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Case Law Database

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

Case No. MISSING
Regular Panel Decision

Main Evaluations, Inc. v. State

The claimant, Main Medical Evaluations, entered into contracts with the New York State Office of Temporary and Disability Assistance (OTDA) to perform consultative medical evaluations. OTDA terminated these contracts, alleging the claimant failed to disclose professional disciplinary proceedings against its chief medical officer, Arvinder Sachdev, and submitted false information during the bidding process. Following the dismissal of its claim in the Court of Claims, the claimant appealed. The appellate court affirmed the lower court's judgment, concluding that OTDA had legitimate grounds for termination due to the claimant's misrepresentations and failure to report substantial contract-related issues concerning Sachdev's integral role. Additionally, the court rejected the claimant's equal protection argument, finding no evidence of selective enforcement based on impermissible considerations.

Contract TerminationProfessional MisconductFalse RepresentationEqual ProtectionGovernment ContractsAppellate ReviewBreach of ContractMedical LicensingAdministrative ProceedingsDue Diligence
References
5
Case No. ADJ7436407, ADJ1895040 (FRE 0238028)
Regular
Feb 04, 2015

Colleen Newby vs. Fresno Community Medical Center, St. Agnes Medical Center, State Compensation Insurance Fund

The Workers' Compensation Appeals Board denied Colleen Newby's Petition for Removal, upholding the denial of her petition to quash a Qualified Medical Evaluator (QME) request. The Board found that the prior employer, Fresno Community Medical Center, was authorized to file an application for adjudication of claim for Newby's subsequent employment with St. Agnes Medical Center. Crucially, the Board determined that a claim form is not a prerequisite for St. Agnes to request a QME panel in this specific scenario, where a second injury is claimed by a prior employer. Newby's due process claim was rejected as she had an opportunity to present her arguments on removal.

Petition for RemovalPetition to QuashQME RequestQualified Medical EvaluatorClaim FormDue ProcessAgreed Medical EvaluatorApplication for AdjudicationTemporary DisabilityPermanent Disability
References
1
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. 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. 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. 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. ADJ9328371
Regular
Oct 31, 2016

LEYLA FATHI vs. MISSION HOSPITAL REGIONAL MEDICAL CENTER, HARTFORD ACCIDENT & INDEMNITY COMPANY

The Workers' Compensation Appeals Board (WCAB) dismissed the defendant's petition for reconsideration because the WCJ's order for additional Qualified Medical Evaluator (QME) panels was an interlocutory procedural order, not a final determination of substantive rights or liabilities. The defendant's petition for removal was also denied, as they failed to demonstrate substantial prejudice or irreparable harm. While good cause for additional evaluations may have existed, the record was insufficient to make a definitive ruling on the merits of the removal. Therefore, the WCAB affirmed the WCJ's order for further medical development of the record.

Petition for ReconsiderationPetition for RemovalAdditional Panel QMEQualified Medical EvaluatorInternal MedicinePsychiatryNeurologyMedical Record DevelopmentFinal OrderInterlocutory Order
References
8
Case No. ADJ18724961; ADJ15255319
Regular
Nov 03, 2025

Tina Garza vs. County of Kern

Defendant County of Kern sought reconsideration of a WCJ's Findings of Fact and Discovery Order which determined that Dr. Scott Graham was the Agreed Medical Evaluator (AME) for both claims and that defendant waived its right to a Qualified Medical Evaluator (QME) examination. The defendant argued that the waiver finding was improper and they were entitled to a new medical-legal evaluation panel. The Appeals Board granted reconsideration, rescinded the WCJ's decision, and returned the matter for further proceedings, primarily due to an inadequate record and deficiencies in the minutes of hearing. The Board also noted that based on current Labor Code interpretations, the parties' agreement to an AME once initiated, generally precludes subsequent QME panel requests for submitted issues.

Workers' Compensation Appeals BoardPetition for ReconsiderationAgreed Medical Evaluator (AME)Qualified Medical Evaluator (QME)Panel QMEMedical-Legal ExaminationWaiver of RightLabor Code Section 4062.2Labor Code Section 4062.3Navarro v. City of Montebello
References
9
Case No. ADJ11255525
Regular
Dec 02, 2019

GWENDOLYN JOHNIGAN vs. UC DAVIS MEDICAL CENTER

This case involves an applicant denied workers' compensation benefits for industrial injury to her right leg and knee, with the Workers' Compensation Appeals Board (WCAB) denying her petition for reconsideration. The WCAB adopted the administrative law judge's finding that the applicant did not sustain industrial injury, relying on a panel qualified medical evaluator's opinion that the work duties were insufficient to cause an injury. The applicant argued the medical evidence was not substantial and sought further development of the record. However, the WCAB found the applicant failed to meet her burden of proof with substantial medical evidence. A dissenting opinion argued the medical evidence was insubstantial and required further development.

Petition for ReconsiderationPanel Qualified Medical EvaluatorOrthopedistSubstantial Medical EvidenceFurther DevelopmentSupplemental ReportingDeposition TestimonyIndustrial InjuryRight LegRight Knee
References
4
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
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