WCPanelIQ
PanelQMEMed-legalRemanded

Hong, Anna

ANNA HONG, Applicant vs. SBC INTERNET SERVICES/PACIFIC BELL; AMERICAN HOME ASSURANCE, administered by SEDGWICK CLAIMS MANAGEMENT SERVICES, Defendants

ADJ number
ADJ2419734
Decision date
Jun 5, 2024
District office
San Francisco
WCJ
—
Claim administrator
Sedgwick Claims Management Services (administering American Home Assurance)
Commissioners
JOSEPH V. CAPURRO, COMMISSIONER, ANNE SCHMITZ, DEPUTY COMMISSIONER, KATHERINE WILLIAMS DODD, COMMISSIONER

Injury / body parts: upper extremities, bilateral wrists, hands

LC §4600LC §5300LC §5301LC §5803LC §5900LC §5901LC §5903LC §5908.5LC §5909LC §5950LC §5952CCR §10305CCR §10325CCR §10392CCR §10507CCR §10508CCR §10845

Summary

Applicant Anna Hong, in pro per, sought reconsideration of a WCJ's Joint Findings of Fact holding that Patterson v. The Oaks Farm did not apply to Dr. Kim's April 19, 2022 RFA for TENS machine supplies, that defendant timely denied authorization on medical necessity grounds, and that the WCAB lacked jurisdiction over medical necessity. The applicant had a 2010 joint award of further medical care to the upper extremities, and had received TENS treatment from 2008 to 2018 (denied on occasion), with a February 13, 2017 stipulation authorizing six months of TENS supplies subject to UR/IMR. The Board held that under Patterson and Rivota, an employer may not unilaterally cease providing ongoing, previously-authorized treatment without substantial medical evidence of a change in the employee's condition or circumstances, even where time limitations on the authorization have expired. Because the record failed to show whether defendant met that burden or when/why it ceased providing treatment, the Board rescinded the findings and deferred the disputed issues for development of the record. The matter was returned to the trial level for further proceedings.

Issues

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Holding

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Analysis

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Applicant takeaway

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Defense takeaway

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Provider takeaway

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