What the panel ordered
The WCAB granted the Petition for Reconsideration, rescinded the February 5, 2024 Findings of Fact and Order, and substituted findings that Patterson is applicable to the issue of continued outpatient treatment at CNS, that defendant failed to meet its burden to prove a change in applicant's condition warranting discontinuation, and that applicant is entitled to continued outpatient treatment at CNS.
Applicant sought reconsideration of the Findings of Fact and Order issued on February 5, 2024, which the WCJ had issued, and the WCAB granted reconsideration and issued a Decision After Reconsideration on May 3, 2024.
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 WCAB found Patterson applicable and that defendant failed to prove a change in applicant's condition warranting discontinuation of treatment, entitling applicant to continued outpatient treatment at CNS.
From the decision · page 93. Patterson v. The Oaks Farm (2014) 79 Cal.Comp.Cases 910 (Appeals Board significant panel decision) is applicable to the issue of whether applicant is entitled to continued outpatient rehabilitation treatment at Centre for Neuro Skills (CNS).
The facts that decided it
What the panel treated as outcome-determinative, and which side it favoured.
Defendant failed to prove a change in applicant's circumstances or condition warranting discontinuation of outpatient treatment at CNS.
Favours Applicant prevailed
This failure meant the applicant was entitled to continued treatment under Patterson.
From the decision · page 94. Defendant failed to meet its burden of establishing the occurrence of a change of circumstances or condition warranting discontinuation of applicant's outpatient rehabilitation treatment at CNS.
What the panel did with the medical opinions
The role the physician served, and the weight the opinion carried. Physicians are named here as the decision names them; we do not score them.
Requested continued outpatient rehabilitation treatment at CNS for 30 treatment days starting August 29, 2023.
From the decision · page 7Here, on August 23, 2023, applicant's physician requested that outpatient rehabilitation treatment at CNS be continued for six additional weeks, seeking "30 treatment days, at 5 days/week, 4 hours/day, beginning August 29, 2023." (Ex. 9, RFA for Continued Day Treatment from Kevin Kohan, D.O., August 23, 2023, p. 1.)
The rules the panel named
Authorities as the decision cited them, with how this panel applied each one.
Patterson v. The Oaks Farm (2014) 79 Cal.Comp.Cases 910
Defendant bears the burden to prove a change in the employee's condition or circumstances to discontinue previously authorized treatment.
Applied to determine entitlement to continued outpatient treatment at CNS.
From the decision · page 7But we have explained that defendant may not impose upon applicant the burden of proving the ongoing medical necessity of previously-authorized treatment--and it is defendant's burden to prove that continued provision of the treatment is no longer medically necessary based upon a change of applicant's condition or circumstances. (Patterson, supra, at p. 918.) Additionally, the expiration of a time-limitation attached to the authorization may not serve as grounds for
What proof carried it
The evidence the panel weighed, by kind.
Defendant's denial of continued treatment was based on lack of documented functional improvement, not on a change in applicant's condition.
From the decision · page 7Notably, the grounds cited for denying the request do not rely on any claim that applicant experienced a change of circumstances or condition warranting discontinuation of the previously- authorized treatment. Rather, the denial asserts that applicant failed to show the medical necessity of the treatment because he lacked documentation showing improvement over the last week before authority for the treatment expired.
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About this page
- A published decision of the California Workers' Compensation Appeals Board, taken apart by what it turned on. The Board publishes the decision itself; this page adds the extraction and quotes the passage behind every claim.
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