What the panel ordered
Petition for Reconsideration granted; Findings of Fact rescinded; matter returned to trial level for further proceedings consistent with decision
Petition for Reconsideration of Findings of Fact issued on November 17, 2023 granted; Findings of Fact rescinded and matter returned to trial level for further proceedings
What was disputed, and how it came out
Each issue the panel decided, with the reasoning it gave. An outcome is what this panel did on this record — not a rule, and not a prediction.
The WCJ misconstrued the stipulation regarding LVN treatment duration and failed to find defendant's obligation to provide home care and LVN treatments after the stipulated period; the record lacks evidence on communication and authorization of treatments before the stipulation; further record development is needed to determine defendant's obligation and compliance with legal standards.
From the decision · page 4We turn first to applicant's contention that the WCJ erroneously failed to find that
The facts that decided it
What the panel treated as outcome-determinative, and which side it favoured.
Applicant's wife testified she was paid to provide home healthcare from January 27, 2023 through April 27, 2023
Favours Applicant prevailed
Supports applicant's claim that home care was provided and relevant to the dispute over treatment obligation
From the decision · page 3The Defendant stipulated to provide home healthcare services for a period of 90 days. The Applicant's wife testified she was paid to provide home healthcare from January 27, 2023 through April 27, 2023. (See MOH/SOE September 7, 2023, p. 2 ll. 23§ 24) The Defendant, pursuant to the terms of the stipulations terminated payments for home healthcare service, and LVN care after the 90 day period expired.
The January 3, 2023 Stipulation explicitly required defendant to provide home care for 90 days and LVN care for an indeterminate period
Favours Applicant prevailed
The WCJ misconstrued the stipulation to require LVN treatment for only 90 days and found no obligation to continue treatment after that period, which was unsupported by the record
From the decision · page 5However, the Stipulation provides that defendant shall: (1) "pay a family member of the Applicant, $17.00 an hour, or hire an outside agency, for up to 28 hours per week of Home Care, for [90 days]"; and (2) "allow a once per week visit by an LVN to refill medications/pill box for the applicant." (Ex. 5, Stipulation and Order, January 3, 2023, pp. 1:14-2:22.) Thus, the Stipulation explicitly requires defendant to provide home care for a ninety-day period and to provide LVN care for an unstated, indeterminate period.
No evidence showed that home care and LVN treatments were requested or authorized before the January 3, 2023 Stipulation
Favours Applicant prevailed
This lack of evidence prevented a clear finding on defendant's obligation to provide treatments and whether Patterson's burden to show a change in condition applied
From the decision · page 5In addition, we are unable to discern support for the finding that defendant was not required to provide home care and LVN treatments on the grounds that the ninety-day period had expired in the first instance because, regardless of whether or not the treatments were limited to ninety days, the record fails to show how, if at all, the treatments were requested or authorized.
What the panel did with the medical opinions
The role the physician served, and the weight the opinion carried. Physicians are named here as the decision names them; we do not score them.
Provided report dated January 18, 2023, including a new request for home care and LVN treatments, faxed to defendant after the stipulation date.
The report was central to the dispute over the obligation to provide home care and LVN treatments and the timing of authorization.
From the decision · page 3The Report from Dr. Patterson dated January 18, 2023 consists of a Request for
The rules the panel named
Authorities as the decision cited them, with how this panel applied each one.
Labor Code section 4610(i)(4)(c); Cal. Code Regs., tit. 8, 9792.9.1(e)(6)
Labor Code section 4610(i)(4)(c) and Administrative Rule 9792.9.1(e)(6) requirements for concurrent review decision to deny or discontinue medical treatment
The decision discusses whether these requirements applied to the termination of home care and LVN treatments under the stipulation and finds they did not apply due to lack of concurrent utilization review.
From the decision · page 4Cases 910 at 917.) In this case, unlike Patterson, the Defendant did not unilaterally terminate medical treatment on its own initiative. The decision to cease treatment of home healthcare and LVN care was based on the stipulations both parties signed on January 3, 2023. (See Exhibit J-5)... Both Labor Code section 4610(i)(4)(C) and Reg. 9792.9.1(e)(6) discuss requirements that shall be met prior to a concurrent review decision to deny or discontinue medical treatment. At the time medical treatment was terminated there was no concurrent utilization review in process, or a requesting physician with which to discuss terminating the medical treatment. In the instant case, the medical treatment was terminated pursuant to the stipulation the parties entered into on January 3, 2023.
What proof carried it
The evidence the panel weighed, by kind.
Applicant's wife testified she was paid to provide home healthcare from January 27, 2023 through April 27, 2023
From the decision · page 3The Defendant stipulated to provide home healthcare services for a period of 90 days. The Applicant's wife testified she was paid to provide home healthcare from January 27, 2023 through April 27, 2023. (See MOH/SOE September 7, 2023, p. 2 ll. 23§ 24) The Defendant, pursuant to the terms of the stipulations terminated payments for home healthcare service, and LVN care after the 90 day period expired.
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About this page
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