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

Case No. ADJ11446545
Regular
Dec 03, 2019

ROSA LOPEZ RODRIGUEZ vs. UNIVERSAL BUILDING SERVICES SUPPLY COMPANY, INSURANCE COMPANY OF THE WEST

This case concerns a dispute over the appropriate medical specialty for a Qualified Medical Evaluator (QME) panel. The applicant, Rosa Lopez Rodriguez, initially requested a chiropractic QME panel, which was issued first. The defendant objected, arguing that chiropractic was inappropriate due to the applicant's prior surgery and lack of full recovery. The Medical Unit then invalidated the chiropractic panel and issued an orthopedic surgery panel. The Workers' Compensation Appeals Board granted reconsideration, overturning the WCJ's decision. The Board held that the party who first requests a QME panel has the right to designate the specialty and that the defendant failed to provide sufficient grounds to invalidate the chiropractic panel. Therefore, the Board amended the findings to sustain the applicant's objection and affirm chiropractic as the appropriate panel specialty.

AD Rule 31.5(a)(10)AD Rule 31.5(a)(9)AD Rule 31.1(b)Labor Code section 4062Labor Code section 4062.2Qualified Medical Evaluator (QME)QME panel specialtyPetition for RemovalPetition for ReconsiderationMedical Unit determination
References
1
Case No. ADJ12910087
Regular
Dec 28, 2020

ESTHER LEMUS SALDANA vs. TAO TAI HOMES CORPORATION, INSURANCE COMPANY OF THE WEST

This case concerns a dispute over the correct Qualified Medical Evaluator (QME) panel for applicant Esther Lemus Saldana. The defendant sought reconsideration of an order finding the applicant's chiropractic QME panel valid and the defendant's orthopedic panel invalid. The Workers' Compensation Appeals Board denied the petition, upholding the administrative law judge's decision. The Board found the applicant properly requested a new panel after retaining counsel, and despite a service error on the chiropractic panel, the defendant had opportunity to contest the specialty. Therefore, the applicant's chiropractic QME panel remains the correct one for the medical-legal evaluation.

QME PanelChiropractic QMEOrthopedic QMEPetition for ReconsiderationFindings of Fact and OrdersMedical-Legal EvaluationQualified Medical EvaluatorAdministrative Director RuleRomero v. Costco WholesaleLabor Code Section 4062.1
References
9
Case No. ADJ11861160
Regular
Oct 25, 2019

ADRIANA MARTINEZ vs. AVITUS, AMERICAN ZURICH INSURANCE COMPANY, GALLAGHER BASSETT SERVICES

This case involves a dispute over the selection of Qualified Medical Evaluator (QME) panels for an applicant with claimed injuries to multiple body parts. The Workers' Compensation Appeals Board (WCAB) granted the applicant's petition for removal, rescinded the prior decision, and found that the applicant's chiropractic QME panel request was proper while the defendant's orthopedic surgery panel request was improper. The WCAB determined that chiropractic medicine is the appropriate specialty and struck the orthopedic surgery panel, ordering the parties to proceed with the chiropractic QME. The WCAB clarified that while chiropractors cannot perform surgery or prescribe medication, they are qualified to evaluate injuries within their scope of practice.

QME panel disputeremoval petitionchiropractic specialtyorthopedic surgery specialtyLabor Code 4062.2Medical Directoradministrative law judgeWorkers' Compensation Appeals Boardproper panel selectioninvalid panel request
References
9
Case No. ADJ11426145
Regular
Aug 16, 2019

MARIA RESENDIZ vs. TAMBRO, INC., INSURANCE CO. OF THE WEST

The Workers' Compensation Appeals Board granted reconsideration, reversing a WCJ's finding and ruling that a chiropractic QME panel, not an orthopedic one, is appropriate for this claim. The Board found the Medical Director's basis for invalidating the chiropractic panel was insufficient, as QMEs cannot provide treatment or opine on disputed treatment issues. The case now requires the parties to utilize the chiropractic QME panel for evaluation. This decision aligns with persuasive reasoning from a prior panel decision regarding specialty disputes.

QME panelchiropractic specialtyorthopedic surgeryspecialty disputeMedical Directorutilization reviewpermanent and stationary statusscope of practicescope of evaluationAD Rule 31.1(b)
References
1
Case No. ADJ9623223
Regular
Aug 04, 2015

KORI HARDING vs. ABM INDUSTRIES

The Workers' Compensation Appeals Board affirmed a finding that an applicant was entitled to a chiropractic QME panel. The Board found the defendant's objection and request for an orthopedic QME panel did not comply with Rule 31.5(10) as the Medical Unit did not determine the initial specialty was "medically or otherwise inappropriate for the disputed medical issue(s)." Newly discovered evidence of disc herniation was deemed insufficient to change this outcome, as the initial determination was flawed. The WCAB affirmed the original award directing use of the chiropractic QME panel.

