Home/Case Law/JESUS RODRIGUEZ vs. AIR EAGLE, INC., CALIFORNIA INSURANCE GUARANTEE ASSOCIATION, SEDGWICK CMS FOR LEGION INSURANCE IN LIQUIDATION
Regular DecisionWorkers' Compensation

JESUS RODRIGUEZ vs. AIR EAGLE, INC., CALIFORNIA INSURANCE GUARANTEE ASSOCIATION, SEDGWICK CMS FOR LEGION INSURANCE IN LIQUIDATION

Filed: Jan 09, 2015
ADJ3415116 (LAO 0794342) ADJ581399 (LAO 0794343)

CompFox AI Summary

This case concerns a dispute over the necessity and timeliness of 24/7 home health care for an injured worker. The Workers' Compensation Appeals Board (WCAB) affirmed the original findings but amended them to rule the defendant's utilization review (UR) decision was untimely, thus invalid. The WCAB found the worker had a valid prescription for home health care and was entitled to services starting October 22, 2013. However, one commissioner dissented, arguing there was insufficient evidence to support the indefinite need for the requested services based on current medical evaluations.

Full Decision Text1 Pages

This case concerns a dispute over the necessity and timeliness of 24/7 home health care for an injured worker. The Workers' Compensation Appeals Board (WCAB) affirmed the original findings but amended them to rule the defendant's utilization review (UR) decision was untimely, thus invalid. The WCAB found the worker had a valid prescription for home health care and was entitled to services starting October 22, 2013. However, one commissioner dissented, arguing there was insufficient evidence to support the indefinite need for the requested services based on current medical evaluations.

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