02 Feb 2021

California: Need for Further Medical Treatment; Assisted Living Facility

In a recent panel decision, the WCAB, denying reconsideration, affirmed the WCJ’s decision that the Applicant, who was previously awarded 100% permanent disability with the need for further medical treatment, was entitled to further medical treatment in the form of continued interdisciplinary post-acute rehabilitation at an assisted living facility absent any change in circumstances. In this case, the Defendant had been providing ongoing authorization for the Applicant to reside at an assisted living facility since January 23, 2020, but had denied a request for his continued stay on October 1, 2020. The WCAB, relying on Patterson v. The Oaks Farm (2014) 79 Cal. Comp. Cases 910 (Appeals Board significant panel decision), held the Applicant was not required to provide ongoing requests for authorization and that the Defendant could not force the Applicant to be discharged from the facility by obtaining a denial by utilization review absent any change of circumstances. Ultimately, ensuring the Applicant’s continued stay, absent any change in circumstances and without the Defendant’s constant demands for ongoing requests for authorization, ensures the Applicant’s safety and maintains continuity in his living situation and medical care. See the Rivota panel decision.

Reminder: Board panel decisions are not binding precedent.