In its June 12, 2014, en banc
decision in Hernandez v. Geneva Staffing, Inc.
the Workers’ Compensation Appeals Board (WCAB) explains the conditions that apply to obtaining workers’ compensation coverage for home health care services provided to an injured employee. As an en banc
decision, the Hernandez decision is binding on WCAB panels and workers’ compensation judges.
In the Hernandez case, an injured employee sought payment for the home health care services his wife provided after the employee’s right hand was severely injured at work. The employer denied payment for the services, contending that the employee failed to provide a valid medical prescription for the home health care services.
The workers’ compensation judge issued a Findings and Award (F&A) which concluded that the employee was entitled to workers’ compensation medical treatment in the form of home health care services provided by his wife. The WCAB rescinded the judge’s F&A and returned the case to the judge for further proceedings consistent with the WCAB’s decision.
The WCAB’s decision provides guidance on the requirements which must be satisfied in order to qualify for payment for home health care services and if payment is authorized how the amount of payment for the services is determined.
The decision explains that statutes enacted by SB 863 in 2012 make clear that home health care services are included in the definition of workers’ compensation “medical treatment.”
The statutes establish two conditions which are part of the injured employee’s burden of proof. First, home health care services must be prescribed by a physician. The WCAB decision describes the standards for a valid prescription. Second, the amount of the employer’s liability for the services is subject to an Official Medical Fee Schedule. The WCAB observed no fee schedule for home health care services has been adopted at this time. The WCAB explained that in the absence of a fee schedule, the employee must submit substantial evidence of the reasonably required number of hours for the services and a reasonable rate of reimbursement; in addition, the employee must show that the home health care services at issue had not been regularly performed in the same manner and to the same degree prior to the date of the injury.
A copy of the WCAB’s decision is available at www.dir.ca.gov/wcab