What the panel ordered
The WCAB panel affirmed the WCJ's April 8, 2021 decision that defendant may not unilaterally cease inpatient care services at Casa Colina until a change in circumstances warrants a new utilization review determination.
Defendant sought reconsideration of the Findings and Order re: Ongoing Treatment at Casa Colina issued by a WCJ on April 8, 2021, which was affirmed after reconsideration by the WCAB panel on November 2, 2022.
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 and WCAB found that under Patterson, once treatment is authorized, it must continue until a change in circumstances warrants a new utilization review determination. Defendant failed to show such a change.
From the decision · page 1We granted reconsideration1 to further study the factual and legal issues in this case. This is our Opinion and Decision After Reconsideration. Defendant sought reconsideration of the Findings and Order re: Ongoing Treatment at Casa Colina issued by a workers' compensation administrative law judge (WCJ) on April 8, 2021. The WCJ found that applicant, while employed on August 16, 2018, as an electrician, sustained an admitted industrial injury to his head, both knees, upper back, lower back, and fingers of his left hand, and claimed injury to other body parts. The WCJ found defendant may not unilaterally cease to provide applicant's inpatient care services at Casa Colina Transitional Living Center (Casa Colina), until there is a change in circumstance that would warrant a new utilization review determination. The WCJ ordered that defendant continue to provide the services until there is a change in circumstances.
The facts that decided it
What the panel treated as outcome-determinative, and which side it favoured.
Defendant failed to show a change in applicant's condition or circumstances to justify termination of inpatient care at Casa Colina.
Favours Applicant prevailed
Without such a showing, the treatment must continue under Patterson.
From the decision · page 11Defendant failed to meet its burden of showing by substantial evidence that applicant's condition and circumstances changed in a way that made the further provision of nurse case manager services no longer reasonable medical treatment in this case.
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.
Diagnosed multiple significant problems due to industrial traumatic brain injury including cognitive deficits, orthopedic issues, anxiety, and inability to safely perform activities of daily living; opined continued participation in Casa Colina's residential program was required.
From the decision · page 2On August 27, 2020, applicant was evaluated by his primary treating physician, Allen Huang, M.D., specialist in physical medicine and rehabilitation. Dr. Huang diagnosed applicant with multiple significant problems due to his industrial traumatic brain injury. He noted that applicant suffers from cognitive deficits, multiple orthopedic issues, crippling anxiety, and an inability to safely perform activities of daily living. Dr. Huang opined that applicant requires continued participation in Casa Colina's residential program. (Applicant's Exhibits 1, 3, 5 and 8.)
The rules the panel named
Authorities as the decision cited them, with how this panel applied each one.
Patterson v. The Oaks Farm (2014) 79 Cal.Comp.Cases 910
The WCJ and WCAB applied Patterson to require continued authorization of treatment until change in circumstances.
From the decision · page 4The Appeals Board in Patterson concluded that:
Labor Code section 4600(a)
Labor Code section 4600(a) provides entitlement to medical treatment reasonably required to cure or relieve effects of industrial injury.
The WCJ and WCAB applied this standard to require continued treatment until change in circumstances.
From the decision · page 3DISCUSSION Labor Code section 4600(a)3 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
What proof carried it
The evidence the panel weighed, by kind.
Testimony of Jennyfer Poduska, executive director of patient access and care at Casa Colina, that there was no change in applicant's circumstances to warrant discontinuation of inpatient rehabilitation program including 24-hour oversight.
The same issues, filtered across the whole corpus — or paste your own facts and let the search rank by factor match.
About this page
- A published decision of the California Workers' Compensation Appeals Board, taken apart by what it turned on. The Board publishes the decision itself; this page adds the extraction and quotes the passage behind every claim.
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