ADJ8115072 · January 26, 2024

The Appeals Board granted the petition for reconsideration to allow further review and development of the record, deferring final decision on the merits.

From the decision · page 2Based upon our preliminary review of the record, we will grant applicant's Petition as one seeking Reconsideration, and we will order that this matter be referred to a WCJ at the Appeals Board for a status conference. Our order granting applicant's Petition for Reconsideration is not a final order, and we will order that a final decision after reconsideration is deferred pending further review of the merits of the Petition for Reconsideration and further consideration of the entire record in light of the applicable statutory and decisional law. Once a final decision after reconsideration is issued by the Appeals Board, any aggrieved person may timely seek a writ of review pursuant to Labor Code section 5950 et seq.

Prescription for home health care services dated April 22, 2022 by Dr. Robert Harrison was received by defendant's claims adjuster.

Favours Applicant prevailed

This prescription triggered defendant's duty to investigate and was central to the dispute over entitlement to home health care services.

From the decision · page 3Here, the record does contain a "prescription" dated April 22, 2022 issued by Dr. Robert Harrison, a licensed M.D. physician, for various home health care services, and defendant does not appear to dispute that the claims adjuster received notice of the prescription. (App. Exh. 64; Def. Exh. R; Minutes of Hearing and Summary of Evidence, August 24, 2023, p. 6.) Thus, although the dispute centers upon whether the prescription fits the definition set forth in Neri Hernandez, we would caution defendant not to turn a blind eye to its affirmative duties to aid and investigate applicant's entitlement to home health care services in the interim.

Issued a prescription for home health care services dated April 22, 2022, which was received by defendant's claims adjuster.

The prescription was relevant to the dispute over entitlement to home health care services and the need for further record development.

From the decision · page 3Here, the record does contain a "prescription" dated April 22, 2022 issued by Dr. Robert Harrison, a licensed M.D. physician, for various home health care services, and defendant does not appear to dispute that the claims adjuster received notice of the prescription. (App. Exh. 64; Def. Exh. R; Minutes of Hearing and Summary of Evidence, August 24, 2023, p. 6.) Thus, although the dispute centers upon whether the prescription fits the definition set forth in Neri Hernandez, we would caution defendant not to turn a blind eye to its affirmative duties to aid and investigate applicant's entitlement to home health care services in the interim.

Neri Hernandez v. Geneva Staffing, Inc. dba Workforce Outsourcing, Inc. (2014) 79 Cal.Comp.Cases 682 (Appeals Board en banc)

Labor Code section 4600(h) includes home health care services in the definition of medical treatment, requiring a physician's prescription received by defendant.

The Board applied this standard to evaluate the sufficiency of the prescription and defendant's duty to investigate.

From the decision · page 2I. We also highlight the following legal principles that may be relevant to our review of this matter: As discussed in Neri Hernandez, Labor Code section 4600(h) includes home health care services in the definition of medical treatment, but they must be prescribed by a physician and the prescription received by defendant. As stated in that case, "...in order to obtain an award of home health care services, section 4600(h) requires applicant to show that he had a prescription, that it was received by defendant, and that he met the requirements of section 5307.1 or section 5307.8." (Neri Hernandez, supra, 79 Cal.Comp.Cases at pp. 688-689.) We further explained: The prescription required by section 4600(h) is either an oral referral, recommendation or order for home health care services for an injured worker communicated directly by a physician to an employer and/or its agent; or, a signed and dated written referral, recommendation or order by a physician for home health care services for an injured worker.

Hamilton v. Lockheed Corporation (2001) 66 Cal.Comp.Cases 473 (Appeals Board en banc)

Decisions by the Appeals Board must be supported by substantial evidence and based on admitted evidence in the record.

The Board emphasized the need for an adequate and complete record to support decisions.

From the decision · page 4Decisions of the Appeals Board "must be based on admitted evidence in the record." (Hamilton v. Lockheed Corporation (Hamilton) (2001) 66 Cal.Comp.Cases 473, 476 (Appeals Board en banc).) An adequate and complete record is necessary to understand the basis for the WCJ's decision. (Lab. Code, § 5313; see also Cal. Code Regs., tit. 8, § 10787.) "It is the responsibility of the parties and the WCJ to ensure that the record is complete when a case is submitted for decision on the record. At a minimum, the record must contain, in properly organized form, the issues submitted for decision, the admissions and stipulations of the parties, and admitted evidence." (Hamilton, supra, 66 Cal.Comp.Cases at p. 475.) The WCJ's decision must "set[] forth clearly and concisely the reasons for the decision made on each issue, and the evidence relied on," so that "the parties, and the Board if reconsideration is sought, [can] ascertain the basis for the decision[.]... For the opinion on decision to be meaningful, the WCJ must refer with specificity to an adequate and completely developed record." (Id. at p. 476, citing Evans v. Workmen's Comp. Appeals Bd. (1968) 68 Cal.2d 753, 755 [33 Cal.Comp.Cases 350].)

Prescription dated April 22, 2022 by Dr. Robert Harrison for home health care services

From the decision · page 3Here, the record does contain a "prescription" dated April 22, 2022 issued by Dr. Robert Harrison, a licensed M.D. physician, for various home health care services, and defendant does not appear to dispute that the claims adjuster received notice of the prescription. (App. Exh. 64; Def. Exh. R; Minutes of Hearing and Summary of Evidence, August 24, 2023, p. 6.) Thus, although the dispute centers upon whether the prescription fits the definition set forth in Neri Hernandez, we would caution defendant not to turn a blind eye to its affirmative duties to aid and investigate applicant's entitlement to home health care services in the interim.