RABENAU vs. SAN DIEGO IMPERIAL COUNTIES DEVELOPMENTAL SERVICES, INC.
(2018) 2018 Cal. Wrk. Comp. P.D. LEXIS 97
Applicant sustained injury to her neck, shoulder, psyche, and digestive system on May 20, 2014. On September 18, 2013, the applicant received an award of 82% permanent disability. The award also provided that “applicant is in need of transportation solely for the purposes of obtaining medical care to cure or relieve from the effects of the industrial injury.”
In May 2015, the applicant’s treating physician submitted a Request for Authorization to provide applicant with transportation for her medical and non-medical needs, due to her physical and psychological impairments. In subsequent reports, the doctor repeated the request and stated applicant “continues to require assistance for transportation for all activities of daily living.” Applicant’s treating psychologist submitted similar requests.
A Utilization Review determination was issued, authorizing the request for non-medical transportation as medically necessary for the period May 20, 2015 – July 4, 2015. Defendant authorized the transportation and continued to do so until October 2, 2017, at which time it stopped providing the transportation services.
When the transportation was terminated, applicant filed a Declaration of Readiness for an Expedited Hearing. Following the hearing, the Workers Compensation Judge determined that the transportation was medically necessary and that under Patterson, absent a change in circumstances, defendant could not unilaterally discontinue medical treatment that it had been voluntarily providing.
Defendant filed a Petition for Reconsideration which was denied.
The Commissioners reviewed the analysis in Patterson and found that the reasoning applied equally to the issue of transportation in this case. Defendant voluntarily provided transportation for nearly 2 years after the Utilization Review certification expired. It offered no medical justification for unilaterally terminating the transportation services. Under the circumstances, the defendant must continue to provide the transportation services. However, nothing precludes defendant from obtaining medical opinions to re-evaluate the applicant’s continued need for transportation.
Written by Edward L. Hummer, Associate Attorney in our Santa Rosa office, June 2018.