CompFox AI Summary
Rogelio Toscano, the applicant, suffered a significant brain injury and has been receiving ongoing outpatient rehabilitation. The defendants attempted to discontinue this care via utilization review, but the Workers' Compensation Appeals Board (WCAB) found this action invalid. The WCAB, adopting the WCJ's report, denied the defendants' petition for reconsideration, affirming that the defendants failed to demonstrate a change of circumstances necessary to justify a new utilization review for previously authorized ongoing treatment. Commissioner Razo dissented, arguing that the majority's reliance on the Patterson rule incorrectly carves out an exception to Labor Code section 4610's utilization review requirements.
Full Decision Text1 Pages
Rogelio Toscano, the applicant, suffered a significant brain injury and has been receiving ongoing outpatient rehabilitation. The defendants attempted to discontinue this care via utilization review, but the Workers' Compensation Appeals Board (WCAB) found this action invalid. The WCAB, adopting the WCJ's report, denied the defendants' petition for reconsideration, affirming that the defendants failed to demonstrate a change of circumstances necessary to justify a new utilization review for previously authorized ongoing treatment. Commissioner Razo dissented, arguing that the majority's reliance on the Patterson rule incorrectly carves out an exception to Labor Code section 4610's utilization review requirements.
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