WCPanelIQ
PanelDenied

Jitka Van Dyne Parmet — ADJ526691, ADJ3636578

JITKA VAN DYNE PARMET, Applicant vs. UNITED AIRLINES, permissibly self-insured; administered by SEDGWICK CLAIMS MANAGEMENT SERVICES, Defendants

ADJ number
ADJ526691, ADJ3636578
Decision date
Mar 21, 2023
District office
Van Nuys
WCJ
—
Claim administrator
Sedgwick Claims Management Services (administering for United Airlines, permissibly self-insured)
Commissioners
KATHERINE A. ZALEWSKI, CHAIR, JOSÉ H. RAZO, COMMISSIONER

Injury / body parts: fibromyalgia, central nervous system, psyche, neck, shoulder, musculature, cognitive/memory (brain), wrist (subsequent fall)

LC §5909LC §4600CCR §9792.9.1

Summary

United Airlines, permissibly self-insured and administered by Sedgwick, sought reconsideration of the WCAB's November 18, 2022 Opinion and Decision After Reconsideration, which had ordered defendant to provide applicant Jitka Van Dyne Parmet home health care (16 hours/day CNA care and 8 hours/day LVN care, seven days/week for six months). Defendant argued the treatment was barred by AD Rule 9792.9.1(h) because a prior October 22, 2021 UR decision remained effective for 12 months, and alternatively that the treatment lacked substantial medical evidence. The Board first found the petition timely under Shipley despite the 60-day deadline, tolling the time due to an internal EAMS processing error. On the merits, the Board held that Dr. Kramer's March 2, 2022 RFA for LVN care was supported by a documented change in material facts (worsening balance, falls, cognitive decline, husband's unavailability), defeating the Rule 9792.9.1(h) bar, and that the CNA care was never the subject of the prior UR (which addressed only housekeeping). The Board denied reconsideration.

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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