Neri Hernandez and Proper Handling of Home Health Care Prescriptions

Bilal Kassem, Esq.

Oakland, California

Home health care is a frequently litigated issue. Often, this is because the injured worker’s urgent need for support at home is weighed against the claims administrator’s need for clarity. The claims administrator usually wants to know exactly what it is they are being asked to approve; however, prescriptions are often missing pertinent information. In fact, communication is sometimes so unclear that the claims administrator might not even know they have received a prescription for home health care. So, what constitutes a prescription for home health care? What happens when it is unclear whether home health care is being requested? When circumstances are not clear, what duty does a claims administrator have to investigate, and when does that duty arise?

The WCAB en banc decision of Neri Hernandez v. Workforce Staffing (2014) 79 Cal.Comp.Cases 682 directly addressed these questions. In Neri Hernandez, the applicant sustained a crush injury to his hand while working as a machine operator. The applicant endured a significant hospital stay and underwent several surgeries. After his release from the hospital, his spouse cared for him at home. His treating physician, Dr. Lee, wrote the following handwritten note on November 11, 2011: