Cuellar, Filiberto

Applicant Filiberto Cuellar, a cook, sustained admitted industrial injury to his lumbar spine, thoracic spine, and neurogenic bowel on September 9, 2019. Defendant Zurich North America authorized home health care services (six hours per day, seven days per week) beginning July 2022 and continued authorization through June 2024, after which it submitted the PTP's renewed request to utilization review (UR), which non-certified the services as not medically necessary. The WCJ found no change in applicant's condition and ordered defendant to continue providing home health services, applying Patterson v. The Oaks Farm. The Appeals Board denied reconsideration, holding that once treatment has been authorized as medically necessary, defendant cannot shift the burden back to applicant via a new RFA and UR, and bears the burden of proving a material change in condition or circumstance. Because there was no material change, there was no valid medical dispute subject to IMR, and the WCAB retained jurisdiction to award continued treatment.