Workers' Compensation Appeals BoardQualified Medical EvaluatorQME PanelMedical UnitPrimary Treating PhysicianChiropractic CareOrthopedicsRule 31.5(10)Industrial InjuryReplacement Panel
References
3
Case No. ADJ10887226
Regular
Sep 12, 2018

Alma Ramirez vs. Jaguar Farm Labor Contracting, Inc., Star Insurance Company

The applicant sought reconsideration of a WCJ's decision that a chiropractic QME panel was inappropriate. The Board granted reconsideration, finding the applicant's initial QME panel request was valid due to the employer's failure to provide proper notice of her rights when unrepresented. The Board determined that while chiropractors cannot perform surgery or prescribe medication, this does not inherently make them inappropriate QMEs for disputes concerning diagnosis, prognosis, or work status. Therefore, the Board amended the WCJ's findings to deem the chiropractic QME panel appropriate and ordered the parties to proceed with it.

QME panelchiropractic specialtyorthopedic specialtyMedical Unit determinationAdministrative Director RulesLabor Code 4062treating physician report objectionapplicant representationpermanent disabilitymedical evaluation
References
5
Case No. ADJ12575364
Regular
Nov 25, 2020

MIGUEL SOLIS vs. KONICA MINOLTA BUSINESS SOLUTIONS, SOMPO AMERICA

The Workers' Compensation Appeals Board (WCAB) granted reconsideration of a WCJ's decision that overturned the Medical Unit's denial of a specialty change for a Qualified Medical Evaluator (QME) panel. The WCAB found that while they have jurisdiction to review Medical Unit decisions, the applicant did not meet the standard for vacating the chiropractic QME panel. The WCAB held that a chiropractor can evaluate disputed medical issues, even with referrals to other specialists, as long as they stay within their scope of practice and report any issues outside their expertise. Therefore, the WCAB rescinded the WCJ's order and directed the parties to utilize the original chiropractic QME panel.

QME panelMedical Unitspecialty disputeorthopedic surgerychiropracticAdjudication NumberPetition for ReconsiderationFindings and OrderLabor Codesubstantial evidence
References
4
Case No. ADJ12550205
Regular
Apr 06, 2020

OLGA PLASCENCIA vs. ADECCO USA, INC

This case involves a dispute over a Qualified Medical Evaluator (QME) panel request. The applicant sought a chiropractic QME panel, while the defendant later denied liability for certain injuries. The Workers' Compensation Appeals Board (WCAB) rescinded the prior ruling and returned the case to the trial judge. This decision was based on the need to further develop the record regarding the applicant's DWC-1 form filing and the effect of the defendant's partial acceptance of liability on the QME panel process. The WCAB emphasized that the validity of the QME panel needs resolution before further proceedings.

Workers' Compensation Appeals BoardReconsiderationFindings and OrderDelay LetterMedical EvaluationQME PanelChiropracticOrthopedicLabor Code Section 4060Causation Dispute
References
5
Case No. ADJ9796670
Regular
Aug 05, 2016

Virginia Lopez vs. California Pizza Kitchen, Travelers Insurance

Applicant Virginia Lopez sought removal after an administrative law judge (WCJ) invalidated a chiropractic QME panel, ordering an orthopedic replacement. The Workers' Compensation Appeals Board (WCAB) granted removal, finding the original chiropractic panel was properly issued and defendants waived their right to object by failing to follow proper procedures. The WCAB amended the WCJ's decision to affirm the chiropractic panel, deeming removal necessary to prevent substantial prejudice. The WCAB affirmed the WCJ's order to issue a replacement panel in the "specialty previously issued," which was chiropractic.

Petition for RemovalQualified Medical Evaluator (QME)Specialty DesignationCompensability ExamLabor Code § 4060Rule 30(b)Rule 31.1(b)Written ObjectionMedical Director ReviewWaiver of Objection
References
6
Case No. ADJ8182717, ADJ8253375, ADJ8253377
Regular
May 18, 2018

VICTOR MCGILL vs. COUNTY OF FRESNO

This case involves a workers' compensation applicant seeking reconsideration of a judge's decision invalidating a chiropractic QME panel. The Appeals Board dismissed the petition for reconsideration as the judge's order was not a final determination. However, the Board granted removal, finding that an orthopedic QME panel was necessary for the applicant's foot and Achilles tendon injuries, as chiropractic was not the appropriate specialty. The decision rescinds the judge's order and returns the matter for further proceedings to obtain an additional orthopedic QME evaluation.

WCABRemovalReconsiderationQMEMedical DirectorChiropracticOrthopedic SurgeryPanelFindings of Fact and OrderMedical Unit
References
0
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