CompFox AI Summary
The Appeals Board rescinded a WCJ's decision denying home health care, finding that a 2015 stipulation obligating the defendant to provide "homecare" without a duration limit was binding. While subsequent agreements addressed retroactive payments, they did not resolve ongoing home care entitlement. The Board determined this open-ended stipulation means the defendant bears the burden to prove home care is no longer medically necessary before termination, remanding for further proceedings. A dissenting opinion argued that the matter should be subject to utilization review and independent medical review as per legislative intent.
Full Decision Text1 Pages
The Appeals Board rescinded a WCJ's decision denying home health care, finding that a 2015 stipulation obligating the defendant to provide "homecare" without a duration limit was binding. While subsequent agreements addressed retroactive payments, they did not resolve ongoing home care entitlement. The Board determined this open-ended stipulation means the defendant bears the burden to prove home care is no longer medically necessary before termination, remanding for further proceedings. A dissenting opinion argued that the matter should be subject to utilization review and independent medical review as per legislative intent.
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