ADJ12007058 · February 16, 2024

The parties had a binding stipulation to submit the homecare issue to the agreed medical evaluator, Dr. Falkinstein, whose report supported the need for homecare services, and the defendant's attempt to narrow the scope of the agreement was rejected as unreasonable.

From the decision · page 3INTRODUCTION: On December 21, 2023, the Defendant, by and through its attorney of record, CW Law, LLP, filed a timely and verified petition for reconsideration dated December 21, 2023, alleging that the undersigned WCJ erred in his Partial Findings of Fact, Award & Order dated December 6, 2023. The Defendant contends that the WCJ erred in construing in his decision-making the parties'[] deferring to Yuri Falkinstein, M.D., the agreed medical evaluator in orthopedics, the Applicant's further need for home healthcare in the minutes of hearing by WCJ Clint Feddersen dated November 1, 2021.

The parties agreed to submit the homecare issue to the agreed medical evaluator, Dr. Falkinstein.

Favours Applicant prevailed

This agreement bound the parties to accept Dr. Falkinstein's medical opinion on the need for homecare services, which supported the applicant's entitlement.

From the decision · page 3STATEMENT OF FACTS: The Applicant, while employed during the period March 9, 2017 to March 9, 2018, as a front desk associate, sustained an industrial injury to her lumbar spine from repetitive cumulative trauma resulting in her needed to ambulate with a cane. On June 22, 2021, Matthew Longacre, M.D., the Applicant's primary treating physician, requested authorization for home healthcare for 20 hours per day. On June 29, 2021, denied the request by utilization review. On October 5, 2021, the Applicant filed her declaration of readiness to proceed claiming that the Defendant failed to authorize homecare services as recommended by Dr. Longacre. On October 12, 2021, the Defendant filed an objection claiming that the dispute needed to be resolve[d] by way of independent medical review. At the expedited hearing before WCJ Feddersen dated November 1, 2021, the parties entered into an agreement reflected in the minutes of hearing as follows: "PARTIES AGREE TO OBTAIN: FURTHER DISCOVERY IN THE FORM OF IN HOME ASSESSMENT(S) AND SUBMIT THE ISSUE OF THE NEED FOR HOMECARE TO THE AME FALKINSTEIN. (RETRO ISSUES RESERVED + DEFERRED."

It is medically reasonable that the applicant be provided necessary home care assistance four hours per day, seven days per week for six months, then a re-assessment to determine ongoing home care needs.

The parties agreed to submit the issue of homecare to Dr. Falkinstein, who opined in a supplemental report that homecare was medically reasonable as described.

From the decision · page 4Falkinstein, in his supplemental report dated June 30, 2023, on page 14, opined, "it is medically reasonable that [the] applicant be provided the necessary home care assistance four hours per day, seven days per week for six months, then a re-assessment to determine ongoing home care needs."

Labor Code 4600

Labor Code 4600 requires a defendant to provide medical treatment reasonably required to cure or relieve the injured worker from the effects of the injury if there is a demonstrated medical need.

The WCJ applied this standard to find the applicant entitled to homecare services based on medical recommendations.

Federal Express Corp. v. Workers' Comp. Appeals Bd. (Payne) (2017) 82 Cal.Comp.Cases 1014, 1017

Parties may bypass independent medical review by submitting disputes to an agreed medical evaluator.

The parties agreed to submit the homecare dispute to the AME Falkinstein, which the WCJ upheld.

County of Sacramento v. Workers' Comp. Appeals Bd. (Weatherall) (2000) 65 Cal.Comp.Cases 1, 3

Stipulations are binding agreements designed to expedite hearings and narrow issues.

The WCJ found the parties' stipulation to submit the homecare issue to the AME binding and rejected defendant's attempt to narrow it.

The parties' stipulation to submit the homecare issue to the agreed medical evaluator, Dr. Falkinstein, and his supplemental report supporting the need for homecare services.

From the decision · page 4Falkinstein, in his supplemental report dated June 30, 2023, on page 14, opined, "it is medically reasonable that [the] applicant be provided the necessary home care assistance four hours per day, seven days per week for six months, then a re-assessment to determine ongoing home care needs."