Texas Workers’ Compensation

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Medical CCH Decisions

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Non-Network
December 30, 2019
DECISION AND ORDER This case is decided pursuant to Chapter 410 of the Texas Workers’ Compensation Act and the Rules of the Texas Department of Insurance, Division of Workers’ Compensation. For the reasons discussed herein, the Administrative Law Judge determined that: (1) the preponderance of the evidence is not contrary to the decision of the Independent Review Organization (IRO) that the Claimant/Petitioner is not entitled to microdiscectomy at left L5-S1, neuromonitoring, preoperative laboratory testing, preoperative...

Non-Network
December 12, 2019
DECISION AND ORDER This case is decided pursuant to Chapter 410 of the Texas Workers’ Compensation Act and the Rules of the Texas Department of Insurance, Division of Workers’ Compensation (DWC). For the reasons discussed herein, the Administrative Law Judge (ALJ) determines that: Claimant is not entitled to a right shoulder MRI without contrast for the compensable injury of (Date of Injury). STATEMENT OF THE CASE On December 12, 2019, Warren E. Hancock, Jr., a...

Non-Network
December 9, 2019
DECISION AND ORDER This case is decided pursuant to Chapter 410 of the Texas Workers’ Compensation Act and Rules of the Division of Workers’ Compensation (DWC) adopted thereunder. For the reasons discussed herein, the Administrative Law Judge (ALJ) determines that: Claimant is not entitled to the requested authorization for left shoulder total arthroplasty revision, removal of glenosphere & humeral component, removal of superior screws with inpatient days. ISSUES A contested case hearing was held on...

Non-Network
November 13, 2019
DECISION AND ORDER This case is decided pursuant to Chapter 410 of the Texas Workers’ Compensation Act and Rules of the Division of Workers’ Compensation (DWC) adopted thereunder. For the reasons discussed herein, the Administrative Law Judge determines that diagnostic interview, 1 hour of psychological testing evaluation, 2 hours of additional psychological testing, and 3 units of psychological test administration are not health care reasonably required for the compensable injury of (Date of Injury). STATEMENT...

Non-Network
November 7, 2019
DECISION AND ORDER This case is decided pursuant to Chapter 410 of the Texas Workers’ Compensation Act and the Rules of the Texas Department of Insurance, Division of Workers’ Compensation. In accordance with the parties’ agreement, the Administrative Law Judge determines that Claimant is entitled to deep hardware removal and removal of support implant for the (Date of Injury), compensable injury. STATEMENT OF THE CASE On November 7, 2019, Kara Squier, a Division administrative law...

Non-Network
October 17, 2019
DECISION AND ORDER This case is decided pursuant to Chapter 410 of the Texas Workers’ Compensation Act and the Rules of the Texas Department of Insurance, Division of Workers’ Compensation. For the reasons discussed herein, the Administrative Law Judge determines that a purchase of binaural Phonak Audeo Marvel 90 rechargeable with TV connector, drying capsules, power pack, dry briks, dry and store, wax guards, and domes is health care reasonably required for the compensable injury...

Non-Network
October 4, 2019
DECISION AND ORDER This case is decided pursuant to Chapter 410 of the Texas Workers’ Compensation Act and the Rules of the Texas Department of Insurance, Division of Workers’ Compensation (DWC). For the reasons discussed herein, the Administrative Law Judge determines that Claimant is entitled to an exploration spinal fusion, neuroplasty of nerve roots and dura, bilateral foraminotomy at L5/S1, and spinal monitoring for the compensable injury of (Date of Injury). STATEMENT OF THE CASE...

Non-Network
October 1, 2019
DECISION AND ORDER This case is decided pursuant to Chapter 410 of the Texas Workers’ Compensation Act and the Rules of the Texas Department of Insurance, Division of Workers’ Compensation. For the reasons discussed herein, the Administrative Law Judge determined that Claimant is not entitled to Fioricet 50mg/300mg/40mg tabs Q day prn #30 with 2 refills for the (Date of Injury), compensable injury. STATEMENT OF THE CASE On September 30, 2019, Britt Clark, a Division...

Non-Network
September 26, 2019
DECISION AND ORDER This case is decided pursuant to Chapter 410 of the Texas Workers’ Compensation Act and the Rules of the Texas Department of Insurance, Division of Workers’ Compensation (DWC). For the reasons discussed herein, the Administrative Law Judge (ALJ) determines that: Claimant is not entitled to 80 hours of chronic pain management for the compensable injury of (Date of Injury). STATEMENT OF THE CASE Thomas Hight, a DWC administrative law judge, held a...

Non-Network
September 12, 2019
DECISION AND ORDER This case is decided pursuant to Chapter 410 of the Texas Workers’ Compensation Act and the Rules of the Texas Department of Insurance, Division of Workers’ Compensation. For the reasons discussed herein, the Administrative Law Judge determined that: (1) the Texas Department of Insurance, Division of Workers’ Compensation, has jurisdiction to hear this case and determine whether the preponderance of the evidence is contrary to the decision of the Independent Review Organization...

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