ADJ16748364 · June 18, 2025

The WCJ found credible evidence that applicant's spouse has been providing appropriate overnight care since March 2023 and is capable of continuing to do so; the Appeals Board adopted the WCJ's findings and denied reconsideration.

From the decision · page 2The WCJ's Findings and Order (F&O) finds that "[a]pplicant has demonstrated his spouse is capable of providing overnight attendant care." (F&O, Finding of Fact No. 2.) The WCJ's Opinion on Decision reviews the medical and testimonial evidence, and notes that applicant's spouse has provided both primary and secondary support to applicant since applicant returned home from the hospital in March, 2023. (Opinion on Decision, at p. 4.) Applicant's spouse currently provides assistance with applicant's activities of daily living (ADLs) from early in the morning until the caregiver arrives at 7:00AM. During the day, applicant's spouse provides

Applicant's spouse has been providing overnight care since March 2023 and is capable of performing required care.

Favours Applicant prevailed

This demonstrated capability and ongoing care supported the WCJ's finding and Appeals Board's denial of reconsideration.

From the decision · page 6When reaching my decision, I considered Applicant's wife's trial testimony that since Applicant's release from inpatient care in March 2023, she has been providing his overnight care. I also considered her testimony that she believed she was able to provide the necessary care and was confident in her ability to do so. I found Applicant's spouse to have testified credibly, and in light of the fact that she was confident in her ability to care for the Applicant overnight and has been performing such duties since his release from impatient care demonstrated her capability to provide care for Applicant.

Requested authorization for non-skilled homecare provided by applicant's spouse for 12 hours per night; the WCJ and Appeals Board found the entire record supports the need for non-skilled overnight attendant care.

Dr. Miller's reports and RFA supported the need for non-skilled overnight care and reimbursement to applicant's spouse, which was accepted as substantial evidence by the WCJ and Appeals Board.

From the decision · page 3We also address defendant's contention that Dr. Miller's reporting does not constitute substantial evidence upon which the WCJ may rely. Defendant avers Dr. Miller's October 21, 2024 report "only addresses reimbursement for the applicant's wife," rather than the underlying need for overnight attendant care. (Petition, at p. 7:17.) However, the issue of the extent of home health care has been resolved by defendant's authorization of 24-hour daily care pursuant to Independent Medical Review decision dated February 27, 2025, and Utilization Review certification dated March 5, 2025. (Minutes, at p. 2:8.) Moreover, to the extent that the reporting of Dr. Miller seeks authorization for "patient's wife for non-skilled homecare, 12 hours per night," (Ex. 5, RFA of Lawrence Miller, M.D., dated October 21, 2024, italics added), we agree with the WCJ's ultimate conclusion that "the entire record supports that Applicant requires non-skilled attendant care for his overnight needs." (Report, at p. 3.)

Labor Code Section 4600

Labor Code Section 4600 allows family members to provide home health care when there is a documented need and the caregiver is capable.

Applied to support applicant's spouse as appropriate overnight caregiver.

From the decision · page 9The Court has previously addressed the issue of home health care provided by a family member of Applicant in the Harvey opinion where they stated:

Credible testimony of applicant's spouse regarding her ability and experience providing overnight care since March 2023.

From the decision · page 6When reaching my decision, I considered Applicant's wife's trial testimony that since Applicant's release from inpatient care in March 2023, she has been providing his overnight care. I also considered her testimony that she believed she was able to provide the necessary care and was confident in her ability to do so. I found Applicant's spouse to have testified credibly, and in light of the fact that she was confident in her ability to care for the Applicant overnight and has been performing such duties since his release from impatient care demonstrated her capability to provide care for Applicant.