Santana, Sacramento

Applicant Sacramento Santana, a production worker who sustained a head/brain injury on June 24, 2021, sought reconsideration of a WCJ's F&O finding that the WCAB lacked jurisdiction and that Patterson v. The Oaks Farm was inapplicable to whether applicant could continue previously-authorized outpatient rehabilitation treatment at the Centre for Neuro Skills (CNS). Defendant had authorized inpatient 'continuous monitoring' and later outpatient CNS day treatment, then denied a continued treatment RFA through UR on medical-necessity grounds. The Appeals Board granted reconsideration, finding the petition timely (because defendant was served by mail in New Jersey, extending the deadline by 10 days), and held that Patterson applies because defendant had previously authorized the CNS treatment. The Board concluded defendant failed to meet its burden of proving a change in applicant's circumstances or condition warranting discontinuation, since the UR denial rested on lack of demonstrated medical necessity rather than any change. The Board rescinded the F&O and substituted findings that Patterson applies, defendant failed its burden, and applicant is entitled to continued CNS treatment absent a showing of changed circumstances.