Toscano, Rogelio

Applicant Rogelio Toscano, a 46-year-old caterpillar operator, sustained a significant brain injury on 11/21/2022 requiring brain surgery, and received ongoing outpatient brain rehabilitation at the Centre for Neuro Skills that was certified through utilization review (UR) beginning January 2024 and continuing through July 2024. Defendants later subjected the same ongoing care to subsequent UR determinations (September 13, 2024 and October 24, 2024, and others) that de-certified the treatment. The WCJ found those subsequent URs invalid under Patterson v. The Oaks Farm because defendants failed to show a material change in circumstances before resubmitting previously authorized ongoing care to UR, and ordered the treatment to continue. The Appeals Board majority denied reconsideration, adopting the WCJ's Report and applying Patterson, Rivota, and Burton. Commissioner Razo dissented, arguing Patterson created no valid exception to Labor Code section 4610 and that the timely, procedurally correct UR was only appealable through IMR under section 4610.5.