What the panel ordered
Defendant's Petition for Reconsideration is granted, and issuance of a final decision after reconsideration is deferred pending further review of the merits and the entire record.
Defendant sought reconsideration of the WCJ's Findings of Fact and Order issued on September 9, 2025, which found applicant sustained injury AOE/COE and ordered defendant to pay for ongoing medical care. The WCAB granted reconsideration to further study the issues and deferred final decision pending further review.
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 found no change in circumstances regarding the applicant's need for continued care, supported by Dr. Patterson's opinion, but the Appeals Board granted reconsideration to further study the issues.
From the decision · page 1Defendant seeks reconsideration of the Findings of Fact and Order (FF&O) issued on September 9, 2025 by the workers compensation administrative law judge (WCJ), wherein, the WCJ found, in pertinent part, that applicant sustained injury arising out of and occurring in the course of employment (AOE/COE) to his head, neck, and back, that there has not been a change of circumstances shown regarding the applicant's need for continued care at Casa Colina at this time, and ordered defendant to pay Casa Colina for applicant's ongoing medical care after July 24, 2024, in an amount to be adjusted by the parties, with jurisdiction reserved.
The facts that decided it
What the panel treated as outcome-determinative, and which side it favoured.
Dr. Patterson testified there has been no change of circumstances and applicant still requires care for traumatic brain injury.
Favours Applicant prevailed
Supported the WCJ's finding that continued care is reasonably required.
From the decision · page 4The deposition of Dr. Patterson dated April 18, 2025, at page 24, he testified that there has been no change of circumstances and that the applicant still has findings consistent with a traumatic brain injury which still requires ca[r]e. Dr. Patterson further testified at page 30 of his deposition that the benefit of having the applicant at the Casa Colina Apple Valley facility was because of
Utilization review and independent medical review denied the request for continued 24-hour residential care.
Favours Defendant prevailed
Supported defendant's contention of change in circumstances but was not found controlling by WCJ.
From the decision · page 4"Applicant is authorized to treat at Casa Colina through the inpatient program. Defendant contends treatment is authorized through 7/19/24." (Stipulation and Order, 6/18/24.) On July 10, 2024, applicant's treating physicians, Marline Sangnil, M.D. and David Patterson, M.D., issued an RFA requesting continued 24-hour residential care at Casa Colina Apple Valley, which was denied by UR on July 15, 2024 (Ex. F.) On July 30, 2024, a UR decision issued denying the appeal of continued 24-hour residential care at Casa Colina Apple Valley). (Ex. E.) On July 25, 2024, IMR upheld the UR denial for continued 24-hour residential care. (Ex. H, IMR, 7/25/2024.) As stated by the WCJ in the Opinion:
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.
No change of circumstances; applicant still has findings consistent with traumatic brain injury requiring care; benefit of Casa Colina is protective environment for behavioral and substance abuse issues.
The WCJ relied on Dr. Patterson's deposition testimony to find no change in circumstances regarding continued care need.
From the decision · page 4The deposition of Dr. Patterson dated April 18, 2025, at page 24, he testified that there has been no change of circumstances and that the applicant still has findings consistent with a traumatic brain injury which still requires ca[r]e. Dr. Patterson further testified at page 30 of his deposition that the benefit of having the applicant at the Casa Colina Apple Valley facility was because of
Co-signed the RFA requesting continued 24-hour residential care at Casa Colina Apple Valley.
The RFA was part of the evidence considered regarding continued care need.
From the decision · page 4"Applicant is authorized to treat at Casa Colina through the inpatient program. Defendant contends treatment is authorized through 7/19/24." (Stipulation and Order, 6/18/24.) On July 10, 2024, applicant's treating physicians, Marline Sangnil, M.D. and David Patterson, M.D., issued an RFA requesting continued 24-hour residential care at Casa Colina Apple Valley, which was denied by UR on July 15, 2024 (Ex. F.) On July 30, 2024, a UR decision issued denying the appeal of continued 24-hour residential care at Casa Colina Apple Valley). (Ex. E.) On July 25, 2024, IMR upheld the UR denial for continued 24-hour residential care. (Ex. H, IMR, 7/25/2024.) As stated by the WCJ in the Opinion:
Evaluated applicant and reviewed history and treatment at Casa Colina for traumatic brain injury.
The AME report was part of the documentary record considered by the WCJ.
From the decision · page 3Our preliminary review of this matter indicates the following: Roger Bertoldi, M.D. who was selected as an Agreed Medical Evaluator (AME) by the parties in the area of neurology, evaluated applicant and issued a report dated June 28, 2023. Dr Bertoldi reviewed applicant's history at Casa Colina Hospital and Centers for Healthcare, Pre-
The rules the panel named
Authorities as the decision cited them, with how this panel applied each one.
Labor Code section 4600(a)
Labor Code section 4600(a) requires employer to provide medical treatment reasonably required to cure or relieve effects of industrial injury.
Applied to determine defendant's obligation for continued medical care.
From the decision · page 5Labor Code section 4600(a) provides that an industrially injured worker is entitled, at his/her employer's expense, to medical treatment that is reasonably required to cure or relieve the effects of the industrial injury. (§ 4600(a).) The coverage of section 4600 extends to any medically related services that are reasonably required to cure or relieve the effects of the industrial injury, even if those services are not specifically enumerated in that section. (Smyers v. Workers' Comp. Appeals Bd. (1984) 157 Cal.App.3d 36, 41.)
Patterson, 79 Cal.Comp.Cases 910
Burden shifts to employer to prove change in circumstances to terminate medical services (Patterson, 79 Cal.Comp.Cases 910).
Applied to assess defendant's burden to show change in circumstances.
From the decision · page 5In Patterson,79 Cal.Comp.Cases 910, the Appeals Board held the burden of proof shifts to the employer to establish that the termination of continued provision of medical services is due to a change in the employee's circumstances or condition showing that the services are no longer reasonably required to cure or relieve the injured worker from the effects of the industrial injury. (Opinion on Decision p. 4.)
What proof carried it
The evidence the panel weighed, by kind.
Deposition testimony of Dr. Patterson supporting no change in circumstances for continued care need.
From the decision · page 4The deposition of Dr. Patterson dated April 18, 2025, at page 24, he testified that there has been no change of circumstances and that the applicant still has findings consistent with a traumatic brain injury which still requires ca[r]e. Dr. Patterson further testified at page 30 of his deposition that the benefit of having the applicant at the Casa Colina Apple Valley facility was because of
Utilization review and independent medical review denials of continued 24-hour residential care request.
From the decision · page 4"Applicant is authorized to treat at Casa Colina through the inpatient program. Defendant contends treatment is authorized through 7/19/24." (Stipulation and Order, 6/18/24.) On July 10, 2024, applicant's treating physicians, Marline Sangnil, M.D. and David Patterson, M.D., issued an RFA requesting continued 24-hour residential care at Casa Colina Apple Valley, which was denied by UR on July 15, 2024 (Ex. F.) On July 30, 2024, a UR decision issued denying the appeal of continued 24-hour residential care at Casa Colina Apple Valley). (Ex. E.) On July 25, 2024, IMR upheld the UR denial for continued 24-hour residential care. (Ex. H, IMR, 7/25/2024.) As stated by the WCJ in the Opinion:
The same issues, filtered across the whole corpus — or paste your own facts and let the search rank by factor match.
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