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

Case No. ADJ9180559
Regular
Sep 18, 2015

JACKIE SUEHIRO (Dec'd), ALVIN SUEHIRO (Husband) vs. RALPHS GROCERY COMPANY, permissibly self-insured, adjusted by SEDGWICK CLAIMS MANAGEMENT SERVICES, INC.

The Appeals Board granted the defendant's petition for removal, rescinding a prior Minute Order. The WCJ had found ex-parte communication by the defendant and ordered a new QME panel without a trial or sworn testimony. The Board found this violated the defendant's due process rights, as no evidence was presented to support the ex-parte communication finding. The case is returned to the trial level for a hearing on all issues, including alleged ex-parte communication, with parties afforded the chance to present evidence and witnesses.

Petition for RemovalMinute OrderQualified Medical EvaluatorEx-parte CommunicationDue ProcessWCJReplacement QME PanelLabor Code Section 5313Admitted EvidenceProof of Service
References
Case No. ADJ11584415
Regular
Sep 30, 2019

GUY SYLVA vs. CITY AND COUNTY OF SAN FRANCISCO

This case involves an applicant's petition for reconsideration of a Workers' Compensation Appeals Board (WCAB) decision that denied temporary disability benefits and a motion to strike a Qualified Medical Evaluator's (QME) reports. The applicant alleged ex parte communication between the defendant and the QME, violating Labor Code section 4062.3. The WCAB granted reconsideration, finding that the issue of ex parte communication was not adequately addressed due to conflicting dates and unadmitted evidence. The matter is remanded to the trial level for further proceedings to determine if ex parte communication occurred and to address the temporary disability issue.

WCABAOE/COEQMEex parte communicationLabor Code section 4062.3Petition for ReconsiderationFindings and Orderremovaltemporary disabilityprimary treating physician
References
Case No. ADJ7452503
Regular
Sep 26, 2011

PATRICIA MAYORGA vs. MOUNT DIABLO UNIFIED SCHOOL DISTRICT, TRISTAR

The Appeals Board denied the defendant's Petition for Removal, which sought to overturn an order quashing the deposition of a treating physician. The defendant argued the communication wasn't an ex parte communication and was necessary for their defense and fraud investigation. However, the Board found the defendant failed to show substantial prejudice or irreparable harm. While ex parte communications with QMEs/AMEs are prohibited, they are not with treating physicians, and the communication was not barred by statute or case law.

Petition for RemovalPetition to Quash DepositionTreating PhysicianEx Parte CommunicationAgreed Medical EvaluatorQualified Medical EvaluatorSubstantial PrejudiceIrreparable HarmWorkers' Compensation Appeals BoardWCJ
References
Case No. ADJ8015424, ADJ8102669
Regular
Aug 01, 2018

ESPERANZA SANCHEZ vs. MCDONALD'S/MJD'S, INC., UNITED STATES FIDELITY & GUARANTY, BROADSPIRE

The Workers' Compensation Appeals Board granted applicant's petition for removal, rescinding the WCJ's order that deferred a discovery dispute regarding ex parte communication. The Board found that allegations of impermissible communication between the defendant and the court-appointed physician must be addressed before further discovery. The case is returned to the trial level for proceedings to determine if ex parte communication occurred and if a new physician is warranted.

Petition for RemovalRegular PhysicianEx Parte CommunicationWCJDepositionsAdmitted EvidenceSubstantial JusticeLabor Code § 5701WCAB Rules § 10324(d)Qualified Medical Evaluator (QME)
References
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. ADJ10452831
Regular
Nov 09, 2018

CAROLINE DOLLEMORE vs. WAYNE PERRY, INC.; STARR SURPLUS LINES, administered by YORK RISK SERVICES GROUP

The Appeals Board granted the applicant's petition for removal, rescinding the WCJ's findings. The WCJ had improperly stricken the QME's reports due to an ex parte communication from the applicant inquiring about her pain impairment rating. While ex parte communications with a QME are prohibited, the Board found that the applicant's communication was not insignificant and could not be categorized as such. However, the Board remanded the case to the trial level to determine if the defendant elected to terminate the evaluation within a reasonable time or engaged in conduct inconsistent with that election, as required by recent en banc precedent.

ex parte communicationqualified medical evaluatorremovalfindings and orderstricken reportsagreed medical evaluatorpetition for removaldefendant's answertrial levelsupplemental report
References
Case No. ADJ1232228 (STK 0213740)
Regular
Jul 20, 2015

LON VALLEM vs. STATE OF CALIFORNIA, CDCR, STATE COMPENSATION INSURANCE FUND

In this workers' compensation case, the defendant sought removal of the judge's findings, dismissal of the Agreed Medical Evaluator (AME), and a new panel, alleging an ex parte communication by the applicant with the AME. The Workers' Compensation Appeals Board (WCAB) denied the petition for removal, upholding the judge's decision. The WCAB found no effort to improperly influence the AME, and that the communication occurred after the record was submitted on a non-disputed issue. The WCAB agreed that excluding the specific report from the alleged ex parte communication was sufficient to protect due process.

Petition for RemovalAgreed Medical Evaluator (AME)Ex Parte CommunicationLabor Code Section 4062.3(g)Alvarez v. Workers' Comp. Appeals Bd.Findings & OrdersWorkers' Compensation Administrative Law Judge (WCJ)Qualified Medical Evaluator (QME) PanelDiscovery ClosurePretrial Conference Statement
References
Case No. ADJ7257372
Regular
Dec 14, 2015

Joshua Geiger vs. George Geiger, State Farm Insurance Bakersfield

This case concerns a defendant's petition for reconsideration of a Workers' Compensation Appeals Board (WCAB) decision. The defendant argued that applicant's spouse had improper ex parte communication with the Agreed Medical Examiner (AME) by providing video and notes of the applicant's seizures. The WCAB denied reconsideration, finding that the communication occurred at the AME's request during the examination and was therefore exempt from statutory ex parte communication prohibitions. The Board concluded that the information provided was de minimis and did not warrant removal of the AME or striking of reports, especially since the seizure disorder was not a disputed issue.

Ex parte communicationAgreed Medical Examiner (AME)Labor Code Section 4062.3Rule 35Petition for ReconsiderationFindings and AwardWCJ ReportEpilepsySeizuresHome health care
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
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