453-05-4541-m5
DECISION AND ORDER South Coast Spine and Rehabilitation, P.A. (Petitioner), appealed the decision of the Texas Workers= Compensation Commission’s (Commission) Medical Review Division (MRD) based in part on the decision of its designee, an independent review organization (IRO). Petitioner appealed the portions of the decision that upheld Brownsville ISD’s (Carrier) denial or otherwise denied reimbursement […]
453-05-1228-m5-etal
DECISION AND ORDER SCD Back & Joint Clinic, Ltd., (“Petitioner”) seeks review of two decisions by the Texas Workers’ Compensation Commission (“Commission”[1]), acting in each case through an independent review organization (“IRO”, in disputes regarding the medical necessity of chiropractic treatment. The Commission found that the insurer, American Home Assurance (“Respondent”) properly denied reimbursement for […]
453-05-8829-m5
DECISION AND ORDER Atlantic Mutual Insurance Company (Carrier) challenges an Independent Review Organization (IRO) decision concluding that Buenavista Workskills (Provider) was entitled to reimbursement for chronic pain management services provided to an injured worker (Claimant). Administrative Law Judge (ALJ) Gary Elkins convened and closed the hearing in this case on April 18, 2006. Carrier appeared […]
453-05-3244-m5
DECISION AND ORDER Petitioner TPCIGA for Reliance National, Inc. (Carrier) disagrees with the decision of an independent review organization (IRO) issued on behalf of the Texas Workers’ Compensation Commission (Commission)/Medical Review Division (MRD)[1] finding that the prescribed medications provided Claimant in July and August 2004 were medically necessary. Carrier denied payment for two medications, Ambien […]
453-05-5861-m5
DECISION AND ORDER Work Perfect Houston (Petitioner) has challenged the decision of an Independent Review Organization (IRO) upholding a decision byRespondent American Home Assurance Company (Carrier) denying Petitioner reimbursement, on the basis of medical necessity, for work hardening services Petitioner provided Claimant __(Claimant) September 7-17, 2004 (the disputed work hardening services).[1] The Administrative Law Judge […]
453-05-4452-m5
DECISION AND ORDER Texas Mutual Insurance Company (the Carrier) appeals the decision of the Texas Workers’ Compensation Commission (Commission),[1] acting through an independent review organization (IRO), requiring reimbursement of $4,079.56 for mechanical traction, electrical stimulation, therapeutic exercise, chiropractic manipulation, and massage therapy provided to a workers compensation claimant from November 4, 2003 through May 10, […]
453-05-9684-m5
DECISION AND ORDER Ark-La-Tex Health Center (Petitioner) appealed the decision of the Texas Workers’ Compensation Commission’s (Commission) Medical Review Division (MRD)[1] to adopt the decision of its designee, an Independent Review Organization (IRO). The IRO upheld Texas Mutual Insurance Company’s (Carrier) denial of reimbursement for services Petitioner had provided a workers’ compensation claimant (Claimant). Carrier’s […]
453-05-6675-m5
DECISION AND ORDER I. STATEMENT OF CASE Liberty Mutual Fire Insurance Company (Petitioner/Carrier) disputes the decision of an independent review organization (IRO) on behalf of the Texas Workers’ Compensation Commission[1] in a dispute regarding medical necessity for physical medicine procedures provided to___. (Claimant). The IRO found that the services and procedures provided by Kris Wilson, […]
453-05-7153-m5
DECISION AND ORDER I. INTRODUCTION This case presents a challenge by Parker Chiropractor Clinic (Provider) to a decision of an independent review organization (IRO) on behalf of the Texas Department of Insurance, Division of Workers’ Compensation,[1] in a dispute regarding medical necessity for chiropractic treatment. The IRO found that the insurer, Texas Mutual Insurance Company […]
453-05-4300-m5
DECISION AND ORDER I. PROCEDURAL HISTORY Liberty Mutual Insurance Company (Petitioner) requested a hearing to contest the Findings and Decision of the Texas Workers’ Compensation Commission[1] (Commission) acting through Envoy Medical Systems, LP, an Independent Review Organization (IRO). The Commission’s decision ordered Petitioner to reimburse Neuromuscular Institute of Texas (Respondent) for office visits on October […]