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

Case No. ADJ11629744
Regular
Apr 24, 2023

ROCHELLE BOYD vs. VISSER, NATIONAL INTERSTATE RICHFIELD

The applicant sought reconsideration after the WCJ denied injury claims to the brain, internal system, psyche, and sexual dysfunction, as well as the issuance of additional QME panels. The Appeals Board granted reconsideration, finding good cause existed for additional QME panels in internal medicine and psychiatry. The original findings of fact were rescinded, and the issue of further QME panels in urology and neurology was deferred. The Board concluded that additional QME evaluations were necessary for a full adjudication of the claimed injuries outside of the admitted orthopedic injuries.

Workers' Compensation Appeals BoardPetition for ReconsiderationQualified Medical EvaluatorQME panelsinternal medicinepsychiatryneurologyurologysexual dysfunctionpsyche
References
3
Case No. ADJ10917207
Regular
Aug 13, 2019

CARMEN ROJO vs. K & M MEAT COMPANY, STARR INDEMNITY & LIABILITY COMPANY

This case involves a dispute over the necessity of an additional Qualified Medical Evaluator (QME) panel in orthopedic surgery. The Applicant sought reconsideration of an administrative law judge's (ALJ) order for a new orthopedic QME panel, arguing it was an abuse of discretion and prejudicial. The Appeals Board granted reconsideration, finding the original QME's referral for an orthopedic evaluation was for treatment, not a recommendation for a new medical-legal evaluation. Consequently, the Board amended the ALJ's findings, holding there was no good cause for an additional orthopedic QME panel and denying the defendant's request.

QME panelorthopedic surgeryreconsiderationremovalFindings & Orderchiropractic QMEmedical-legal evaluationgood causesupplemental pleadingmedical dispute
References
9
Case No. ADJ9683216
Regular
Sep 30, 2016

DUNIA DE LA CRUZ vs. SOOD ENTERPRISES, INC. dba JACK IN THE BOX, SECURITY NATIONAL INSURANCE COMPANY ADMINISTERED BY AMTRUST NORTH AMERICA

The Workers' Compensation Appeals Board (WCAB) denied defendant's petition for reconsideration and dismissed its petition for removal. The WCAB found that an additional Qualified Medical Examiner (QME) panel in rheumatology was appropriate to further develop the medical record on causation, as recommended by the initial orthopedic QME. Defendant argued the WCJ erred by ordering this without first determining applicant's credibility and AOE/COE, but the Board deemed the need for a rheumatological evaluation a critical issue justifying reconsideration. Therefore, the WCAB upheld the WCJ's order for an additional QME panel.

QME panelrheumatologyAOE/COEcredibilitymedical causationdepositionsupplemental evaluationgood causethreshold issuesreconsideration
References
17
Case No. ADJ18210611
Regular
May 08, 2025

ELENITA JOVER vs. COUNTY OF SAN BERNARDINO DEPARTMENT OF PUBLIC HEALTH

Elenita Jover, a licensed vocational nurse, sought reconsideration of a Findings and Award that denied her request for additional Qualified Medical Evaluation (QME) panels. The initial F&A found injuries to her cervical and lumbar spine, shoulders, and right thumb, but not to other claimed body parts like stress, psyche, or internal systems. The Appeals Board granted the petition, rescinded the original F&A, and ordered additional QME panels for pulmonology, internal medicine (diabetes), ophthalmology, ENT, and neurology, returning the case to the trial level for further proceedings. This decision was based on the original QME's recommendation for further evaluations and the need to develop the evidentiary record to ensure substantial justice.

Petition for ReconsiderationQualified Medical EvaluationLicensed Vocational NurseArising out of and in the course of employmentPermanent DisabilityDue ProcessPulmonologistInternistOphthalmologistOtolaryngologist
References
7
Case No. ADJ9453193
Regular
Feb 27, 2018

CRAIG OLIVER vs. ALLEGIS GROUP, ESIS

The Workers' Compensation Appeals Board granted the defendant's Petition for Removal, rescinding a prior order for additional QME panels. The WCAB found that the WCJ's interlocutory order was issued without evidence supporting good cause for additional QME panels. Consequently, the matter was returned to the trial level for further proceedings to allow for the proper development of the record.

