CompFox AI Summary
This case involves a workers' compensation applicant seeking reconsideration of a decision awarding him 42 hours of weekly home health care, an ultralight wheelchair, and home modifications. The Uninsured Employers Benefit Trust Fund (UEBTF) argued against liability, claiming the treating physician did not use the correct form for home health care requests and that it had timely conducted utilization review. The Appeals Board affirmed the award, finding the UEBTF had a duty to investigate the need for services upon receiving medical reports and recommendations. Furthermore, the Board held that a prior stipulation obligated the UEBTF to continue providing home health care, and their utilization review process was either untimely or improperly conducted.
Full Decision Text1 Pages
This case involves a workers' compensation applicant seeking reconsideration of a decision awarding him 42 hours of weekly home health care, an ultralight wheelchair, and home modifications. The Uninsured Employers Benefit Trust Fund (UEBTF) argued against liability, claiming the treating physician did not use the correct form for home health care requests and that it had timely conducted utilization review. The Appeals Board affirmed the award, finding the UEBTF had a duty to investigate the need for services upon receiving medical reports and recommendations. Furthermore, the Board held that a prior stipulation obligated the UEBTF to continue providing home health care, and their utilization review process was either untimely or improperly conducted.
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