORDER This case is a dispute over reimbursement for prescription medications. The Administrative Law Judge (ALJ) finds the Petitioner, Transcontinental Insurance Company (T.I.C.), should not be required to reimburse ___ for the cost of those medications. I. DISCUSSION ___, the Claimant and the Respondent in this matter, suffered a lumbar injury on ___. […]
453-04-0981-m5
DECISION AND ORDER I. DISCUSSION Continental Casualty Company, Petitioner, requested a hearing following the issuance of a September 12, 2003, decision of the Medical Review Division (MRD) of the Texas Workers’ Compensation Commission (Commission) granting the request of Medway Health Centers, Respondent, for reimbursement. The amount in dispute is $6,872.00, plus interest and the independent […]