Texas community resource
Workers' Compensation Medical Necessity IRO Review
Texas Department of Insurance Managed Care Quality Assurance Office
Independent medical review of qualifying workers' compensation care denials based on medical necessity, appropriateness, or experimental or investigational status.
Information last checked:
How to get help
Submit Form LHL009 to the insurance carrier or its utilization review agent no later than 45 calendar days after receiving the adverse determination on appeal. The published phone provides copies of the form.
Who this service helps
A health-care provider or pharmacy agent, injured employee or representative, or qualifying subclaimant after the carrier or utilization review agent issues the applicable adverse determination and adverse reconsideration decision. A life-threatening condition may qualify for immediate review without reconsideration.
Where this service is available
Service area: Texas workers' compensation medical-necessity disputes statewide, including injured employees, providers, pharmacies, and subclaimants in the Central Texas counties.
A service area describes where help is offered or who may be served. It is not necessarily the organization’s physical location.
Cost / fees
An injured employee does not pay for any part of an IRO review. Payment responsibility for other requesters depends on the dispute type and outcome.
About this service
TDI's Managed Care Quality Assurance Office processes requests and assigns a certified independent review organization to review a qualifying denial.
Other resources that may help
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