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

Case No. ADJ9379623
Regular
May 18, 2018

ETHERY AMARI vs. CHILDREN'S HOSPITAL OF LOS ANGELES

The Workers' Compensation Appeals Board granted the applicant's petition for removal, rescinding a prior order that denied her request for an additional neurology Qualified Medical Evaluator (QME). The applicant sustained admitted injuries including to her spine and shoulder, and also claimed headaches. Her treating physician recommended a neurology consult twice, and the applicant testified about worsening headaches post-injury. The Board found that these factors constituted good cause and demonstrated significant prejudice, warranting the appointment of a neurology QME panel.

Petition for RemovalPanel Qualified Medical EvaluatorNeurology QMEWCABFindings and OrderIndustrial InjuryCervical SpineLumbar SpineHeadachesPrimary Treating Physician
References
1
Case No. MISSING
Regular Panel Decision

Long Island Neurological Assocs., P.C. v. Highmark Blue Shield & Reed Smith LLP

Plaintiff Long Island Neurological Associates, P.C. sued Highmark Blue Shield and Reed Smith LLP for under-reimbursement of surgical services under ERISA. The case involved a 4-year-old patient who received complex out-of-network surgery from Dr. Schneider due to the unavailability of in-network providers. Highmark significantly under-reimbursed the billed amount and denied multiple appeals, failing to provide requested documentation. The patient's parents assigned their rights to the Plaintiff, leading Defendants to move for dismissal, asserting an anti-assignment provision in their Administrative Service Agreement (ASA). The Court denied the motion, ruling that the ASA is not an ERISA plan document and thus its anti-assignment clause is not binding on plan participants, confirming Plaintiff's standing. The Rule 12(b)(6) motion was also denied as abandoned.

ERISAMotion to DismissAnti-assignment clauseAdministrative Service Agreement (ASA)Plan DocumentSubject Matter JurisdictionStandingUnder-reimbursementOut-of-network providerHealth Insurance
References
27
Case No. ADJ14784661
Regular
Aug 01, 2025

Jeremy Vietmeier vs. Northrop Grumman Systems Corporation, American Home Assurance Company

Applicant Jeremy Vietmeier sought reconsideration of a WCJ's May 8, 2025 Findings of Fact and Orders (F&O) which found good cause for an additional neurology QME panel but denied one in psychiatry. The Appeals Board dismissed the petition for reconsideration but granted it as a petition for removal. They rescinded the original F&O and substituted new findings, determining that good cause exists for additional QME panels in both neurology and psychiatry. The Board also provided guidance regarding the admissibility of a psychiatric report from David Kauss, Ph.D., disagreeing with a dissenting commissioner on its immediate inadmissibility, noting the issue was not yet ripe for a ruling.

WCABPetition for ReconsiderationPetition for RemovalQualified Medical Evaluator (QME)Medical DirectorDivision of Workers' Compensation (DWC)AdmissibilityPsychiatric ReportGood CauseFinal Order
References
17
Case No. ADJ11629744
Regular
Apr 24, 2023

ROCHELLE BOYD vs. VISSER, NATIONAL INTERSTATE RICHFIELD

The applicant sought reconsideration after the WCJ denied injury claims to the brain, internal system, psyche, and sexual dysfunction, as well as the issuance of additional QME panels. The Appeals Board granted reconsideration, finding good cause existed for additional QME panels in internal medicine and psychiatry. The original findings of fact were rescinded, and the issue of further QME panels in urology and neurology was deferred. The Board concluded that additional QME evaluations were necessary for a full adjudication of the claimed injuries outside of the admitted orthopedic injuries.

Workers' Compensation Appeals BoardPetition for ReconsiderationQualified Medical EvaluatorQME panelsinternal medicinepsychiatryneurologyurologysexual dysfunctionpsyche
References
3
Case No. ADJ3218661 ( OAK 0339889)
Regular
Apr 09, 2009

, CHANCE ROLLINS vs. , JOHN MARTIN STABLES, INC.; AIG CLAIM SERVICES, INC.

The Workers' Compensation Appeals Board (WCAB) dismissed the defendant's Petition for Reconsideration and denied their Petition for Removal. The defendant sought to challenge an order denying their request for a new Qualified Medical Evaluator (QME) panel in a neurology specialty, arguing the chosen QME's specialty was inappropriate. The WCAB found the order at issue was not a final order and thus not subject to reconsideration. Furthermore, the WCAB determined that the defendant had previously agreed to the QME and failed to demonstrate irreparable harm or substantial prejudice to warrant removal.

