Michaels, Joseph

Applicant Joseph Michaels sustained an industrial injury on July 11, 2018 to his cervical spine, head, and brain (TBI), and received inpatient residential rehabilitation at Casa Colina's Transitional Living Center. After UR denied continued inpatient care following RFAs by Dr. David Patterson, the WCJ found the UR denials timely under five-business-day timelines, found the inpatient care was not prematurely terminated, and found applicant failed to provide substantial medical evidence that ongoing inpatient care was reasonable and necessary—despite finding defendant violated Labor Code section 4610(i) and Rule 9792.9.1(e)(6)(A) by failing to provide a safe discharge plan. Applicant sought reconsideration arguing the WCJ applied the wrong standard, contending that under Patterson v. The Oaks Farm, defendant bears the burden to show a change in circumstances before terminating previously authorized ongoing treatment. The Appeals Board granted reconsideration, finding the record inadequate as to why UR applied and the effect of defendant's failure to obtain an agreed-upon care plan, and deferred a final decision pending further review and possible development of the record.