WCPanelIQ
PanelQMEDenied

Burton, Linda

LINDA BURTON, Applicant vs. LOS ANGELES COUNTY METROPOLITAN TRANSIT AUTHORITY, permissibly self-insured; Defendants

ADJ number
ADJ12874580
Decision date
Date unavailable
District office
Van Nuys
WCJ
Clint Feddersen
Claim administrator
Los Angeles County Metropolitan Transit Authority (permissibly self-insured)
Commissioners
—

Injury / body parts: back, neck, psyche, shoulders, respiratory system, hypertension, urological system, bilateral wrists and hands, upper digestive system, dermatology, cognitive

LC §4600LC §4610LC §5502LC §4050

Summary

Linda Burton, a bus operator for LACMTA, sustained admitted industrial injuries and was receiving authorized ongoing inpatient residential care at Casa Colina's Transitional Living Center. After defendant attempted to non-certify the residential care via a utilization review (UR) determination dated August 30, 2023, the WCJ found that under Patterson v. The Oaks Farm, the ongoing care could not be unilaterally terminated absent evidence of a change in circumstances, rendering the UR invalid ab initio. The WCJ ordered LACMTA to continue authorizing the residential care until defendant could prove a material change in circumstances warranting cessation. LACMTA petitioned for reconsideration, attacking the Patterson reasoning itself and arguing its UR was timely and provided substantial evidence of changed circumstances. The WCAB denied reconsideration, adopting and incorporating the WCJ's Report, holding that the timeliness of the UR was moot because no RFA was required for ongoing care under Patterson in the first place.

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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