453-03-4479-m5
DECISION AND ORDER EZ Rx Pharmacy (Petitioner) sought reimbursement of $452.18 from ACE USA (the Carrier) for prescription medication provided to an injured worker (the Claimant). Based on a review by an independent review organization (IRO), the Medical Review Division (MRD) of the Texas Workers’ Compensation Commission found that the disputed prescriptions were not medically […]
453-03-4135-m5
DECISION AND ORDER Texas Mutual Insurance Company (Carrier) appealed the findings of an Independent Review Organization (IRO) decision, which awarded $1,050.00 reimbursement to Denton Sports & Physical Therapy Clinic (Provider) for a physical therapy program rendered to ___ (Claimant) from July 18, 2002, through September 20, 2002. In this Order, the Administrative Law Judge (ALJ) […]
453-04-0661-m5
DECISION AND ORDER I. DISCUSSION Central Dallas Rehab (Petitioner) sought reimbursement from American Home Assurance Company (Respondent) for work hardening, office visits, treatments and physician conferences from March 25, 2003, through May 19, 2003, provided to ___ (Claimant). Respondent contended that the services were not medically reasonable or necessary. An Independent Review Organization (IRO) agreed […]
453-03-3423-m5
DECISION AND ORDER Waco Ortho Rehab (Provider) appealed the decision of an Independent Review Organization (IRO) that partially reimbursed Provider for office visits and other procedures performed from September 28, 2001, through March 13, 2002. Prior to the hearing, the parties informed the Administrative Law Judge (ALJ) that Provider had withdrawn its reimbursement request for […]
453-04-0781-m5
DECISION AND ORDER This case involves the appeal by Jeffrey S. Standifer, D.C. (Petitioner), from the decision of an Independent Review Organization (IRO) that found chiropractic services to the injured worker, ___ (Claimant), were not medically necessary. The services had a MARS value of $8,483.70. The decision agrees with the IRO, finding insufficient evidence to […]
453-04-0673-m5
DECISION AND ORDER Claimant ___ fell off a ladder onto a concrete surface on ___, and suffered injuries to his back, as well as his extremities. Citing a lack of medical necessity, Dallas Fire Insurance Company (DFIC) denied reimbursement for services provided to ___ from February 3, 2003, through February 19, 2003. These services included: […]
453-03-3877-m5
DECISION AND ORDER Liberty Mutual Fire Insurance Company (Carrier) appealed a decision of the Medical Review Division (MRD) of the Texas Worker’s Compensation Commission (Commission), adopting the determination of an Independent Review Organization (IRO). The IRO authorized reimbursement to Kelly Alana, D.C. (Provider) for physical therapy services and office visits from January 17, 2002, through […]
453-04-1322-m5
DECISION AND ORDER This case is a dispute over whether North American Specialty Insurance Company (Carrier) should reimburse Medway Rehabilitation (Provider) $7,168 for work hardening services provided to Claimant from December 20, 2002, through January 30, 2003, and $400 for functional capacity evaluations (FCEs) performed on January 20, 2003, and February 3, 2003. The medical […]
453-03-3809-m5
DECISION AND ORDER Industrial Medical Associates (Industrial) appealed a Texas Workers Compensation Commission (Commission) order and independent review organization (IRO) determination that nine office visits for an injured worker (Claimant) from October 1, 2001, through June 26, 2002 were medically unnecessary.[1] Zurich America Insurance Company (Zurich) had denied Industrial’s claim for the office visits. Industrial […]
453-04-0105-m5
DECISION AND ORDER This case involves a cross-appeal of the decision of the Medical Review Division (MRD) of Texas Workers’ Compensation Commission (TWCC). The dispute involves reimbursement of a total of $2,549.00 in claimed services rendered during the period November 16, 2001, through January 7, 2002 (Treatment Period). Main Rehab and Diagnostic (Provider) appeals the […]