Jennifer Patterson vs. The Oaks Farm California Insurance Guarantee Association For California Compensation Insurance Company In Liquidation

THE OAKS FARM CALIFORNIA INSURANCE GUARANTEE ASSOCIATION for CALIFORNIA COMPENSATION INSURANCE COMPANY in liquidation JENNIFER PATTERSON WORKERS’ COMPENSATION APPEALS BOARDSTATE OF CALIFORNIAJENNIFER PATTERSON, Applicant,vs.THE OAKS FARM; CALIFORNIAINSURANCE GUARANTEE ASSOCIATIONfor CALIFORNIA COMPENSATIONINSURANCE COMPANY, in liquidation, Defendants.Case No. ADJ3905924 (ANA 0339374)(Oxnard District Office)OPINION AND DECISIONAFTER RECONSIDERATION(Significant Panel Decision)            We previously granted defendant’s petition for reconsideration of the March 6, 2014 Findings And Order of the workers’ compensation administrative law judge (WCJ) as served on March 10, 2014. In that decision, the WCJ found that applicant requires the services of a nurse case manager, that the issue was appropriate for determination at an expedited hearing, and that applicant is not required to secure a Request For Authorization (RFA) from her primary treating physician to be sent to utilization review and then Independent Medical Review in order to obtain the nurse case manager services already found necessary by the Agreed Medical Evaluator (AME). Based upon those findings, the WCJ ordered defendant “to reinstate services of a nurse case manager,” that were authorized by defendant before it unilaterally terminated them in December 2013.            Defendant contends that the WCJ’s decision is not supported by substantial medical evidence, that applicant did not meet her burden of proving a need for nurse case manager services, and that applicant was required to submit an RF A in order to support a request for nurse case manager services.            An Answer was received from applicant. The WCJ provided a Report and Recommendation on Petition for Reconsideration (Report) recommending that reconsideration be denied.            We affirm the March 6, 2014 decision of the WCJ, and hold as follows:            1. The provision of a nurse case manager is a form of medical treatment under

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