453-03-4518-m5
DECISION AND ORDER Texas Mutual Insurance Company (“TMIC” or “the carrier”) denied payment for office visits and physical therapy for a worker with cervical, thoracic, and lumbar area injuries. TMIC asserted that these services were not reasonable or necessary. The provider, Injury 1 Treatment Center (Injury 1), a chiropractic clinic, requested medical dispute resolution. An […]
453-03-2722-m5
DECISION AND ORDER American Casualty Company of Reading, PA. (Petitioner or Carrier) has appealed an Independent Review Organization’s (IRO’s) conclusion authorizing reimbursement to physician Alan Berg, D.O. (Dr. Berg or Respondent) for $3,933.00 of therapeutic services he provided to ___ (Claimant). The Administrative Law Judge (ALJ) finds that Respondent should be reimbursed for 1) two […]
453-03-2910-m5
DECISION AND ORDER ___ (Petitioner) appealed the Findings and Decision of the Texas Workers’ Compensation Commission (Commission) acting through Envoy Medical Systems, LLC, an Independent Review Organization (IRO), denying Petitioner reimbursement for certain massage therapy sessions for the period October 1, 2001, through October 29, 2001, (Disputed Services). The amount in controversy is $210.00. The […]
453-03-4136-m5
DECISION AND ORDER Petitioner, Central Dallas Rehab, sought reimbursement from Zurich American Insurance Company (the Carrier) for treatment (at a cost of $2,096) given to the injured worker, ___ (Claimant), that included chiropractic modalities and five days of a work hardening program. The Independent Review Organization (IRO) found the treatment was not medically necessary. This […]
453-03-4643-m5
DECISION AND ORDER Work Ready Rehab (Petitioner) appealed the findings and decision of the Texas Workers’ Compensation Commission’s designee, an independent review organization (IRO), which found that two weeks of a work hardening program and a functional capacity evaluation (FCE) Petitioner provided a workers’ compensation claimant (Claimant) was not medically necessary healthcare. The IRO’s decision […]
453-04-0140-m5
DECISION AND ORDER Claimant ___ injured her back in a work-related incident in May 2001. Dr. Brian Randall, D.C., provided chiropractic treatment to ___. The workers’ compensation carrier, National Fire Insurance Company of Hartford (“National Fire Insurance” of “the carrier”), declined to pay for certain of the chiropractic services from July 9 through December 21, […]
453-04-0846-m5
DECISION AND ORDER Danny Doyle, D. C. (Provider) challenged the decision of the Medical Review Division (MRD) of the Texas Workers’ Compensation Commission upholding Liberty Mutual Insurance Company’s (Carrier) denial of reimbursement for seven sessions of physical medicine administered between June 26, 2002, and October 28, 2002. Both Carrier and the MRD concluded that physical […]
453-03-4016-m5
DECISION AND ORDER I. DISCUSSION Howard Grant, M.D., (Petitioner) appealed the June 19, 2003 Findings and Decision of the Texas Workers’ Compensation Commission (Commission) acting through Ziroc, an Independent Review Organization (IRO), on June 18, 2003, denying reimbursement for services provided by Petitioner to injured worker ___ (Claimant) from October 8, 2002, through October 24, […]
453-03-4035-m5
DECISION AND ORDER Twin City Fire Insurance Company (Carrier) appealed a decision of the Medical Review Division (MRD) of the Texas Worker’s Compensation Commission (Commission) which authorized reimbursement to Main Rehab & Diagnostic (Provider or Main Rehab) for physical therapy services and office visits from May 28 through June 19, 2002.[1] This decision finds that […]
453-03-4134-m5
DECISION AND ORDER This case is a dispute over whether reimbursement is appropriate for physical therapy modalities rendered to ___ (Claimant) by Patrick Davis, D.C. (Provider), between May 23, 2002, through August 14, 2002. Provider sought reimbursement from Legion Insurance Company (Carrier) for the treatment rendered to Claimant, which Carrier denied as not medically necessary. […]