Petition for RemovalQualified Medical EvaluatorQME panelinternal medicinepain medicinesubstantial prejudiceDeclaration of Readiness to ProceedDORexpedited hearingmandatory settlement conference
References
5
Case No. MISSING
Regular Panel Decision

Trapani v. 10 Arial Way Associates

Cesare Trapani, an employee of P & W Electric, Inc., was injured at a construction site owned by 10 Arial Way Associates and managed by The Marcus Organization, Inc. Both property owner and manager sought defense and indemnification as additional insureds under an insurance policy issued by Assurance Company of America to P & W. A Judicial Hearing Officer initially found them to be additional insureds, a finding upheld by the Supreme Court which denied summary judgment to P & W and Assurance. On appeal, the order was reversed. The appellate court determined that the work contract did not expressly or specifically require additional insured coverage, and a certificate of insurance alone was insufficient. Consequently, the motions by P & W Electric, Inc. and Assurance Company of America were granted, the cross-motions by 10 Arial Way Associates and The Marcus Organization, Inc. were denied, and a judgment was entered declaring that the latter are not entitled to insurance coverage as additional insureds.

Additional InsuredInsurance PolicyContract InterpretationSummary JudgmentDeclaratory JudgmentConstruction Site InjuryThird-Party LiabilityCertificate of Insurance ValidityWork ContractAppellate Procedure
References
11
Case No. ADJ7194315
Regular
Nov 15, 2013

ROSALINDA RODRIGUEZ vs. MERCURY INSURANCE SERVICES, LLC, TRAVELERS PROPERTY & CASUALTY COMPANY OF AMERICA

The Appeals Board granted the defendant's Petition for Removal, rescinding the WCJ's order that removed the case from calendar due to lack of jurisdiction. The WCJ erred in finding he could not rule on the defendant's petition to strike the applicant's request for additional QME panels. The Board determined that Labor Code section 133 and WCAB Rule 10348 grant the WCJ jurisdiction to determine the reasonableness and necessity of such requests. The case is returned to the WCJ to decide whether additional QME panels are warranted.

Petition for RemovalQualified Medical EvaluatorPanel RequestJurisdictionAdministrative Director RuleGood CauseMedical DirectorOff CalendarOrder RescindedReturn to Trial Level
References
0
Case No. ADJ12080707
Regular
Sep 04, 2019

MICHAEL OLAGUE vs. CITY SECURITY COMPANY, NATIONAL LIABILITY & FIRE INSURANCE COMPANY

The Appeals Board granted applicant's petition for removal, rescinding the trial judge's order to take the case off calendar. The applicant requested additional Qualified Medical Evaluator (QME) panels, but the judge deferred this due to pending AOE/COE issues and an initial QME exam being set. The Board found that Labor Code section 5502 mandates an expedited hearing for disputes involving medical-legal examinations, entitling the applicant to a hearing on the request for additional panels. The case is returned to the trial level for further proceedings, potentially including placement back on the expedited hearing calendar.

Petition for RemovalExpedited HearingAOE/COEInitial Physical AggressorQualified Medical Evaluator (QME)PQME panelsMedical-legal evaluationLabor Code Section 5502Off-calendarRescind Order
References
0
Case No. ADJ14784661
Regular
Aug 01, 2025

Jeremy Vietmeier vs. Northrop Grumman Systems Corporation, American Home Assurance Company

Applicant Jeremy Vietmeier sought reconsideration of a WCJ's May 8, 2025 Findings of Fact and Orders (F&O) which found good cause for an additional neurology QME panel but denied one in psychiatry. The Appeals Board dismissed the petition for reconsideration but granted it as a petition for removal. They rescinded the original F&O and substituted new findings, determining that good cause exists for additional QME panels in both neurology and psychiatry. The Board also provided guidance regarding the admissibility of a psychiatric report from David Kauss, Ph.D., disagreeing with a dissenting commissioner on its immediate inadmissibility, noting the issue was not yet ripe for a ruling.

WCABPetition for ReconsiderationPetition for RemovalQualified Medical Evaluator (QME)Medical DirectorDivision of Workers' Compensation (DWC)AdmissibilityPsychiatric ReportGood CauseFinal Order
References
17
Case No. ADJ4052884 (AHM 0136124) ADJ6520242
Regular
Feb 20, 2014

EMILIO EDDIE ROMERO (Deceased) SARA ROMERO (Widow) vs. CLOROX PRODUCTS MANUFACTURING

The Appeals Board granted the defendant's petition for removal, rescinding an order to replace a Qualified Medical Evaluator (QME). The WCJ had terminated the QME believing his partial review and stated refusal to review more records showed prejudgment on causation. However, the Appeals Board found it premature to disqualify the QME, noting his opinion of idiopathic pulmonary fibrosis as an unknown cause of disease could render additional MSDS irrelevant if correct. The Board ordered a deposition of the QME to explore his opinions and any alleged bias before deciding on a replacement, allowing further record development.

Petition for RemovalPQMEPanel Qualified Medical EvaluatorCausationIdiopathic Pulmonary FibrosisMaterial Safety Data SheetsMSDSSubstantial Medical EvidenceDepositionMcDuffie v. Los Angeles County Metropolitan Transit District
References
1
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