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Access over workers' compensation decisions, including En Banc, Significant Panel Decisions, and writ-denied cases.

Case No. ADJ7232076
En Banc
Sep 26, 2011

Tsegay Messele vs. Pitco Foods, Inc.; California Insurance Company

The Appeals Board holds that the 10-day period for agreeing on an AME under Labor Code § 4062.2(b) is extended by five days when the initial proposal is served by mail, and clarifies the method for calculating this time period, finding both parties' panel requests premature.

Workers' Compensation Appeals BoardTsegay MesselePitco FoodsInc.California Insurance CompanyADJ7232076Opinion and Decision After ReconsiderationOrder Granting RemovalDecision After RemovalEn Banc
References
Case No. ADJ8835693
Regular
Apr 01, 2015

DIANA MORALES vs. ROBERT HALF INTERNATIONAL, INC., INSURANCE COMPANY OF THE STATE OF PENNSYLVANIA

The Workers' Compensation Appeals Board granted the employer's petition for removal, rescinding an administrative law judge's order for additional QME panels. The employer argued the order improperly bypassed statutory procedures for obtaining QME panels, specifically Labor Code Sections 4060, 4062, and 4062.2, and would cause irreparable harm and prejudice. The Board agreed, finding the required prerequisite of a treating physician's determination and an objection thereto was not met for internal medicine, neurology, or gynecology. Consequently, the order for these panels was rescinded.

Workers' Compensation Appeals BoardPetition for RemovalQualified Medical ExaminerLabor Code Sections 406040624062.2Medical DirectorDivision of Workers' CompensationAgreed Medical EvaluatorApplication for Adjudication of Claim
References
Case No. ADJ1271468 (LAO 0838972) ADJ3841157 (LAO 0840312) ADJ249664 (LAO 0843194)
Regular
Mar 03, 2009

JORGE PEREZ vs. REGENT MANUFACTURING, INC., STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board granted reconsideration and rescinded a prior award concerning industrial injuries sustained by Jorge Perez. The primary issue was whether the applicant was entitled to recommended dental treatment, which the defendant had denied via utilization review (UR). The Board found the record unclear regarding the timeliness of the defendant's UR denial and the applicant's subsequent objection process. Consequently, the case was remanded for further development of the record, particularly concerning the UR timeline and the dispute resolution procedures under Labor Code sections 4062 and 4062.2.

Workers' Compensation Appeals BoardRegent ManufacturingState Compensation Insurance FundJorge Perezindustrial injurieslow backright lower extremityneckleft earside of face
References
Case No. ADJ10334253
Regular
Jun 06, 2017

TERESA CAMBEROS vs. LYON, ET AL., DBA TACO BELL, CYPRESS INS. CO.

The applicant sought reconsideration of a WCJ's order requiring compliance with Labor Code section 4062.2 for selecting a new QME panel now that she is represented by counsel. The Appeals Board dismissed the reconsideration petition as the order was procedural, not final. The Board also denied the petition for removal, finding no irreparable harm or prejudice, and affirming that represented workers must use the section 4062.2 striking process for new QME panels.

Workers' Compensation Appeals BoardQualified Medical EvaluatorQMEPetition for ReconsiderationPetition for RemovalLabor Code Section 4062.2Labor Code Section 4062.1Final OrderInterlocutory OrderMedical-Legal Evaluation
References
Case No. ADJ3799579 (VNO 0474814) ADJ1009432 (VNO 0518597)
Regular
Jun 16, 2010

SHAWN PETTWAY vs. ANTELOPE VALLEY UNION HIGH SCHOOL DISTRICT

This case concerns whether Labor Code section 4062 or 4062.2 governs the medical evaluation process for applicant Shawn Pettway's injuries. The Workers' Compensation Appeals Board (WCAB) granted the defendant school district's petition for removal. The WCAB found that since Pettway's injuries occurred prior to January 1, 2005, the older section 4062 applies, entitling the defendant to select its own Qualified Medical Evaluator if an Agreed Medical Evaluator cannot be reached. Consequently, the WCAB rescinded the prior order compelling the parties to agree on an AME or panel.

