Stephens v. County of San Bernardino: Home Health Care and an Unfinished Record

The WCAB reopened a dispute over continuing home health care after an initial authorization went unfulfilled. Its December 29, 2025 order identified gaps in the medical and service record, granted reconsideration, and deferred a final decision.

The decision and its procedural limit

Stephens v. County of San Bernardino, No. ADJ14145123 (W.C.A.B. Dec. 29, 2025), is a panel order granting reconsideration. The decisive distinction is between reopening a case and resolving the disputed benefit. The Board expressly described its order as nonfinal and reserved the merits for further study. It did not award indefinite home health care, establish a new reimbursement rate, or decide that renewed treatment requests are unnecessary. Id., slip op. at 2, 10–11.

What the parties had established

The applicant sustained an admitted industrial respiratory injury on December 11, 2020. The record described long-COVID cognitive, behavioral, and emotional effects. An AME recommended home health care, and utilization review approved an aide for four hours per day, five days per week, for 60 days. At the August 2025 trial, the parties stipulated that the aide had not been provided and that the family had not received payment. Id., slip op. at 1, 3, 8.

The parties agreed to reimburse the wife at $28.75 per hour for four hours per day over 60 days, totaling $6,900, plus a $690 self-imposed penalty. That stipulation was not identical to the five-days-per-week authorization described in the opinion. The distinction matters: A negotiated payment resolves what the parties agreed to resolve; it does not automatically define the terms of a future medical award. Id., slip op. at 3–4.

The WCJ awarded reimbursement for the initial period but found continuing services unsupported by the evidence. The applicant sought reconsideration, invoking continuing-treatment principles. The WCJ recommended denial; the Board instead granted further review. Id., slip op. at 1–2, 4–5.

The unanswered question: Authorization, delivery, and continuing need

The wife testified about safety supervision and the applicant’s compromised mental functioning. The record also documented substantial rehabilitation and improvement. Yet an authorized aide and durable medical equipment had not been supplied. Only one original request for authorization, dated August 22, 2024, appeared in the existing record. The opinion’s opening account refers to October 2, the trial stipulation to October 9, and its later discussion to an October 4 utilization-review notice. Those recitals should be reconciled with the original documents rather than presented as one verified authorization date. Id., slip op. at 5.

The panel discussed Labor Code section 4600’s treatment obligation, section 4610’s utilization-review framework, and the administrator’s duty to investigate. Its preliminary concern was whether the evidence supported stopping reimbursement where documented care needs remained and authorized services had not been delivered. It concluded that the interplay required more study. That is a reason for reconsideration, not a final resolution in the applicant’s favor. Id., slip op. at 5–7.

The strongest analytical lesson is to separate three issues: What care was medically required, what the employer actually provided, and what the family supplied instead. A favorable answer to one does not mechanically establish the others. The claim for services after the original period required an explanation of present function, service scope, and the relevant treatment process.

Why updated medical interpretation mattered

The applicant completed 270 hours of brain rehabilitation and transitioned to an independent exercise program. The Board nevertheless noted the absence of recent AME or QME reports incorporating the rehabilitation records and explaining current neurological and physical capacity. A discharge summary showing improvement did not answer every question about safe daily functioning. Conversely, a recommendation predating rehabilitation did not fully explain the later period. Id., slip op. at 8.

The Board discussed its authority to develop an inadequate record under Labor Code sections 5701 and 5906. It did not order a particular new examination in the final decretal language. The order left the next proceedings and ultimate factual findings open. Id., slip op. at 7–8, 11.

The reconsideration clock was a separate issue

The panel also addressed amended Labor Code section 5909. EAMS showed transmission to the Board on October 29, 2025, when the report was served. The 60th day fell on Sunday, December 28; the next-business-day rule permitted action on Monday, December 29. The Board therefore treated its order as timely. That clock concerned the Board’s action after transmission, not a general extension of a party’s deadline to file a reconsideration petition. Id., slip op. at 2–3.

What this order means for another claim

This panel decision is a fact-specific procedural ruling, not an en banc decision or an appellate holding that ongoing home health care must be awarded. Its value is in the questions it identifies: The gap between approval and delivery, the medical explanation of current limitations, and the separate proof for services beyond an initial period.

The Board deferred its final decision and explained that judicial review would follow a final decision through the applicable statutory procedure. This analysis addresses the December 29 order and does not assert that no later decision exists. Id., slip op. at 9–11. Our home health care records guide translates those questions into a consultation packet; our workers’ compensation practice can assess the actual orders and treatment records in an individual matter.