ADJ15040609 — California WCAB decision

What the panel ordered

Petition for Reconsideration denied by the WCAB panel.

Defendant sought reconsideration of the January 21, 2025 Findings and Award by the WCJ, which was denied by the WCAB panel on April 28, 2025.

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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 prevailedhead · neck · back · shoulders · psyche · psychiatric · brain · lungs · bowel · bladder · upper extremities · lower extremities · sexual dysfunction

The WCJ found defendant failed to timely investigate applicant's need for home modifications as medical treatment to cure or relieve effects of industrial injury, and the WCJ's award for home modifications and interim housing was supported by stipulations and evidence. The WCAB panel agreed and denied reconsideration.

From the decision · page 1Defendant seeks reconsideration of the January 21, 2025 Findings and Award, wherein the workers' compensation administrative law judge (WCJ) found that applicant, while employed as an AC HVAC Commercial Installer on June 18, 2020 (ADJ17146930) and August 25, 2020 (ADJ15040609) sustained industrial injury to his head, neck, back, shoulders, psyche, psychiatric, brain, lungs, bowel, bladder, upper and lower extremities, and in the form of sexual dysfunction per prior 100 percent stipulations. The WCJ found in relevant part that the court retained jurisdiction to decide the present dispute involving home modifications, and that defendant failed to timely investigate applicant's need for treatment to cure or relieve from the effects of his industrial injuries. Pursuant to reporting in evidence, the WCJ awarded home modifications in the form of a mobile home to be constructed on applicant's residential property. The WCJ further awarded interim housing in the form of an Americans with Disabilities Act (ADA) compliant apartment or skilled nursing facility.

The facts that decided it

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

Defendant had reasonable notice of the need for home modifications as early as 2022 based on Dr. Gupta's report and subsequent therapy group report.

Favours Applicant prevailed

This notice triggered defendant's duty to investigate and provide benefits, which defendant failed to do, supporting the award for home modifications.

From the decision · page 9Here, we agree with the WCJ that defendant had reasonable notice of the need for a "good faith investigation to determine whether benefits are due" as early as 2022 when treating physician Dr. Gupta reviewed the home assessment evaluation by Julie Salonga dated December 29, 2021, and concluded that applicant's residence "will need some modification." (Ex. 4, Report of Pramila Gupta, M.D., dated February 16, 2022, at p. 34.) Pursuant to Dr. Gupta's request for input from an occupational therapist, the May 8, 2023, reporting of Capuchino Therapy Group confirmed that "it may be more cost effective to build a structure that is fully accessible" and "level without steps" to facilitate wheelchair access. (Ex.

The parties stipulated that applicant was permanently and totally disabled and in need of home care assistance and home modifications to accommodate his wheelchair.

Favours Applicant prevailed

The stipulations established the medical necessity of home modifications, supporting the WCJ's award and the WCAB's denial of reconsideration.

From the decision · page 2On March 25, 2024, the parties entered into Joint Stipulations with Request for Award, in which they stipulated that applicant had sustained injury to his head, neck, back, psyche, upper extremities, arm, shoulder, pulmonary [system], cardiovascular [system], bowel and bladder dysfunction, and sexual dysfunction. (Stipulations with Request for Award, dated March 25, 2024, at pp. 4-5.) The parties further stipulated that applicant was "in need of [adaptive] devices for ADL's [Activities of Daily Living], including a wheelchair, walker and home care assistance." (Id. at p. 5.) The parties agreed that applicant was permanently and totally disabled, notwithstanding the fact that applicant was not yet at Maximum Medical Improvement. (Id. at p. 7.) As relevant to the present dispute, the parties offered the following stipulation:

The WCJ allowed defendant additional time and opportunity to obtain rebuttal evidence and conduct discovery on home modifications, but defendant failed to adequately investigate or rebut the need for modifications.

Favours Applicant prevailed

This showed defendant was given due process and opportunity but did not fulfill its duty, supporting the denial of reconsideration.

From the decision · page 13Defendant references the right to cross examination as essential to due process. That right was afforded to him because Mr. McIlwain was present as a witness at the trial and was cross examined by Defendant. The continuance was meant to alleviate the surprise of the McIlwain report being offered by the applicant and to allow further discovery in regards to that report. Defendant did in fact complete that discovery, thus alleviating any due process issue stemming from the surprise report. Defendant wrongfully characterizes my order as an order for "discovery against their own interest." The McIlwain report, dated 10/16/2024, was for a rebuild project just over 1 million dollars. Defendant had no rebuttal evidence of this, and I allowed them to obtain rebuttal evidence, and found in favor of that evidence.

ADJ15040609 · April 28, 2025

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