Workers’ Compensation · Primary-source case analysis

Hernandez: Proving Self-Procured Home Health Care in a Workers’ Compensation Case

By Aneeta Mishra and Timothy Chan

Published April 16, 2026

Hernandez explains the proof needed when an injured worker seeks reimbursement for home health care supplied outside an institutional provider, including care performed by a spouse.

Care after a severe hand injury

Roque Neri Hernandez suffered a severe crush injury to his dominant hand and spent more than three weeks in the hospital. A judge awarded payment to his spouse for home health care, using her former earnings and estimated hours. The employer sought reconsideration under newly enacted sections 4600(h) and 4603.2(b)(1).

The new statutes applied to nonfinal cases

The WCAB held that the home-health-care provisions applied to every case not yet final, regardless of the injury date or dates of service. The prescription requirement could be satisfied by a physician’s oral referral or recommendation communicated directly to the employer or agent, or by a signed and dated written referral, recommendation, or order.

Services and rate require evidence

The record must show what services were reasonably required and actually performed. Reimbursement is based on an appropriate rate for comparable caregiving services, not automatically on the family caregiver’s lost earnings. The applicable official or Medicare schedule governs when it covers the service; otherwise section 5307.8 applies.

Disposition

Because the record lacked sufficiently detailed evidence about the services and rate, the WCAB rescinded the findings and award and returned the case for development of the record and a new decision.

Key takeaways

• A physician’s qualifying prescription is a threshold requirement.
• The evidence should identify the type, frequency, duration, and dates of care actually provided.
• A spouse’s prior wages do not establish the reimbursement rate.
• The fee schedule question depends on whether the service is covered by an existing schedule.