ADJ18067229 — California WCAB decision

What the panel ordered

Petition for Reconsideration denied by WCAB panel.

Petition for Reconsideration filed by Defendant challenging WCJ's Findings and Award of April 3, 2025; WCAB panel denies 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.

Reconsideration / removalApplicant prevailed

The WCAB panel found that the defendant did not meet the burden of proof to show a change in applicant's medical condition or circumstances to justify discontinuing ongoing home health care, and thus denied the petition for reconsideration.

From the decision · page 1We have considered the allegations of the Petition for Reconsideration and the contents of the report of the workers' compensation administrative law judge (WCJ) with respect thereto. Based on our review of the record, and for the reasons stated in the WCJ's Report, which we adopt and incorporate, and for the additional reasons given below, we will deny reconsideration.

The facts that decided it

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

The rules the panel named

Authorities as the decision cited them, with how this panel applied each one.

California Labor Code

Labor Code section 5909

Governs the timing and notice requirements for petitions for reconsideration before the WCAB.

From the decision · page 1Former Labor Code section 5909 provided that a petition for reconsideration was deemed denied unless the Appeals Board acted on the petition within 60 days from the date of filing. (Lab. Code, § 5909.) Effective July 2, 2024, Labor Code section 5909 was amended to state in relevant part that:

CA-WCAB Significant Panel Decision

Patterson v. The Oaks Farm (2014) 79 Cal. Comp. Cases 910

Establishes that defendants must show a change in circumstances to justify a new utilization review for ongoing care previously authorized.

From the decision · page 2In addition to the reasons set forth in the WCJ's Report, we note that in this case, unlike in Allied Signal Aero. v. Workers' Comp. Appeals Bd. (Wiggs) (2019) 35 Cal.App.5th 1077 [86 Cal.Comp.Cases 367], the issue is not whether defendant agreed to waive utilization review or refer it to a nurse for alternative dispute resolution on a one-time basis. We do not find any waiver by defendants, nor would we go so far as to characterize the provided treatment in this case as a "stipulation" between the parties. Instead, the issue in the present case is whether ongoing care, which had already been certified as reasonable and necessary through the utilization review process on May 24, 2024 and provided by defendants, should have been sent for a redundant subsequent utilization review absent any evidence that material facts had changed. The WCJ correctly applied the reasoning in Patterson v. The Oaks Farm (2014) 79 Cal. Comp. Cases 910 (Appeals Board Significant Panel Decision), and National Cement Co. v. Workers' Comp. Appeals

California Court of Appeal

Allied Signal Aero. v. Workers' Comp. Appeals Bd. (Wiggs) (2019) 35 Cal.App.5th 1077

Clarifies limits on utilization review and stipulations for ongoing care; distinguished in this case as no waiver or stipulation for ongoing care was found.

From the decision · page 2In addition to the reasons set forth in the WCJ's Report, we note that in this case, unlike in Allied Signal Aero. v. Workers' Comp. Appeals Bd. (Wiggs) (2019) 35 Cal.App.5th 1077 [86 Cal.Comp.Cases 367], the issue is not whether defendant agreed to waive utilization review or refer it to a nurse for alternative dispute resolution on a one-time basis. We do not find any waiver by defendants, nor would we go so far as to characterize the provided treatment in this case as a "stipulation" between the parties. Instead, the issue in the present case is whether ongoing care, which had already been certified as reasonable and necessary through the utilization review process on May 24, 2024 and provided by defendants, should have been sent for a redundant subsequent utilization review absent any evidence that material facts had changed. The WCJ correctly applied the reasoning in Patterson v. The Oaks Farm (2014) 79 Cal. Comp. Cases 910 (Appeals Board Significant Panel Decision), and National Cement Co. v. Workers' Comp. Appeals

ADJ18067229 · July 10, 2025

What the panel ordered

What was disputed, and how it came out

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