What the panel ordered
Petition for reconsideration is denied as to ADJ11143930 and dismissed as to ADJ11143932.
Defendant filed a timely verified petition for reconsideration of the WCJ's finding that the IMR determination was the result of a plainly erroneous finding of fact; the WCAB reviewed the record and adopted the WCJ's report.
What was disputed, and how it came out
Each issue the panel decided, with the reasoning it gave. An outcome is what this panel did on this record — not a rule, and not a prediction.
The IMR determination incorrectly stated that Dr. Rothi's June 30, 2022 RFA was for six months of continuous home healthcare, when in fact the RFA made no mention of six months and the PR-2 report indicated a follow-up appointment was scheduled for August 10, 2022. This was a plainly erroneous finding of fact, not subject to expert opinion.
From the decision · page 5The September 7, 2022 Independent Medical Review determination of the administrative director clearly asserts as its rational the statement that Dr. Rothi's June 30, 2022 RFA was for "home health aide assistance four hours a day, two days a week for six months for bathing, house mobility, and hygiene (failed back surgery, bilateral knee, bilateral shoulder pain) quantity in months #6". (Exhibit 16, IMR Determination, dated September 7, 2022, page 2). The rationale continued on page 3 indicating that "the request is for six months of continuous home healthcare without evaluating for compliance and the continued need for these services." This is factually incorrect. Dr. Rothi's June 30, 2022 RFA makes no mention of six months. It requests home health assistance for "4 hours a day, X 2 days a week PRN". Furthermore Dr. Rothi's accompanying PR- 2 report clearly indicates a follow-up appointment scheduled for August 10, 2022. (See applicant's Exhibit 21, PR-2 reports by Dr. Rothi up through September 20, 2022, pages 8 through 11). On this basis it is clear that the determination of the administrative director was the result of a plainly