453-05-7890-m5
DECISION AND ORDER SCD Back and Joint Clinic, Ltd., (Provider) challenged the decision of the Texas Workers’ Compensation Commission (TWCC or Commission)[1] denying reimbursement for office visits and a variety of physical medicine treatments rendered by Provider for the benefit of __(Claimant) between July 7 and October 12, 2004 (the disputed period). On June 21, […]
453-05-6619-m5
DECISION AND ORDER I. INTRODUCTION Continental Western Insurance Company (Carrier) appealed a Texas Workers’ Compensation Commission (Commission)[1] Medical Review Division (MRD) decision, issued on the basis of medical necessity, that ordered payment for a chronic pain management (CPM) program provided to an injured worker (Claimant) by Bexar County Healthcare Systems (Provider) from November 29, 2004, […]
453-05-6882-m5
DECISION AND ORDER Jarrod M. Cashion, D. C. (Provider), challenged the decision of the Texas Workers’ Compensation Commission (TWCC or Commission)[1] that denied reimbursement to Provider for sessions of therapeutic exercises and a special service rendered by Provider for__ (Claimant) between March 27 and June 22, 2004 (disputed period). Provider contended that physical therapy was […]
453-05-9358-m5
DECISION AND ORDER I. DISCUSSION South Coast Spine and Rehab, P.A. (South Coast) requested a hearing to contest the denial for reimbursement of services including office visits, therapeutic exercises, ultrasound, and a functional capacity evaluation from December 21, 2004, through January 26, 2005. This decision denies the relief sought by South Coast. The hearing convened […]
453-05-9327-m5
DECISION AND ORDER North Texas Physical Therapy and Rehabilitation Center (Petitioner) appeals a decision by the Medical Review Division (MRD) of the Texas Workers’ Compensation Commission[1] (Commission) regarding the medical necessity of physical therapy services including an initial evaluation,[2] one-on-one therapy,[3] soft tissue mobilization,[4] ultrasound,[5] re-evaluation,[6] and electrical stimulation[7] (disputed services) provided to a workers’ […]
453-05-9252-m5
DECISION AND ORDER I. INTRODUCTION Dr. B. Misra, M.D. (Provider) disputes a decision of an independent review organization (IRO) on behalf of the Texas Workers’ Compensation Commission (TWCC)/Medical Review Division (MRD) regarding office visits of Claimant, ___from July 14, 2004, through January 3, 2005. As set out below, the Administrative Law Judge (ALJ) agrees with […]
453-05-9074-m5
DECISION AND ORDER Texas Mutual Insurance Company (Carrier) sought review of an Independent Review Organization (IRO) decision and resulting order by the Medical Review Division (MRD) of the Texas Worker’s Compensation Commission (TWCC). The MRD ordered Carrier to reimburse Cotton Merritt, D.C. (Provider) $10,400.75 for chiropractic services provided by him from June 1, 2004, to […]
453-05-2842-m5
DECISION AND ORDER Texas Mutual Insurance Company (Carrier) appealed the decision of the Medical Review Division (MRD) of the Texas Workers’ Compensation Commission (TWCC) ordering reimbursement for hot/cold pack therapy (CPT Code 97010), unattended electrical stimulation (CPT Code 97014), mechanical traction (CPT Code 97102), special supplies (CPT Code 99070), an initial office visit (CPT Code […]
453-05-7365-m5
DECISION AND ORDER Jairo A. Puentes, M.D. (Provider) challenges an Independent Review Organization (IRO) decision concluding that medical services he provided to an injured worker (Claimant) were not medically necessary. Based on the evidence presented at hearing, the Administrative Law Judge (ALJ) concludes the disputed services were not shown to be medically necessary for the […]
453-05-4389-m5
DECISION AND ORDER The Transportation Insurance Company (Carrier) challenged the decision of the Medical Review Division (MRD) of the Texas Workers’ Compensation Commission (TWCC or Commission)[1] that granted reimbursement to Claimant for prescriptions of Vicodin that were dispensed to __(Claimant) between August 24, 2003, and November 26, 2003 (disputed period). Carrier contended that the medication […]