453-04-2320-m5
DECISION AND ORDER Texas Mutual Insurance Company (Carrier) disputes the decision of the Medical Review Division (MRD) of the Texas Workers= Compensation Commission (the Commission, TWCC) ordering reimbursement of $4,393 to Professional Physical Therapy (Provider) for treatment provided to Claimant from January 21, 2003, through February 28, 2003. The Administrative Law Judge (ALJ) finds the […]
453-04-2055-m5
DECISION AND ORDER This case is a dispute over whether Atlantic Insurance Company (Carrier) should reimburse VONO (Petitioner) $813.95 for prescription medications. The medical necessity of the medications is the only issue to be resolved. The Administrative Law Judge (ALJ) concludes that Petitioner met its burden of proving the medications were medically necessary. Therefore, Carrier […]
453-04-0802-m5
DECISION AND ORDER The issue involved in this case is whether electric stimulation therapy, vasopneumatic therapy, massage therapy, mechanical traction therapy, myofacial release, and ultrasound therapy (disputed services) performed by Joseph F. Wilson, D.C. (Provider), from July 11, 2002, through September 24, 2002, were medically necessary. Texas Mutual Insurance Company (Carrier) denied payment for the […]
453-04-1957-m5
DECISION AND ORDER I. SUMMARY Main Rehab and Diagnostic, (Provider) appealed the decision of an independent review organization certified by the Texas Department of Insurance in Texas Workers= Compensation Commission (TWCC) Medical Review Division (MRD) denying reimbursement for medical services provided to Claimant. This decision orders that Texas Builders Insurance Company (Carrier) is not required […]
453-04-2256-m5
DECISION AND ORDER John D. Carlson, D.C. (Petitioner) requesting a hearing challenging the Findings and Decision of the Texas Workers’ Compensation Commission (Commission) acting through the Texas Medical Foundation, an Independent Review Organization (IRO), finding physical therapy treatments were not medically necessary for the treatment of injured worker ___ (Claimant). After considering the evidence and […]
453-04-2300-m5
DECISION AND ORDER This case is a dispute over whether Texas Mutual Insurance Company (Carrier) should reimburse 30/60/90 LLC (Provider) $2,252.80 for work hardening services provided to Claimant from December 10, 2001, through December 21, 2001.[1] The medical necessity of the disputed services is the only issue to be resolved. The Administrative Law Judge (ALJ) […]
453-04-2821-m5
DECISION AND ORDER Liberty Mutual Insurance Company (Carrier) challenges an Independent Review Organization decision concluding that College Hospital Costa Mesa (Provider) is entitled to reimbursement for outpatient surgery performed on an injured worker. Petitioner had refused reimbursement based on Respondent’s failure to obtain preauthorization prior to performing the surgery. Administrative Law Judge (ALJ) Gary Elkins […]
453-04-1811-m5
DECISION AND ORDER I. SUMMARY Ghada Koudsi, D.C., (Provider) appealed the decision of Envoy Medical Systems, LP, an independent review organization certified by the Texas Department of Insurance, in Texas Workers= Compensation Commission (TWCC) Medical Review Division (MRD) tracking number M5-04-0209-01, denying reimbursement for medical services provided to the Claimant. This decision orders that Insurance […]
453-04-1808-m5
DECISION AND ORDER Petitioner, Central Dallas Rehab (Provider), appealed the Findings and Decision of the Medical Review Division (MRD) of the Texas Workers= Compensation Commission (TWCC) denying reimbursement from Transcontinental Insurance Company (Carrier) for medical services provided to ______, (Claimant). Provider disputes the IRO’s conclusion that these services were not medically necessary. The Administrative Law […]
453-04-1160-m5-etal
DECISION AND ORDER Main Rehab and Diagnostic (Petitioner) appealed the decisions of the Texas Workers’ Compensation Commission’s (Commission) designee, an independent review organization (IRO), in MR Docket Nos. M5-03-3103-01 and M5-04-0315-01, which denied reimbursement for a work hardening (WH) program and associated functional capacity evaluations (FCEs) and office visits Petitioner provided to a workers’ compensation […]