ADJ3107843 — California WCAB decision

What the panel ordered

The WCAB affirmed the WCJ's Findings and Award, upholding the penalties and attorney's fees awarded to the applicant for the delayed reimbursement of the replacement security system.

Defendant sought reconsideration of the Findings and Award issued by the WCJ on August 24, 2020, which found defendant liable for penalties and attorney's fees for delay in reimbursement of replacement security system cameras. The WCJ recommended denial of reconsideration.

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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.

Penalties under Labor Code §5814Applicant prevailedsecurity system cameras

The WCJ found defendant liable for penalties and attorney's fees due to unreasonable delay in reimbursing the replacement security system, which was considered medical treatment as prescribed by the treating physician and previously authorized and paid for by defendant.

From the decision · page 1Defendant seeks reconsideration of the Findings and Award (F&A) issued on August 24, 2020, by the workers' compensation administrative law judge (WCJ). In the F&A, the WCJ found that defendant was liable for penalties and attorney's fees for delaying reimbursement of replacement security system cameras, which maintained a security system that defendant previously authorized and installed in applicant's home.

The facts that decided it

What the panel treated as outcome-determinative, and which side it favoured.

Defendant paid for the original security system in 2011 after authorization by applicant's treating physician and did not object at that time.

Favours Applicant prevailed

Established that the security system was considered medical treatment and defendant was obligated to maintain it.

From the decision · page 4While ordinarily a home security system would not be considered medical treatment, when it is prescribed by a doctor to assist a patient who is both blind and suffers psychological injury, it becomes medical treatment. Defendant paid for the security system in 2011 in response to a request for authorization from applicant's treating physician. Whether the security system was reasonable and necessary medical treatment was decided in 2011, when defendant did not object to the request per section 4062.2 and instead paid for the system. Whether the security system is part of applicant's medical award is not at issue.

Defendant delayed reimbursement for the replacement security system for over a year after the request and only investigated after trial began.

Favours Applicant prevailed

Supported the finding of unreasonable delay warranting penalties and attorney's fees.

From the decision · page 4Certainly, defendant could have disputed in 2011 whether the security system was reasonable and necessary medical treatment. Defendant was also free to dispute and investigate whether the security system needed replacement in 2019 and whether applicant continued to use the security system. Defendant investigated these latter issues. After its investigation, defendant stipulated that the replacement system was necessary. But this occurred after applicant's attorney intervened, after the matter proceeded to trial, and over a year after the request for reimbursement was made. Defendant received the request for reimbursement in January 2019. Six months later, defendant attempted to conduct utilization review on the issue of whether it was required to maintain the security system that it paid for. Only after trial, in 2020, did defendant depose the installer. It does not appear that defendant deposed applicant or called applicant as a witness.

ADJ3107843 · March 18, 2024

What the panel ordered

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The facts that decided it

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