Approved Workers’ Comp Home Health Care Not Provided: What to Document

An insurer can approve home health care without actually arranging it. When a spouse fills the gap, the records must distinguish the care that was authorized, the work that was performed, and the medical basis for care beyond the approved period.

The December 29, 2025 WCAB panel decision in Stephens v. County of San Bernardino illustrates that problem. It granted reconsideration for further study; it did not award ongoing care or decide that an initial authorization lasts indefinitely. Stephens, No. ADJ14145123, slip op. at 2, 10–11 (W.C.A.B. Dec. 29, 2025).

Document approved home health care that was not delivered

Keep the physician’s request, the actual utilization-review determination, its service dates, and every communication about arranging an aide. Identify the approved tasks, hours per day, days per week, and duration separately. An authorization for four hours on five days each week is different from an agreement to reimburse a family member for four hours on each of 60 days.

In Stephens, the parties stipulated that an aide had not been provided and the family had not been paid. They also agreed to reimburse the wife $6,900 and a $690 self-imposed penalty for the initial period. Those figures were a case-specific stipulation, not a statewide reimbursement rate or automatic penalty. The opinion’s opening account uses October 2, 2024; the trial stipulation uses October 9; and the later discussion refers to an October 4 notice. It also identifies an original August 22 request for authorization. Preserve the original documents and reconcile those references rather than treating the summaries as interchangeable. Id., slip op. at 1, 3–5.

California Labor Code section 4600(h) also requires home health care to be reasonably required and prescribed by a licensed physician and surgeon. It limits employer liability for services supplied more than 14 days before receipt of the prescription. Keep proof of receipt; an authorization dispute does not remove that separate statutory requirement.

Record the care without turning ordinary chores into a bill

A useful care log identifies the date, time, task, injury-related reason, person providing assistance, and supporting medical instruction. Separate safety supervision, medication assistance, bathing, and mobility help from ordinary household work. Describe what changed after the injury and why the person cannot safely complete the task alone.

The wife in Stephens described continuous supervision and cognitive safety concerns. That evidence mattered, but it did not itself establish every hour of compensable care. A physician’s assessment, the authorized scope, the services actually performed, and their reasonable value remain distinct questions. Id., slip op. at 5, 8.

Ask the physician to address current function

Medical need can continue after rehabilitation, but an older report may not explain the patient’s present abilities. Preserve rehabilitation discharge reports and ask the treating or evaluating physician to address the functions that improved, the limitations that remain, the assistance required, and the expected duration. Do not assume that improvement eliminates all need for assistance—or that an earlier recommendation proves an unchanged need forever.

The WCAB noted both progress after a 270-hour brain rehabilitation program and the absence of a recent AME or QME report digesting those records. That missing connection was part of its reason for further review. Id., slip op. at 5, 8.

Separate unpaid approved care from disputed future treatment

Labor Code section 4600 imposes an obligation to provide treatment reasonably required to cure or relieve an industrial injury. Treatment requests also implicate utilization review under section 4610. The panel emphasized that the review process does not erase the claims administrator’s duty to investigate whether benefits are due. Id., slip op. at 5–7.

For that reason, identify whether the dispute concerns failure to deliver approved services, reimbursement for services already supplied, the adequacy of a current medical request, or a medical-necessity determination. The available procedure can differ. The panel left the interaction of those issues unresolved; its order is not permission to bypass utilization review or independent medical review in every continuing-care dispute.

Bring a focused packet to a legal consultation

• The prescription or recommendation and every request for authorization.
• The utilization-review response and proof it reached the relevant people.
• Messages asking the administrator to arrange care and its responses.
• Current rehabilitation and physician reports explaining functional needs.
• Care logs, invoices, payments, and any agreed rate or reimbursement.
• The WCJ’s findings, hearing record, and any reconsideration order.

These records allow counsel to identify the actual service gap and the proof needed for the disputed period. Southern California families can request a review through our California workers’ compensation practice. For the panel’s reasoning and procedural limits, read the complete Stephens case analysis.