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

Case No. ADJ6870507
Regular
Jun 24, 2010

ULISES FUENTES vs. DICKIE DOBINS CLEANERS, ILLINOIS WEST INSURANCE AGENCY, TOWER SELECT INSURANCE AGENCY

This case involves a dispute over the issuance of a Qualified Medical Evaluator (QME) panel in a workers' compensation claim. The applicant sought reconsideration of an order for a QME panel, alleging a deviation from an agreed medical evaluator process and lack of notice. The defendant presented a conflicting account of events, claiming the applicant's attorney conditioned the agreed medical evaluation on the defendant providing temporary disability benefits. The Appeals Board found the divergent factual accounts warranted removal and rescinded the QME panel order. The case is returned to the trial level for factual resolution and to determine if sanctions are appropriate.

WORKERS' COMPENSATION APPEALS BOARDRemovalQME PanelLabor Code § 4062.2Agreed Medical EvaluatorPetition to CompelEx parteNoticeSanctionsLabor Code § 5813
References
1
Case No. ADJ7199986 ADJ7399845
Regular
Oct 03, 2011

ELMIRA SMITH vs. PACIFIC AUTISM CENTER FOR EDUCATION, TRI- STAR RISK MANAGEMENT

The applicant sought removal to challenge a finding that defendant's requested Qualified Medical Evaluator (QME) panel was properly assigned. The Appeals Board granted removal, rescinded the finding, and determined that *neither* panel was properly assigned. Both panel requests were found to be premature as they were made before the statutory 10-day period for agreeing on an Agreed Medical Evaluator had expired, plus an additional five days for mail service. This decision clarifies the timing requirements for QME panel requests following an unsuccessful attempt to select an AME.

Petition for RemovalQualified Medical Evaluator (QME)Agreed Medical Evaluator (AME)Labor Code section 4062.2(b)WCAB Rule 10507Messele v. Pitco FoodsInc.Premature RequestPanel AssignmentMedical Unit
References
2
Case No. ADJ12557876
Regular
Nov 04, 2020

VERONICA MADRIGAL vs. MONTEREY COUNTY OFFICE OF EDUCATION, INTERCARE HOLDINGS INSURANCE SERVICES, INC.

Here is a summary of the case for a lawyer in four sentences: The defendant sought reconsideration of a WCJ's order denying their petition for a new QME panel and finding their objections to the existing panel harmless error. The Appeals Board denied the petition, agreeing that the applicant's counsel's communication with the QME, while a technical violation of Labor Code section 4062.3(b), did not result in prejudice warranting a new panel. The Board also found the defendant waived their right to object to the QME's report by relying on it to terminate temporary disability benefits. Furthermore, the defendant failed to provide evidence that the original QME panel was improperly issued, thus failing to prove entitlement to a new orthopedic panel.

QME panelLabor Code section 4062.3ex parte communicationadvocacy letterharmless errorstipulated findings and orderremovalreconsiderationmedical evaluatoragreed medical evaluator
References
5
Case No. ADJ7294109
Regular
Jun 07, 2013

MANSOUREH AZIMZADEH vs. BURG & BROCK, EMPLOYERS COMPENSATION CO.

This case involves an applicant challenging a Workers' Compensation Judge's decision to disregard the Qualified Medical Examiner's (QME) reports due to flawed apportionment analysis and ordering a new QME panel. The Appeals Board granted removal, rescinded the order for a new QME panel, and returned the matter for further development of the record. The Board agreed that the QME's reports lacked substantial medical evidence due to a misunderstanding of apportionment law and that further development with the same QME would be unhelpful. The Board emphasized that new medical-legal reporting would be necessary to properly weigh evidence.

RemovalReconsiderationPetitionPanel Qualified Medical ExaminerPQMESubstantial Medical EvidenceApportionmentFindings and OrderMedical UnitDiscovery
References
9
Case No. ADJ10230241
Regular
Jul 19, 2019

SAUL ROMERO vs. CARNICERIA NUEVA VALLARTAS, INC.

The WCAB granted reconsideration and rescinded the WCJ's findings, remanding the case for further development of the medical record. The defendant argued the applicant failed to prove an industrial injury, citing a lack of substantial medical evidence. The Board found that no comprehensive medical-legal report from an agreed or panel QME, nor a complete report from the applicant's primary treating physician addressing causation, was present. The case is returned to the trial level for a new decision after a comprehensive medical-legal report is obtained, likely through an agreed or panel QME.

