453-05-9151-m5
DECISION AND ORDER Carl M. Naehritz, D.C. (Petitioner) seeks reimbursement of $2,342.22 for a type of spinal decompression therapy and associated office visits provided to a workers’ compensation claimant from August 16, 2004, through September 7, 2004. The Texas Workers’ Compensation Commission (Commission), acting through an independent review organization (IRO), denied reimbursement. This decision orders […]
453-05-7999-m5
DECISION AND ORDER S.I.C.E.M. (Provider) appealed the decision of the Texas Workers’ Compensation Commission’s (Commission) Medical Review Division (MRD)[1] that denied reimbursement for services provided a workers’ compensation claimant (Claimant). Great American Insurance Company (Carrier) denied reimbursement based on its determination that the services were improperly billed. This decision finds that Carrier does not owe […]
453-05-9128-m5
DECISION AND ORDER Gabriel Gutierrez, D.C. (Provider), appealed the decision of an Independent Review Organization (IRO) that found the work hardening treatment rendered to Claimant, __, between August 27, 2004, and September 13, 2004, was not medically necessary. In that report, the IRO decided Provider was entitled to no reimbursement for the treatment rendered. Provider […]
453-05-9076-m5
DECISION AND ORDER I. INTRODUCTION Texas Mutual Insurance Company (Carrier) disputes a decision of an independent review organization (IRO) on behalf of the Texas Workers’ Compensation Commission (TWCC)/Medical Review Division (MRD) regarding medical services for claimant, ___. The IRO/MRD found that ultrasound, manual therapy, therapeutic exercises, neuromuscular re-education, and office visits from April 7 through […]
453-05-9788-m5
DECISION AND ORDER The issue involved is whether Zurich American Insurance Company (Carrier) correctly denied payment of claims filed by George Kristopher Wilson, D.C., Fort Worth Injury Rehabilitation Clinic (Provider) for chiropractic treatments provided to an injured worker (Claimant) between November 5, 2003, and January 16, 2004. Carrier challenged the medical necessity of the treatment, […]
453-05-9024-m5
DECISION AND ORDER The provider, Main Rehab & Diagnostic (Main Rehab), sought reimbursement for approximately six weeks of work hardening therapy provided to claimant ___in 2004. Citing a lack of medical necessity, the carrier, American Casualty Company (ACC), declined to pay for the disputed services. An Independent Review Organization (IRO) determined that the disputed services […]
453-05-6735-m5
DECISION AND ORDER I. PROCEDURAL HISTORY Neuromuscular Institute of Texas (Petitioner) requested a hearing to contest the Findings and Decision of the Texas Workers’ Compensation Commission[1] (Commission) acting through Intracorp, an Independent Review Organization (IRO). The Commission’s decision denied Petitioner reimbursement for therapeutic procedures and exercises, ultrasound, paraffin bath, manual therapy techniques, functional capacity evaluation […]
453-05-9681-m5
DECISION AND ORDER This case involves the question whether reimbursement is appropriate for treatment rendered to Claimant by Mark C. Sherrod, D.C. (Petitioner), between April 21, 2004, and June 22, 2004 (Service Period), for an injury sustained in___. Dr. Sherrod initially sought reimbursement from Texas Mutual Insurance Company (TMIC) in the amount of $874.00.[1] TMIC […]
453-05-4350-m5
DECISION AND ORDER Petitioner, Gabriel R. Gutierrez, D.C. (Provider), challenged the Findings and Decision of the Medical Review Division (MRD) of the Texas Workers’ Compensation Commission[1] (TWCC) denying reimbursement from Fire & Casualty Insurance Company (Carrier) for medical services provided to an injured worker (Claimant). Provider disputes the conclusion of the Independent Review Organization (IRO) […]
453-05-9255-m5
DECISION AND ORDER I. INTRODUCTION Texas Mutual Insurance Company (Carrier) disputes a decision of an independent review organization (IRO) on behalf of the Texas Workers’ Compensation Commission (TWCC) Medical Review Division (MRD) regarding medical services for __(Claimant). The IRO disagreed with the Carrier and found that the services were reasonably medically necessary to treat the […]