In 2002, Heather Reese sustained industrial injury while employed by All Saints Healthcare to her lumbar spine, psychological system, central nervous system (in the form of a sleep disorder) and cardiovascular system (in the form of deep vein thrombophlebitis). Stipulations with Request for Award for 100% permanent disability were approved including an award for future medical care.
In 2013, her PTP, Philip A. Sobol, M.D., requested authorization for home care assistance at four hours per day, five days per week for one year on an indefinite basis to aid in food preparation, cooking and cleaning, laundry, sweeping, mopping, vacuuming, household chores and grocery shopping due to the patient’s permanent disability. The State Fund adjuster sent a letter to Sobol denying the request for home care assistance (and other requests) but did not send the letter to Reese’s attorney.
On March 19, 2014 the parties proceeded to an expedited hearing on the need for home health care services. The WCJ found that despite the fact that UR was untimely Reese was not entitled to further medical treatment in the form of home health care services. In his Opinion, he noted that applicant had the burden to show that the requested treatment was reasonable and necessary. He found that the request for assistance for food preparation, cooking and cleaning, laundry, sweeping, mopping, vacuuming, household chores and grocery shopping was not considered medical treatment based on Bishop v. Workers’ Comp. Appeals Bd. (2011) 76 Cal.Comp.Cases 1192 (writ den.) (Bishop). With respect to the request for assistance with dressing and bathing, he found that Dr. Sobol had not provided a sufficient rationale.
The WCAB reversed in the panel decision of Reese v All Saints Healthcare. It rejected the view in Bishop and relied instead on Smyers v. Workers’ Comp. Appeals Bd (1984) 157 Cal.App.3d 36 [49 Cal. Comp. Cases 454] (Smyers). The Court of Appeal stated that “Our holding in the instant case extends coverage to recipients of housekeeping services when there is a demonstrated medical need. …. We hold that the proper approach by the Board is to treat the question of reimbursement under section 4600 for housekeeping services as a factual question to be resolved in each case by lay and expert evidence. The test then is whether household services in the particular case before the Board are medically necessary and reasonable.” Thus, under Smyers, applicant’s request for housekeeping services was not precluded.
Further, on June 12, 2014, the WCAB issued Neri Hernandez v. Geneva Staffing, Inc. dba Workforce Outsourcing, Inc. (2014) 79 Cal.Comp.Cases 682 (Appeals Board en banc) concerning home health care services. In Hernandez, the WCAB summarized the impact of section 4600(h): “Section 4600(h) makes clear that home health care services are included in the definition of ‘medical treatment,’ but it also limits an employer’s duty to provide that treatment by imposing two additional conditions which are part of an injured worker’s burden of proof. The first condition requires that home health care services be prescribed by a physician, and an employer may become liable for home health care services provided 14 days prior to receipt of a prescription. The second condition requires that an employer’s liability for home health care services is subject to either section 5307.1 or section 5307.8. (Id. at pp. 688-689.)