453-04-0079-m5
DECISION AND ORDER TASB Risk Management Fund (TASB) denied payment for hot/cold packs, myofascial release/soft tissue mobilization, therapeutic procedure/exercise, joint mobilization, ultrasound, and massage provided to a worker with injuries to her shoulder and cervical and lumbar spinal areas. The provider, Denton Sports & Physical Therapy (Denton), requested medical dispute resolution. An independent review organization […]
453-04-0364-m5
DECISION AND ORDER Suhail al-Sahli, D.C. (Provider), seeks reimbursement of $7,764 from Metropolitan Transit Authority of Harris County (Carrier) for physical therapy services, office visits, and a work hardening program provided to an injured worker between February 27, 2002, and July 26, 2002. Carrier denied payment, primarily on the grounds that the treatment was not […]
453-04-0625-m5
DECISION AND ORDER I. SUMMARY J. Todd Whitehead, D.C., (Provider) appealed the decision of Envoy Medical Systems, LLC, an independent review organization certified by the Texas Department of Insurance, in Texas Workers’ Compensation Commission (TWCC) Medical Review Division (MRD) tracking number M5-03-2470-01, denying reimbursement for medical services provided to the Claimant. This decision orders that […]
453-04-2054-m5
DECISION AND ORDER Zurich American Insurance Company (Carrier) appealed a decision of the Medical Review Division (MRD) of the Texas Worker’s Compensation Commission (Commission) that authorized reimbursement of $549.00 to Andrew Block, Ph.D. (Provider) for psychological therapy, evaluation, and testing. Carrier contended that the services and office visits were not medically reasonable or necessary. Based […]
453-04-1362-m5
DECISION AND ORDER Jeffrey Standifer, D.C. (Provider), appealed the decision of an Independent Review Organization (IRO) upholding the denial of reimbursement for a physical therapy program rendered to ___ (Claimant) from July 8, 2002, through March 17, 2003. In this decision, the Administrative Law Judge (ALJ) finds that Provider failed to meet its burden of […]
453-04-0842-m5
DECISION AND ORDER I. PROCEDURAL HISTORY Petitioner, American Risk Funding Insurance Co. (Carrier), appeals a decision of an Independent Review Organization (IRO) ordering reimbursement to Cotton Merritt, D.C. (Provider) in the amount of $4,576.00. The ALJ finds that Carrier has failed to show that the chiropractic medical services in question were not medically necessary, except […]
453-03-3624-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) in MR Case No. ___ ordering reimbursement of $4,658 to Humpal Physical Therapy & Sports Medicine Centers (Provider) for physical therapy provided to Claimant A from July 1, 2002, […]
453-03-3857-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) in MR Case No. ___ ordering reimbursement of $4,658 to Humpal Physical Therapy & Sports Medicine Centers (Provider) for physical therapy provided to Claimant A from July 1, 2002, […]
453-04-0362-m5
DECISION AND ORDER Claimant appealed the findings of an Independent Review Organization (IRO) denying reimbursement for medications purchased between November 6, 2002, and April 14, 2003. In this Order, the Administrative Law Judge (ALJ) concludes Claimant is not entitled to reimbursement. I. JURISDICTION, NOTICE AND PROCEDURAL HISTORY There were no contested issues of jurisdiction or […]
453-04-0365-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) in MR Case No. ___ ordering reimbursement of $4,658 to Humpal Physical Therapy & Sports Medicine Centers (Provider) for physical therapy provided to Claimant A from July 1, 2002, […]