Burton: An Older Home-Access Request Needed Current Medical Support

In Burton v. Los Angeles County Metropolitan Transit Authority, the Workers’ Compensation Appeals Board granted reconsideration of a treatment award and deferred its final merits decision. The January 13, 2026 panel order focused on a specific problem: Requests for wheelchair access assessments, home-modification evaluation and transportation had remained disputed while the worker’s location, condition and medical recommendations changed.

The order expressly described its review as preliminary. It did not finally decide that the disputed services should be granted or denied. Its useful distinction is between authority to decide a treatment dispute after untimely utilization review and the current medical evidence needed to decide each requested service.

The requested services came from an older RFA

Linda Burton had established specific and cumulative industrial injuries involving her neck, wrists, spine, psyche, hypertension and GERD. The specific injury occurred on August 6, 2019; the cumulative period ran from December 1, 2004 through that date. The WCJ also found urinary and gastrointestinal compensable consequences involving incontinence. Her treating physician’s June 21, 2024 request for authorization included an assessment of wheelchair access to her apartment, evaluation of home modifications and wheelchair transportation for treatment and daily activities. Official order, pages 1–3. A separate April 26, 2024 RFA from urologist Dr. Justin Houman was also before the WCJ, but the resulting findings were not specifically challenged in the reconsideration petition. The disputed access and transportation items came from Dr. Sangnil’s June RFA. Page 3, footnote 2.

A September 2024 ruling had already determined that there was no timely, compliant UR determination or deferral for that RFA. The parties were directed to develop medical justification for each requested item using the Medical Treatment Utilization Schedule. Burton then moved from California to Alabama and later returned. Further development was ordered as those circumstances changed. Pages 2–3.

At the September 2025 hearing, the record included the older RFA, more recent medical materials and Burton’s testimony about using a walker, her limited ability to walk without it and the help she needed with personal care. The WCJ awarded several treatment items in October 2025. The employer specifically challenged the wheelchair-access assessment, home-modification evaluation and wheelchair transportation, arguing that the award rested on circumstances no longer current. Pages 1, 3–4.

Untimely UR had established WCAB jurisdiction

The panel applied the framework described in the en banc Dubon II decision. An untimely UR decision permits the WCAB to determine medical necessity on substantial medical evidence consistent with Labor Code § 4604.5. Other disputes concerning a UR decision ordinarily belong in IMR under that framework. Page 6.

In Burton’s proceeding, timeliness had already been decided. The reconsideration petition did not present a new timeliness dispute; it challenged the medical support for the services awarded. Treating the earlier jurisdictional ruling as the entire answer would therefore miss the question before the panel. Pages 6–7.

The panel rejected a categorical exemption for transportation and home modifications

The WCJ’s report had stated that transportation and home modifications were outside UR and IMR, relying on Onruang. The panel disagreed with that reading. It explained that the UR reviewer in Onruang had declined to address medical necessity on the mistaken view that transportation fell outside UR. The resulting absence of a UR decision supplied jurisdiction under Dubon II; the service category itself did not create a general exemption. Pages 6–7.

The panel also identified Onruang as a writ-denied case rather than binding authority. More importantly for the disputed award, it required application of the MTUS to each item. Jurisdiction over the request did not remove the need to establish the requested treatment’s reasonableness and necessity. Page 7.

The evidence had to address present circumstances

The employer argued that Burton’s condition had improved and that she no longer needed a wheelchair. The WCJ viewed the record differently, emphasizing substantial impairment, QME descriptions of wheelchair dependence and the fact that the award sought assessment and evaluation before deciding on particular modifications or a vehicle. Burton’s testimony described primarily using a walker. The competing accounts required medical assessment, rather than an assumption that either description settled every access or transportation need. Pages 1, 4.

The panel did not resolve those competing accounts in the January order. It agreed that substantial medical evidence must rest on current facts and observed that location, condition and evidence had changed over more than a year and a half. Its preliminary assessment was that the record was not properly developed on the disputed issues. Pages 6–7.

This makes the distinction between an evaluation and a completed modification important. An assessment may be the requested service, but the medical record still must explain why that assessment is needed. A description of severe impairment does not automatically supply every item-specific connection; an asserted improvement likewise requires evaluation against the actual medical record.

Reconsideration was granted for further review

The Board explained that it had acted within the amended § 5909 period, measured from transmission of the case to the Board. The record showed transmission and service of the WCJ’s report on November 14, 2025; the January 13 action was within 60 days. Pages 4–5.

The remaining discussion explained the Board’s continuing authority after granting reconsideration and distinguished interim steps from a final decision. The operative order granted reconsideration and deferred the final decision pending further study of the merits and record. Pages 8–10. That procedural disposition must remain visible when using the order’s preliminary medical-evidence discussion.

Keep the old request and current medical explanation together

The case illustrates why a treatment dispute that has lasted through a move or change in mobility needs an updated, item-specific medical explanation. The practical guide addresses what to compare when an older RFA no longer describes the worker’s current circumstances.

For review of a similar dispute, bring the RFA, UR response, prior rulings and current treating reports. Counsel must determine both who can decide the dispute and what medical evidence supports the particular services now requested.