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Case Law Database

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

Case No. ADJ8363948

Regular

Oct 19, 2012

NICOLE NELSON vs. COUNTY OF SOLANO, INTERCARE HOLDINGS INSURANCE SERVICES

The defendant County of Solano sought removal to obtain a new panel of Qualified Medical Evaluators (QMEs) due to alleged ex parte communications between the applicant and the current QME. The Appeals Board denied this petition, finding that the communications were either insignificant and inconsequential or related to the QME examination itself. Specifically, emails concerning necessary forms and an insignificant mention of a claims adjuster's number did not violate the ex parte communication prohibition. Therefore, the WCJ's denial of the defendant's request for a new QME panel was upheld.

Petition for RemovalQualified Medical Evaluator (QME)ex parte communicationLabor Code section 4062.3termination of evaluationreplacement panelinsignificant communicationinconsequential communicationindustrial injurypsyche

References

Case No. ADJ795505 (LAO 0794863)

Regular

Feb 13, 2014

VICTORIA SHANLEY vs. HENRY MAYO NEWHALL MEMORIAL HOSPITAL, TRAVELERS INSURANCE CO.

The Appeals Board reconsidered a WCJ's decision upholding utilization review (UR) denials for an MRI and EMG. While other contentions regarding the UR physician's qualifications and licensing were dismissed based on precedent, the Board found the UR decisions invalid due to untimely communication. Specifically, the defendant failed to prove by substantial evidence that the UR decisions were communicated by phone, fax, or email within 24 hours of being made. The matter is returned to the trial level to determine medical necessity, as the UR denials are void.

Utilization ReviewLabor Code Section 4610Administrative Director Rule 9792.9Physician QualificationLicensing RequirementsCommunication TimeframesTimely CommunicationMedical NecessityIndependent Medical ReviewInvalid UR Decision

References

Case No. ADJ3540065

En Banc

Jan 23, 2017

BRADLEY MAXHAM vs. CALIFORNIA DEPARTMENT OF CORRECTIONS AND REHABILITATION, STATE COMPENSATION INSURANCE FUND

The Appeals Board clarifies the distinction between "information" and "communication" under Labor Code § 4062.3, holding that a communication to a medical evaluator becomes "information" if it contains, references, or encloses medical or nonmedical records relevant to the medical issue, which requires prior agreement between the parties.

Workers' Compensation Appeals BoardPetition for RemovalAgreed Medical Evaluator (AME)Labor Code section 4062.3WCAB Rule 35informationcommunicationprejudiceirreparable harmex parte communication

References

Case No. ADJ4158530 (LBO 0325085) ADJ332706 (LBO 0325079)

Regular

Jul 23, 2013

VICTORIA ANTUNEZ vs. SEASIDE PRINTING CO., CALIFORNIA CASUALTY, GALLAGHER BASSETT SERVICES, PACIFIC NATIONAL INSURANCE, CIGA, INTERCARE INSURANCE SERVICES

The Board granted reconsideration regarding a defendant's petition challenging findings of industrial injury and the nature of a communication with an Agreed Medical Evaluator (AME). The Board affirmed findings of compensable injury for one period and no injury for another, but amended the awards to clarify that a letter from CIGA to the AME was improper, though not an ex parte communication. The Board found the letter constituted additional information improperly sent without affording the other party an objection opportunity, leading to exclusion of a supplemental report. Jurisdiction was reserved over costs and sanctions related to this improper communication.

Workers' Compensation Appeals BoardReconsiderationFindings and AwardIndustrial InjuryTemporary DisabilityPermanent DisabilityApportionmentAgreed Medical Evaluator (AME)Ex Parte CommunicationLabor Code Section 5412

References

Case No. ADJ3636557

Regular

May 08, 2009

MARIA ANA PAREDES (Deceased) CARLOS ALFREDO ALVAREZ (Widower) vs. ANDROMEDA ENTERTAINMENT dba GALAXY BALLROOM, STATE COMPENSATION INSURANCE FUND

This case concerns a petition for reconsideration and removal challenging a Workers' Compensation Judge's (WCJ) decision denying sanctions for alleged improper ex parte communication. The Board denied reconsideration and dismissed removal, affirming the WCJ's finding that the communication between defense counsel and the panel QME was administrative, not substantive, and therefore not a violation of Labor Code section 4062.3. The Board found no basis for sanctions under Labor Code section 5813 as no party initiated an improper ex parte communication. Consequently, the WCJ's denial of the motion to strike the QME report and request for penalties was upheld.

