On Feb. 12, 2015, applicant Jorge Martinez, 61, a maintenance worker for TBGA, LLC, was working on a ladder when he fell approximately 8 feet to the ground. He sustained to his head, a knee and a shoulder. Martinez filed a workers’ compensation claim against his employer, TBGA, LLC, which was insured by State Compensation Insurance Fund. He brought a claim in an attempt to collect workers’ compensation benefits., Martinez sustained blunt-force trauma of his head, resulting in a severe traumatic brain injury, a subdural hematoma, a right temporal contusion, a left calvarial fracture extending to the inferior posterolateral wall of the orbit, a left maxillary sinus fracture, a posterolateral nondisplaced fracture of the sphenoid sinus, and a laceration over the left parietal region of the head. As a result, he lost consciousness. He also sustained an open wound of the left knee, causing the tibia and patella to be exposed; a supraclavicular puncture wound to the left shoulder; and a clavicular fracture of the left shoulder. Martinez was emergently transported to the nearest hospital, where he was determined to have a Glasgow coma score of 7. Martinez underwent an emergent craniotomy and then regained consciousness. At the time of discharge, Martinez was allegedly still suffering symptoms related to his , as well as suffering hyponatremia, a low sodium concentration in the blood. He was discharged to a transitional living center residential program, where he participated in multidisciplinary rehabilitation from March 5, 2015, through June 5, 2015, at which time he transitioned to the day-treatment program. On July 8, 2016, Martinez underwent a comprehensive neuropsychological evaluation, which indicated that Martinez continued to experience very serious neurobehavioral sequelae marked by headaches, dizziness, blurry vision, decreased hearing acuity, fatigue, weakness of the left leg, hypersomnia, lability of affect, anxiety and memory problems. Martinez’s treating neuropsychologist opined that Martinez had an injury to the brain that resulted in incurable mental incapacity and that Martinez met the criteria for 100 percent permanent and total disability under Labor Code § 4662(a)(4). On July 10, 2015, Martinez transitioned back to the residential program, pursuant to the recommendations of his treating physicians. It was believed that Martinez would benefit from continued cognitive therapy at the transitional living center so that he could more successfully transition back home and into the community. However, on March 20, 2017, Martinez’s primary treating physician declared Martinez permanent and stationary. The physician also opined that Martinez is unable to return to the open labor market, as Martinez was 100 percent totally and permanently disabled, pursuant to Labor Code § 4662, as Martinez had a traumatic brain injury that resulted in incurable mental incapacity. Based on the reporting of Martinez’s treating physicians, the parties stipulated that Martinez is 100 percent permanently and totally disabled, and unable to compete in the open labor market. As a result, a 100 percent award was signed by a judge on the Workers’ Compensation Appeals Board on Nov. 8, 2018. Martinez later advised his attorney that there were several instances during which the home health aide agency that he was using was not properly staffed and that, as a result, it was unable to provide the care for which Martinez was authorized and entitled to, and had been receiving since 2015, in the form of residential care and home health care when not in the facility. Martinez’s counsel asserted that, based on the medical findings, Martinez should be entitled to 24-hour home health aide for the foreseeable future. However, counsel contended that she searched through the respondent’s medical provider network but found no viable home care-options for Martinez. She asserted that the respondent’s medical provider network was invalid since it did not have the required minimum three providers and that, as a result, Martinez should be entitled to receive treatment outside the realm of the respondent’s medical provider network. The respondent’s counsel disputed the nature and extent of Martinez’s and asserted that Martinez did not require 24-hour home health aide for the foreseeable future. However, TBGA’s workers’ compensation insurer ultimately approved the requested home health aide.