Gutierrez, Ray

Applicant Ray Gutierrez, a warehouse worker, suffered an admitted injury on July 21, 2023 to his head, abdomen, chest, and upper extremities. Defendant's utilization review (UR) authorized home health care at 8 hours/day, 5 days/week for a limited 60-day duration on May 24, 2024, and the care was provided for 68 days. When PTP Dr. Tran issued an RFA on August 22, 2024 for an additional 3 months of home health care, defendant's UR non-certified the request on August 26, 2024. The WCJ found, and the Appeals Board majority affirmed, that under Patterson v. The Oaks Farm and its progeny, once treatment of an ongoing nature is authorized, defendant bears the burden of showing a material change in the applicant's condition or circumstances (supported by substantial medical evidence) before resubmitting to UR, and that defendant failed to meet this burden. The Petition for Reconsideration was DENIED, with Commissioner Razo dissenting on the grounds that the original authorization was time-limited (like Wiggs) and that the August 2024 UR and home health notes showed sufficient changed circumstances.