CompFox AI Summary
The applicant sought reconsideration of a denial of home health care services by the Independent Medical Review (IMR). The Workers' Compensation Appeals Board (WCAB) found the IMR determination was plainly erroneous because it failed to apply the correct 2016 Medical Treatment Utilization Standards (MTUS) definition of "homebound." The WCAB concluded that the applicant's documented use of a walker constituted objective evidence of her homebound status, contradicting the IMR's finding of insufficient evidence. Consequently, the WCAB rescinded the prior order and remanded the case to the Administrative Director for a new IMR review by a different reviewer.
Full Decision Text1 Pages
The applicant sought reconsideration of a denial of home health care services by the Independent Medical Review (IMR). The Workers' Compensation Appeals Board (WCAB) found the IMR determination was plainly erroneous because it failed to apply the correct 2016 Medical Treatment Utilization Standards (MTUS) definition of "homebound." The WCAB concluded that the applicant's documented use of a walker constituted objective evidence of her homebound status, contradicting the IMR's finding of insufficient evidence. Consequently, the WCAB rescinded the prior order and remanded the case to the Administrative Director for a new IMR review by a different reviewer.
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