Workers' Compensation Appeals Boardindustrial injuryherniauninsuredsubstantial medical evidencereconsiderationmedical-legal reportprimary treating physiciancausationreasonable medical probability
References
5
Case No. ADJ10389861
Regular
Feb 05, 2020

TERESA GARCIA vs. WAL-MART ASSOCIATES, INC., ACE AMERICAN INSURANCE

The Workers' Compensation Appeals Board granted reconsideration to amend an order regarding a Qualified Medical Evaluator (QME) panel in urology. While the WCJ's decision addressed a threshold issue (injury arising out of and in the course of employment), making it a final order subject to reconsideration, the defendant's challenge focused on an interlocutory issue. The Board affirmed the WCJ's decision, but clarified that if parties cannot agree on an Agreed Medical Evaluator (AME) urologist, the Medical Unit must issue a QME panel for the applicant's zip code. The Board found no basis for removal, as no significant prejudice or irreparable harm was demonstrated.

Workers' Compensation Appeals BoardPetition for ReconsiderationThreshold IssueInjury AOE/COELumbar SpineInterlocutory DecisionRemoval StandardIrreparable HarmQualified Medical Evaluator (QME)Urology
References
3
Case No. ANA 394407
Regular
Feb 01, 2008

DEWAYNE TORRENCE vs. CITY OF LOS ANGELES

The Appeals Board denied the applicant's petition for removal, upholding the WCJ's order for a new Qualified Medical Evaluator (QME) panel. The applicant, previously examined by Dr. Flores as a QME while unrepresented and later treated by him, argued he should not undergo another QME evaluation. However, the Board found that since Dr. Flores also provided treatment, he was disqualified from conducting a subsequent QME evaluation under relevant regulations, necessitating a new panel when parties could not agree on an evaluator.

Petition for RemovalQualified Medical EvaluatorAgreed EvaluatorLabor Code Section 4062.2Labor Code Section 4062.3(j)Industrial Medical Council Rule 11(d)Rule 31(d)Primary Treating PhysicianSecondary PhysicianUnrepresented Employee
References
0
Case No. ADJ9178558 ADJ9178559
Regular
Feb 05, 2015

JAVIER RIVERA vs. JACO ENVIRONMENTAL, INC., ZURICH AMERICAN INSURANCE COMPANY

The Workers' Compensation Appeals Board denied a Petition for Removal filed by Zurich American Insurance Company concerning a dispute over Qualified Medical Evaluator (QME) panel selection. The administrative law judge had found both parties requested QME panels timely, but ruled the defendant's request invalid for seeking a different specialty without justification. The Board agreed that removal was not warranted and upheld the decision to assign a QME in pain management, the same specialty as the primary treating physician. The Board also clarified the interpretation of Rule 31.1(b), emphasizing the requirement for supporting documentation when requesting a QME in a different specialty.

Petition for RemovalQualified Medical Evaluator (QME) panelprimary treating physicianspecialtypain managementMedical Directortimely requestjustificationRule 31.1(b)extraordinary remedy
References
3
Case No. SFO 503274
Regular
Apr 02, 2008

RONALD KIHARA vs. UNIVERSITY OF CALIFORNIA, SEDGWICK CLAIMS MANAGEMENT SERVICES

The Appeals Board granted the defendant's Petition for Removal, rescinding the prior order for a second QME panel. This action was taken because the Administrative Law Judge mistakenly believed both parties agreed to the second panel. The case is now returned to the trial level for further proceedings to determine if a second QME panel is indeed necessary.

Petition for RemovalSecond QME PanelUnrepresented CaseMedical DirectorQualified Medical EvaluatorsSubstantial EvidenceWCJFinding and OrderRescindedTrial Level
References
0
Case No. ADJ8074524
Regular
Jan 17, 2013

Geoconda Acevedo vs. Reliable Caregivers, PEGASUS RISK MANAGEMENT

The Appeals Board dismissed the defendant's petition for reconsideration because the selection of a Qualified Medical Evaluator (QME) is not a final order. However, the Board granted removal to address issues with defective QME panels. The Board rescinded the prior award and ordered the WCJ to appoint a regular physician if the parties cannot agree on an Agreed Medical Examiner. This action aims to resolve the ongoing delays and procedural defects in selecting a QME for the applicant's evaluation.

QME panelremovalagreed medical examinerpanel qualified medical evaluatorWCJ authoritylabor code section 5701substantive right or liabilityprimary treating physicianindustrial injuryreconsideration
References
6
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