Workers' Compensation Appeals BoardPetition for ReconsiderationPetition for RemovalEx Parte CommunicationQualified Medical Evaluator (QME)Labor Code Section 4062.3SanctionsLabor Code Section 5813Panel QME ReportAdministrative Communication

References

Case No. ADJ2001631 (LAO 0876091)

Regular

Oct 01, 2010

SALVADOR AGUAYO, JR. vs. AMERICAN GOLF CORPORATION, ARCH INSURANCE COMPANY

The Workers' Compensation Appeals Board granted reconsideration to address an attorney's fee award of $4,500.00. This fee was awarded for services related to alleged prohibited ex parte communications with Qualified Medical Evaluators (QMEs), as per Labor Code section 4062.3. The Board rescinded the award, finding no explicit determination of prohibited communication occurred as the prior WCJ's orders were voided. The matter was returned to the trial level to first determine if prohibited ex parte communication occurred, and if so, to award fees based on incurred costs and attorney fees for related discovery.

Salvador Aguayo Jr.American Golf CorporationArch Insurance CompanyWorkers' Compensation Appeals BoardreconsiderationFindings and Awardattorney's feeprohibited communicationsQualified Medical EvaluatorsQME

References

Case No. ADJ10038732

Regular

Dec 02, 2016

Deborah Matthews vs. California Department of Corrections and Rehabilitation, State Compensation Insurance Fund

This case involves a defendant's petition for removal after an administrative law judge (WCJ) ordered a new Qualified Medical Examiner (QME) panel. The WCJ found the defendant violated Labor Code section 4062.3 by engaging in ex parte communication with the prior QME. The defendant admitted a violation of Labor Code section 4062.3 but argued a new panel was unwarranted due to applicant forfeiture or the communication's insignificance. The Workers' Compensation Appeals Board (WCAB) denied the petition, finding no waiver by the applicant and that the communication was not insignificant. The WCAB emphasized that prejudice is not required to obtain a new panel for such violations.

Labor Code 4062.3Ex parte communicationPQME panelPetition for RemovalAggrieved partyWaiverDoctor shoppingFindings of Fact and OpinionWCJAppeals Board

References

Case No. ADJ16326594

Regular

Oct 31, 2025

Peter Pham vs. Southern California Edison

Defendant sought removal of a WCJ's December 12, 2023 Findings of Fact and Order (F&O), which denied their motion for a replacement Qualified Medical Evaluator (QME). The defendant argued that the applicant's email to the QME constituted impermissible ex parte contact. The Appeals Board granted the petition for removal, rescinding the F&O, and substituting new Findings of Fact that the email was indeed impermissible ex parte contact, thereby ordering a replacement QME panel. Additionally, while earlier QME reports and deposition testimony by Dr. Weiss remain in evidence, her report dated July 22, 2023, was stricken to preserve the appearance of impartiality in the medical evaluation process.

Ex parte contactQualified Medical EvaluatorRemoval petitionFindings of Fact and OrderLabor Code Section 4062.3Appearance of impartialityMedical evaluation processReplacement QME panelPsychiatric injuryStipulated facts

References

Case No. ADJ7652327; ADJ7686431

Regular

Mar 21, 2012

DEBORAH HELMS vs. CAPISTRANO UNIFIED SCHOOL DISTRICT, CORVEL CORPORATION

In this case, the defendant school district sought removal of an order allowing the applicant to obtain a new Qualified Medical Evaluator (QME) due to a new alleged cumulative trauma injury. The Appeals Board denied the petition, adopting the WCJ's reasoning that a new panel was appropriate. The Board also clarified that the defendant's communication to a QME was a subsequent, not ex parte, communication.

