453-04-0670-m5
DECISION AND ORDER Laurence M. Smith, D.C., (Provider) appealed the decision of an Independent Review Organization (IRO) upholding the denial of reimbursement for 23 office visits with manipulations, a nerve conduction velocity (NCV) study, and a myofascial release procedure administered to S. H. (Claimant) on various dates of service. In this decision, the Administrative Law […]
453-03-3354-m5
DECISION AND ORDER DISPOSING OF CASE BY SUMMARY DISPOSITION AND INTRODUCING EVIDENCE INTO THE RECORD I. SUMMARY Texas Mutual Insurance Company (Carrier or TMIC) sought review of a decision by an Independent Review Organization (IRO) ordering payment to Clinical Support Services (CSS or Provider) for intra-operative nerve monitoring and testing provided during surgery on Claimant. […]
453-03-4445-m5
DECISION AND ORDER Suhail Al-Sahli, D.C. (Provider) is appealing the decision of the Texas Workers= Compensation Commission’s (Commission=s) designee, an independent review organization (IRO), which upheld Liberty Mutual Insurance Company’s (Carrier=s) denial of a claim for reimbursement for work hardening provided to Claimant ___ based on lack of medical necessity. This decision concludes that Suhail […]
453-03-4443-m5
DECISION AND ORDER I. PROCEDURAL HISTORY Petitioner Humpal Physical Therapy (Provider), seeks reimbursement from Liberty Mutual Insurance Company (the Carrier) for $5,498.00 in medical services associated with physical therapy services that Provider administered to workers compensation claimant ___ from August 7-September 30, 2002. An Independent Review Organization (IRO) denied reimbursement for these expenses. Provider challenged […]
453-04-0993-m5
DECISION AND ORDER Employers Insurance Company of Wausau (EICW), petitioner, seeks an order from the State Office of Administrative Hearings (SOAH) to reverse the decision of the Medical Review Division (MRD) of the Texas Workers= Compensation Commission (TWCC) on the issue of whether chiropractic services rendered by Jack Barnett, D.C., were medically necessary. Following a […]
453-03-4678-m5
DECISION AND ORDER Texas Mutual Insurance Company (TMIC) appealed an independent review organization (IRO) determination that physical therapy sessions provided to an injured worker (Claimant) by Health and Medical Practice Associates (HMPA) from April 18, 2002, through July 5, 2002, were medically necessary and should be paid. Except for six therapeutic activities/procedures (four of which […]
453-03-4463-m5
DECISION AND ORDER I. INTRODUCTION Suhail Al-Sahli, D.C. (Provider) requested a hearing before the State Office of Administrative Hearings (SOAH) after the Texas Workers’ Compensation Commission’s Medical Review Division (MRD)[1] denied his request for reimbursement from St. Paul Fire & Marine Insurance Company (Carrier) in the amount of $2,370 for office visits and treatment provided […]
453-04-0780-m5
DECISION AND ORDER I. SUMMARY Central Dallas Rehab (Provider) appealed the decision of Maximus, and independent review organization certified by the Texas Department of Insurance, in Texas Workers’ Compensation Commission (TWCC) Medical Review Division (MRD) tracking number M5-03-2681-01, denying reimbursement for medical services provided to the Claimant. This decision orders American Home Assurance Company (Carrier) […]
453-04-7665-m5
DECISION AND ORDER Pedro Nosnick, M.D., (Petitioner) appealed the decision of the Texas Workers’ Compensation Commission’s (Commission) Medical Review Division (MRD) to adopt the decision of its designee, an independent review organization (IRO), in MDR No. M5-04-2181-01. The decision upheld American Casualty Company of Reading, PA.’s (Carrier) denial of reimbursement for a neurological evaluation and […]
453-03-1068-m5
DECISION AND ORDER Therapy Experts, Inc. (Provider) has appealed a decision of the Texas Workers’ Compensation Commission’s (Commission) Medical Review Division (MRD) issued on October 11, 2002. The MRD’s decision is based on an independent review organization’s (IRO) determination that six weeks of work hardening provided to the injured worker (Claimant) from October 1 through […]