453-04-0624-m5
DECISION AND ORDER Medway Health Centers (Provider) challenges an Independent Review Organization (IRO) decision denying it reimbursement for a work hardening program provided to an injured worker (Claimant). The Administrative Law Judge (ALJ) concludes the services provided were not medically necessary to treat the Claimant’s injury. Consequently, reimbursement is denied. I. Statement of the Case […]
453-04-1837-m5
DECISION AND ORDER I. DISCUSSION Texas Mutual Insurance Company, (Petitioner) requested a hearing following a November 12, 2003 Decision of the Texas Workers’ Compensation Commission (Commission). The Commission, relying upon a May 27, 2003 decision of Independent Review Incorporated, an Independent Review Organization (IRO), authorized reimbursement for chiropractic services provided by Central Dallas Rehab (Respondent) […]
453-04-1979-m5
DECISION AND ORDER I. DISCUSSION Texas Mutual Insurance Company, (Petitioner) requested a hearing following a November 14, 2003 Decision of the Texas Workers’ Compensation Commission (Commission). The Commission, relying upon a May 20, 2003 decision of Maximus, an Independent Review Organization (IRO), authorized reimbursement for chiropractic services provided by Central Dallas Rehab (Respondent) to injured […]
453-04-3637-m5
DECISION AND ORDER Texas Mutual Insurance Company (Carrier) appealed the decision of an Independent Review Organization (IRO) upholding the reimbursement for joint mobilizations, therapeutic exercises, and office visits administered to ___ (Claimant) between March 26, 2003, and April 14, 2003. In this decision, the Administrative Law Judge (ALJ) finds that Carrier met its burden of […]
453-04-0822-m5
DECISION AND ORDER Pacific Employers Insurance Company (Carrier) challenged the decision of the Medical Review Division (MRD) of the Texas Workers’ Compensation Commission (Commission) ordering the Carrier to pay for certain medications for ___ (Claimant) for the period December 28, 2002, through April 10, 2003. The MRD concluded that the medications were medically necessary to […]
453-04-0046-m5
DECISION AND ORDER I. INTRODUCTION Brett M. Downey, D.C. (Provider) challenges a decision of the Texas Workers= Compensation Commission (TWCC) Medical Review Division (MRD), based on an independent review organization (IRO) review regarding reimbursement for chiropractic services the Provider furnished to ___(Claimant). Agreeing partially with Insurance Company of the State of Pennsylvania (Carrier), which had […]
453-04-1816-m5
DECISION AND ORDER I. SUMMARY Ricky Lee Hanks, D. C., (Provider) appealed the decision of an independent review organization denying reimbursement for medical services provided to Claimant. This decision orders that American Home Assurance Company (Carrier) is not required to reimburse the Provider for the amount claimed. The Administrative Law Judge (ALJ) convened and closed […]
453-04-3615-m5
DECISION AND ORDER This dispute arises out of services Petitioner Primary Health Care, P.C. (Petitioner) provided to Claimant ___ (Claimant) on 49 separate occasions between January 16, 2002, and June 26, 2002.[1] Petitioner’s services included ultrasound, electrical stimulation, mechanical traction, massage, office visits, x-rays, hot and cold packs, bronchospasm evaluation, electrocardiogram, physical performance test, therapeutic […]
453-04-0843-m5
DECISION AND ORDER Texas Mutual Insurance Company (Petitioner) appealed the findings and decision of the Texas Workers’ Compensation Commission’s designee, an independent review organization (IRO), in MDR Docket No. M5___ which granted reimbursement to Patrick Davis, D.C., (Respondent) for physical therapy services and office visits provided a workers’ compensation claimant (Claimant). Petitioner had denied reimbursement […]
453-03-4482-m5
DECISION AND ORDER Claimant ___ injured his back on ___, as a result of a fall at his welding job. At issue are work hardening services, functional capacity exams (FCEs), equipment associated with a TENS unit, and physical therapy provided to ___ by Atlantic Healthcare Clinic (AHC) in the fall of 2001. The workers’ compensation […]