Qualified Medical EvaluatorQME panelneurologyneurosurgerypain managementtreating physicianadministrative law judgepetition for reconsiderationpetition for removalinterlocutory order
References
7
Case No. ADJ3218661 (OAK 0339889)
Regular
Feb 07, 2011

CHANCE ROLLINS vs. JOHN MARTIN STABLES, INC.; AMERICAN HOME ASSURANCE administered by AIG, CLAIMS SERVICES

The Appeals Board vacated its prior order granting reconsideration and dismissed the defendant's petition for reconsideration, finding the WCJ's ruling was not a final order. However, the Board granted removal, rescinded the WCJ's order, and denied the applicant's request for a neurology consultation under Labor Code §4601(a). The matter was returned to the trial level with instructions to issue an order for a new QME panel in neurology, as Dr. Jamasbi's request for a consultative neurological evaluation constituted good cause for a new panel under 8 Cal. Code Regs. §31.7. Attorney fees for the ex parte communication were upheld.

WCABPetition for ReconsiderationPetition for RemovalLabor Code 4601(a)Labor Code 4062.3QMEAgreed Medical EvaluatorNeurological ConsultMedical DirectorSpecialty Panel
References
0
Case No. ADJ18210611
Regular
May 08, 2025

ELENITA JOVER vs. COUNTY OF SAN BERNARDINO DEPARTMENT OF PUBLIC HEALTH

Elenita Jover, a licensed vocational nurse, sought reconsideration of a Findings and Award that denied her request for additional Qualified Medical Evaluation (QME) panels. The initial F&A found injuries to her cervical and lumbar spine, shoulders, and right thumb, but not to other claimed body parts like stress, psyche, or internal systems. The Appeals Board granted the petition, rescinded the original F&A, and ordered additional QME panels for pulmonology, internal medicine (diabetes), ophthalmology, ENT, and neurology, returning the case to the trial level for further proceedings. This decision was based on the original QME's recommendation for further evaluations and the need to develop the evidentiary record to ensure substantial justice.

Petition for ReconsiderationQualified Medical EvaluationLicensed Vocational NurseArising out of and in the course of employmentPermanent DisabilityDue ProcessPulmonologistInternistOphthalmologistOtolaryngologist
References
7
Case No. 2016-03-0413
Regular Panel Decision
Oct 05, 2017

Dodson, Deborah v. LHC Group

Deborah Dodson, an employee of LHC Group, injured her left ankle and right knee in May 2015. She underwent knee surgery and was placed at maximum medical improvement by Dr. Johnson. She later developed small fiber neuropathy, and despite a referral, faced difficulties obtaining a neurologic impairment evaluation. The Court granted Ms. Dodson's request for a neurologic impairment evaluation, either by Dr. Butler or another neurologist, referring Dr. Butler to the Penalty Program for failure to provide an impairment opinion. However, the Court denied her claim for additional temporary total disability benefits, finding she reached MMI on March 23, 2017, when Dr. Butler ceased active treatment.

Workers' CompensationNeurologic Impairment EvaluationTemporary Total Disability BenefitsMaximum Medical ImprovementSmall Fiber NeuropathyPain ManagementExpedited HearingMedical TreatmentImpairment RatingPenalty Program
References
3
Case No. ADJ2834861 (GRO 00349120) ADJ3453107 (GRO 0031731) ADJ405168 (GRO 0034913)
Regular
Nov 14, 2019

TOM JANISE vs. DSH ATASCADERO, STATE COMPENSATION INSURANCE FUND

The Appeals Board granted applicant's Petition for Removal, rescinding an order that closed discovery and set a trial date. This was because a court-ordered neurology panel Qualified Medical Evaluator (QME) was not selected until after discovery was closed, despite delays from the Medical Unit. The Board agreed that applicant should not be prejudiced by this delay and allowed for the QME evaluation to proceed. Consequently, the trial was converted to a status conference.

Petition for RemovalAppeals BoardWCJQualified Medical EvaluatorDWC Medical Unitneurologydiscovery closureproof of serviceStatus Conferencerescinded order
References
0
Case No. ADJ9173387
Regular
Dec 15, 2014

CASANDRA ALDERETE vs. ADVENTIST MEDICAL CENTER, ADVENTIST HEALTH SYSTEMS

The Appeals Board dismissed the Applicant's Petition for Reconsideration as it was filed from a non-final procedural order. The Board also denied the Applicant's Petition for Disqualification of the WCJ due to a lack of specificity and proper procedure. However, the Board granted removal on its own motion to correct an erroneous WCJ order for a neurology QME panel. The case is returned to the trial level to determine the correct QME specialty based on the timing of the parties' panel requests.

WCABQME panelspecialty disputeAdministrative Director's RulesLabor Code section 4062.2AD Rule 31.1removal on board motionPetition for ReconsiderationPetition for Disqualificationinterlocutory order
References
1
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