ADJ8192069 — California WCAB decision

What the panel ordered

Petition for Reconsideration DENIED.

Defendant sought reconsideration of the October 14, 2025 Findings and Award, which found injury and that the WCAB lacked jurisdiction to set aside the August 5, 2025 UR certification of home healthcare.

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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.

Medical treatment / UR / IMRApplicant prevailedbilateral upper extremities · shoulders · neck · dental · internal · psyche · voice

A valid, timely UR decision certifying medical necessity is binding on the employer; the WCAB lacks jurisdiction to set aside such a certification except for timeliness issues.

From the decision · page 12Here, the August 5, 2025 UR determination certified the requested home healthcare treatment as medically necessary. Because the UR decision was valid and timely, the determination is binding on the employer and the employer must provide the treatment forthwith to cure or relieve the employee from the effects of the industrial injury. (Lab. Code, § 4600, subd. (a).)

The facts that decided it

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

What proof carried it

The evidence the panel weighed, by kind.

Surveillancefavours Applicant prevailed

Subrosa video reviewed by Dr. Smolins, found consistent with applicant's reported limitations.

From the decision · page 5On September 2, 2025, Dr. Smolins issued a report stating in relevant part that he reviewed subrosa video dated March 7, 2025, showing applicant at a gas station, pushing her child in a cart, carrying clothing, carrying a drink, carrying her purse, and carrying her child. (Joint Exhibit 101, Report of Dr. Smolins, September 2, 2024, p. 1.) Dr. Smolins stated that he did not see evidence of pain behavior, but that the videos did not reveal her performing activities that were inconstant with her complaints. (Id. at pp. 1-2.) Dr. Smolins further stated that,

activities of daily livingfavours Applicant prevailed

Applicant's testimony regarding her functional limitations and need for assistance with ADLs, as well as Dr. Smolins' reports and review of subrosa video.

From the decision · page 6On September 29, 2025, the issue of applicant's entitlement to home health care services for 24 hours a day for 7 days a week was submitted for disposition. As relevant herein, applicant testified that: She generally sleeps for three to four hours at night. At times, she will choke and stop breathing, and she has started sleepwalking. Once, her family woke up and discovered that the stove was on and that she was in bed with a bowl of cereal. At night, she may "lock up" or go to the restroom. At times, blood rushing to her head may cause her to black out when she goes to the bathroom. She fell and hit her head. She tried wearing diapers but developed sores that became infected. She has difficulty wiping herself and needs assistance scooping her stool out. She does not have regular bowel movements. She is missing teeth, which makes it hard to keep food down. She will throw up and black out. It is also hard to prepare food because she cannot feel heat in her hands. She burned herself while cooking and washing her hands.

ADJ8192069 · December 24, 2025

What the panel ordered

What was disputed, and how it came out

The facts that decided it

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What the panel did with the medical opinions

The rules the panel named

What proof carried it

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