Castro v. U.S. Fire Ins. (BPD) (42 CWCR 200)

Applicant injured his back and defendants accepted liability for the injury and provided benefits.

The parties agreed to an Agreed Medical Evaluator. The Agreed Medical Evaluator, as part of his report, indicated the applicant was in need of home care four hours each day, seven days a week, along with transportation to and from medical appointments.

At a hearing on October 10, 2013, defendant stipulated with authorized transportation home care services per the report of the Agreed Medical Evaluator. WCJ incorporated the stipulation into the Minutes and it became final.  Despite the stipulation and order, defendant failed to provide home care transportation services.

The applicant requested an expedited hearing. At the expedited hearing the applicant offered no evidence. The WCJ awarded the transportation and homecare.  Defendants filed a Petition for Reconsideration.

The WCAB agreed with the WCJ. The WCAB concluded that when the defendant stipulated to authorize the services for the home care and transportation, they acknowledged the home care and transportation services were reasonable medical treatment.  The defendant, having agreed to authorize the treatment, became obligated to continue providing treatment until it was no longer reasonably required.  WCAB indicated, as in the case with other medical treatment issues, a determination that medical treatment is no longer required must be based on substantial medical evidence.

The WCAB reasoned that there was no need for the applicant to present evidence supporting the continued need for services at the expedited hearing because it was the obligation of the defendant, if they wanted to justify no longer furnishing such treatment, to show that it was no longer required because of the change in circumstances. Defendants failed to introduce such evidence and therefore did not meet their burden of proof, nor did the burden of proof shift to the applicant to show a continuing need.

WCAB admonished that a defendant may not unilaterally disregarded stipulation for board orders, but it must seek relief from them by showing good cause.

In the present case, the WCAB observed that the defendant had not offered any evidence that the home care and transportation services recommended by the Agreed Medical Evaluator were no longer required. All the evidence in the record justified the provision of the home care and transportation services to which defendant had previously stipulated and the WCAB ordered.

The WCAB affirmed the WCJ’s decision.

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