453-04-3714-m5
DECISION AND ORDER Reza Nabavi, P.T., Petitioner, contests a decision of the Texas Workers= Compensation Commission (TWCC) that found that the aquatic physical therapy services provided to Claimant were not medically necessary. This decision finds that Provider proved by a preponderance of the evidence that the services rendered were reasonable and medically necessary, that the […]
453-04-3097-m5
DECISION AND ORDER Texas Mutual Insurance Company (Petitioner) requested a hearing following a December 29, 2003 Decision of the Texas Workers’ Compensation Commission (Commission). The Commission, relying upon a December 24, 2003 decision of Maximus, an Independent Review Organization (IRO), authorized reimbursement for chiropractic services provided by Central Dallas Rehab (Respondent) to injured worker ___ […]
453-04-3447-m5
DECISION AND ORDER American Home Assurance Corporation (Carrier) contested the decision of the Medical Review Division (MRD) of the Texas Workers’ Compensation Commission (the Commission) ordering reimbursement to____. (Claimant) for prescription medications purchased between June 18, 2003, and August 18, 2003. Carrier had denied reimbursementon the basis that the medication was not medically necessary to […]
453-04-1959-m5
DECISION AND ORDER Southeast Health Services, Inc. (Provider) contested the decision of the Medical Review Division (MRD) of the Texas Workers= Compensation Commission (the Commission) declining to order reimbursement of $2,230 fordetailed office visits, hot/cold packs, therapeutic exercises, myofascial release, joint mobilization, vasopneumatic treatment, and electrical stimulation that were provided to Claimant on nine dates […]
453-04-3674-m5
DECISION AND ORDER Petitioner, East Texas Chiropractic (Provider), appealed the Findings and Decision of the Medical Review Division (MRD) of the Texas Workers= Compensation Commission (TWCC) denying reimbursement from ACE USA/ESIS (Carrier) for medical services provided to ___., (Claimant). Provider disputes the IRO’s conclusion that these services were not medically necessary. The Administrative Law Judge […]
453-03-3304-m5
DECISION AND ORDER I. INTRODUCTION Mockingbird Workskills (Petitioner or Provider) seeks reimbursement from American Casualty Company of Reading, PA (Carrier) for $9,792.00 in disputed medical services associated with 22 dates of service for a work hardening program provided to workers= compensation claimant ___ (Claimant), between January 2, 2002, and January 31, 2002. Carrier denied payment […]
453-04-2032-m5-etal
DECISION AND ORDER This case involves appeals by Central Dallas Rehab (“Petitioner”) from decisions of independent review organizations (“IROs”) on behalf of the Texas Workers’ Compensation Commission (“Commission”) in a dispute primarily regarding the medical necessity for chiropractic treatment. The IROs found that the insurer, Zurich American Insurance Company (“Respondent”), properly denied reimbursement for physical […]
453-04-2032-m5
DECISION AND ORDER This case involves appeals by Central Dallas Rehab (APetitioner) from decisions of independent review organizations (AIROs) on behalf of the Texas Workers= Compensation Commission (ACommission) in a dispute primarily regarding the medical necessity for chiropractic treatment. The IROs found that the insurer, Zurich American Insurance Company (ARespondent), properly denied reimbursement for physical […]
453-04-3738-m5
DECISION AND ORDER Liberty Mutual Fire Insurance Company (Carrier) appealed the decision of the Texas Workers’ Compensation Commission’s (Commission) designee, an independent review organization (IRO), in MDR Docket No. M5___, which granted reimbursement for physical therapy and other services provided on a workers’ compensation claimant (Claimant) by DFW Pain Center, Inc. (Provider). The IRO decision […]
453-04-4338-m5
DECISION AND ORDER Vista Medical Center Hospital (Vista) has appealed the Findings and Decision issued by the Medical Review Division (MRD) of the Texas Workers’ Compensation Commission (TWCC) in a hospital fee dispute. The MRD ruled that Vista failed to submit adequate documentation of the disputed services and denied reimbursement on that ground. Vista argues […]