CompFox AI Summary
The Workers' Compensation Appeals Board (WCAB) granted reconsideration of a prior decision that found Utilization Review (UR) inapplicable to a home health care evaluation. The WCAB determined that a request for an evaluation for home health care assistance constitutes medical treatment under Labor Code Section 4600 and is therefore subject to the UR process. Consequently, the prior decision compelling the employer to provide the evaluation was rescinded. The case is returned to the trial level for further proceedings, as disputes regarding the medical necessity of UR-denied treatment must be resolved through Independent Medical Review (IMR).
Full Decision Text1 Pages
The Workers' Compensation Appeals Board (WCAB) granted reconsideration of a prior decision that found Utilization Review (UR) inapplicable to a home health care evaluation. The WCAB determined that a request for an evaluation for home health care assistance constitutes medical treatment under Labor Code Section 4600 and is therefore subject to the UR process. Consequently, the prior decision compelling the employer to provide the evaluation was rescinded. The case is returned to the trial level for further proceedings, as disputes regarding the medical necessity of UR-denied treatment must be resolved through Independent Medical Review (IMR).
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