Petition for RemovalAgreed Medical EvaluatorQualified Medical EvaluatorLabor Code Section 4062Labor Code Section 4062.2Industrial InjuriesCampus SupervisorBack InjuryInternal InjuryKidney Injury
References
Case No. ADJ2728444 (MON 0350632) ADJ2607754 (MON 0350633) ADJ3092568 (MON 0350634) ADJ4333657 (MON 0350635)
Regular
Aug 09, 2012

FELISA LOPEZ vs. TARGET CORPORATION

The Appeals Board denied Felisa Lopez's Petition for Removal, upholding the Workers' Compensation Judge's order for her to attend an examination by Dr. Markovitz under Labor Code section 4050. While the examination is permitted, Dr. Markovitz's report will not be admissible as evidence due to discovery limitations under Labor Code sections 4061(h), 4062(a), and 4062.2. Consequently, the report cannot be shared with the Agreed Medical Evaluator, Dr. Gillis, nor can it be referenced during his deposition.

Petition for RemovalAgreed Medical EvaluatorAMEDiscoveryLabor Code section 4050Labor Code section 4062Labor Code section 4062.2Admissible EvidenceDepositionInternal Medicine
References
Case No. VNO 0549032
Regular
Mar 07, 2008

RANDY MICHAEL MASSEY vs. RADIO EXPRESS, EMPLOYERS COMPENSATION INSURANCE COMPANY

The Workers' Compensation Appeals Board granted reconsideration, rescinded the previous award, and returned the case to trial. The Board found the trial judge erred by ordering spinal surgery without allowing the defendant to properly challenge industrial causation, violating due process and relevant Labor Code sections. The defendant was entitled to pursue the AME/QME process to determine if the need for surgery was industrially caused, not just medically indicated.

Workers' Compensation Appeals BoardRandy Michael MasseyRadio ExpressEmployers Compensation Insurance CompanyChief Information Officerindustrial injuryspinal surgeryPetition for Reconsiderationexpedited trialLabor Code sections 4062
References
Case No. ADJ8173186
Regular
Jun 07, 2013

NATHAN LITTLE vs. DIVERSIFIED UTILITY SERVICES, OLD REPUBLIC GENERAL INSURANCE CORPORATION

The Workers' Compensation Appeals Board denied Nathan Little's Petition for Removal concerning a Qualified Medical Examiner (QME) panel. The Board adopted the WCJ's report, which found the QME process was initiated correctly under Labor Code section 4062.2 while the applicant was represented. Although the applicant later became unrepresented, the Board stated the original procedure should be followed for this QME panel. The denial means the applicant must proceed with the designated QME process.

Petition for RemovalQME PanelLabor Code section 4062.1Labor Code section 4062.2unrepresented applicantrepresented applicantsubstantial prejudiceirreparable harmpanel QMEdermatology
References
Case No. SBR 0321988 SBR 0321989
Regular
Aug 11, 2008

MARGARET MARTINEZ vs. STATE OF CALIFORNIA, Legally Uninsured; STATE COMPENSATION INSURANCE FUND/STATE CONTRACT SERVICES

This case involves an applicant who sustained industrial injuries on multiple dates, affecting various body parts. The Workers' Compensation Appeals Board (WCAB) granted reconsideration to review the judge's award of future medical treatment recommended by specific physicians. Ultimately, the WCAB affirmed the original award, finding the applicant entitled to the treatment as recommended by the agreed medical evaluator and named physicians.

Workers' Compensation Appeals BoardReconsiderationIndustrial InjuriesMedical TreatmentAgreed Medical EvaluatorUtilization ReviewLabor Code sections 461040624062.2Penalty
References
Case No. ADJ4550848
Regular
May 29, 2009

KIM WILLIS vs. PALMDALE UNIFIED SCHOOL DISTRICT, Permissibly Self-Insured, Administered By SOUTHERN CALIFORNIA RISK MANAGEMENT ASSOCIATES, INC. (SCRMA)

The Workers' Compensation Appeals Board dismissed the defendant's petition for reconsideration because the WCJ's order to take the case off-calendar for further medical record development under Labor Code § 4062.2 was not a final order. Such procedural and discovery-related orders are not subject to reconsideration. Even if considered a petition for removal, it would be denied on its merits according to the WCJ's report. The applicant alleges an industrial knee injury from May 2, 2007.

WCABReconsiderationOff-calendarLabor Code § 4062.2Develop medical recordFinal orderInterim orderProcedural decisionEvidentiary decisionPetition for removal
References
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