Erlinda Cantillo — ADJ12704660

Applicant Erlinda Cantillo sought reconsideration of a WCJ's Findings and Order upholding an IMR determination that denied home healthcare (4 hours/day, 4 days/week for 3 months) requested by her primary treating physician Dr. Ahmed. The IMR reviewer applied the MTUS Initial Approaches to Treatment Guidelines (2017) and denied the request, despite acknowledging that applicant had 'severe difficulty' with activities of daily living and ambulated with a walker. The Board found the IMR reviewer applied the MTUS in a plainly erroneous manner under Labor Code section 4610.6(h)(5), because the guidelines recommend home healthcare precisely to overcome ADL deficits and when patients require ambulatory devices, and the reviewer failed to explain how the evidence fell outside the MTUS. The Board also found the reviewer erred in treating the absence of a home evaluation as a separate basis for denial, since the MTUS does not require a home evaluation as a precondition for recommending home healthcare. The Board granted reconsideration, rescinded the F&O, and remanded the dispute to the AD for submission to a different IRO or reviewer under section 4610.6(i).