Petition for RemovalOrder Off CalendarPanel PhysicianQualified Medical Evaluators (QMEs)Cumulative Trauma InjuryMedical EvaluationSubsequent CommunicationEx Parte CommunicationLabor Code section 4062.3(e)Labor Code section 4062.3(f)

References

Case No. ADJ6873149

Regular

May 29, 2012

MIRIAN AVILA vs. CANADIAN AMERICAN OIL COMPANY, PACIFIC COMPENSATION INSURANCE COMPANY

This case concerns whether a Qualified Medical Evaluator (QME) improperly interviewed non-party witnesses without the defendant's knowledge or consent, violating Labor Code section 4062.3 and AD Rule 35. The Appeals Board rescinded its order granting reconsideration, affirming the Workers' Compensation Judge's (WCJ) decision that these collateral interviews did not constitute prohibited ex parte communication. The majority held that the statute applies to communications between parties or their representatives and the QME, not to a QME's discussions with non-parties. Conversely, the dissenting commissioner argued that such interviews were impermissible under the spirit and letter of the law, constituting a denial of due process and advocating for the QME's report to be stricken.

PQMEnonparty witnessesex parte communicationLabor Code section 4062.3AD Rule 35oral interviewspetition to strikenew panelsubstantial evidencedue process

References

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Updated Daily

Case Law Database

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

Case No. ADJ8363948

Regular

Oct 19, 2012

NICOLE NELSON vs. COUNTY OF SOLANO, INTERCARE HOLDINGS INSURANCE SERVICES

References

Case No. ADJ795505 (LAO 0794863)

Regular

Feb 13, 2014

VICTORIA SHANLEY vs. HENRY MAYO NEWHALL MEMORIAL HOSPITAL, TRAVELERS INSURANCE CO.

References

Case No. ADJ3540065

En Banc

Jan 23, 2017

BRADLEY MAXHAM vs. CALIFORNIA DEPARTMENT OF CORRECTIONS AND REHABILITATION, STATE COMPENSATION INSURANCE FUND

Workers' Compensation Appeals BoardPetition for RemovalAgreed Medical Evaluator (AME)Labor Code section 4062.3WCAB Rule 35informationcommunicationprejudiceirreparable harmex parte communication

References

Case No. ADJ4158530 (LBO 0325085) ADJ332706 (LBO 0325079)

Regular

Jul 23, 2013

VICTORIA ANTUNEZ vs. SEASIDE PRINTING CO., CALIFORNIA CASUALTY, GALLAGHER BASSETT SERVICES, PACIFIC NATIONAL INSURANCE, CIGA, INTERCARE INSURANCE SERVICES

References

Case No. ADJ3636557

Regular

May 08, 2009

MARIA ANA PAREDES (Deceased) CARLOS ALFREDO ALVAREZ (Widower) vs. ANDROMEDA ENTERTAINMENT dba GALAXY BALLROOM, STATE COMPENSATION INSURANCE FUND

References

Case No. ADJ2001631 (LAO 0876091)

Regular

Oct 01, 2010

SALVADOR AGUAYO, JR. vs. AMERICAN GOLF CORPORATION, ARCH INSURANCE COMPANY

References

Case No. ADJ10038732

Regular

Dec 02, 2016

Deborah Matthews vs. California Department of Corrections and Rehabilitation, State Compensation Insurance Fund

Labor Code 4062.3Ex parte communicationPQME panelPetition for RemovalAggrieved partyWaiverDoctor shoppingFindings of Fact and OpinionWCJAppeals Board

References

Case No. ADJ16326594

Regular

Oct 31, 2025

Peter Pham vs. Southern California Edison

References

Case No. ADJ7652327; ADJ7686431

Regular

Mar 21, 2012

DEBORAH HELMS vs. CAPISTRANO UNIFIED SCHOOL DISTRICT, CORVEL CORPORATION

References

Case No. ADJ6873149

Regular

May 29, 2012

MIRIAN AVILA vs. CANADIAN AMERICAN OIL COMPANY, PACIFIC COMPENSATION INSURANCE COMPANY

PQMEnonparty witnessesex parte communicationLabor Code section 4062.3AD Rule 35oral interviewspetition to strikenew panelsubstantial evidencedue process

References

Showing 1-10 of 526 results

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