Richard Irby, Sr. — ADJ18785621, ADJ18785634

Applicant Richard Irby Sr. sustained industrial injury to his cervical spine both as a specific injury on July 5, 2023 and during a cumulative injury period ending the same date while employed as a composite technician/mechanic. His treating physician submitted an RFA for 40 hours per week of home health care services to be provided by applicant's spouse. Defendant's UR decision conditionally non-certified the request but the parties stipulated the UR was both untimely and defective, vesting jurisdiction over medical necessity in the WCAB. The WCJ found the home health care medically necessary, and defendant petitioned for reconsideration, arguing the RFA failed to specify hours, daily breakdown, and duration of services. The Appeals Board denied reconsideration, finding the medical record—including the PTP reporting, a nurse home health assessment, and multiple QME reports—provided broad consensus supporting medical necessity of 40 hours per week of unskilled home health care.