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

Case No. ADJ7673518, ADJ7647749
Regular
Jan 23, 2015

ANA DE AYALA vs. AO-THE UNIVERSITY CORPORATION / CALIFORNIA STATE UNIVERSITY NORTHRIDGE

The Workers' Compensation Appeals Board granted reconsideration and reversed a prior ruling, finding the applicant sustained industrial injury to her neck. While the applicant testified to injuring her neck in a workplace incident and this was partially corroborated, the Board found insufficient evidence for other claimed injuries. The Board specifically disagreed with the administrative law judge's credibility assessment concerning the neck injury itself, relying on medical reports and testimony supporting the neck injury claim. The Board affirmed the denial of claims for all other alleged injuries, finding insufficient medical evidence to link them to the incident.

Petition for ReconsiderationFindings and OrderIndustrial InjuryNeck InjuryBack InjurySpine InjuryUpper ExtremitiesPsycheGastroesophageal SystemInternal System
References
Case No. ADJ9975590; ADJ9976116
Regular
Feb 25, 2016

Ana Nieto vs. Avitus, Inc., American Zurich Insurance Company

The Workers' Compensation Appeals Board (WCAB) dismissed the defendant's petition for reconsideration, finding the appealed order was interlocutory and not subject to reconsideration. The WCAB treated the petition as one for removal and denied it, as the defendant failed to demonstrate substantial prejudice or irreparable harm. The defendant's contention that their trial exhibits and an orthopedic QME panel were erroneously stricken was rejected, as was their claim that the orthopedic QME panel was improperly denied. The defendant failed to provide sufficient evidence to support their request for an orthopedic QME panel over a chiropractic one.

Workers' Compensation Appeals BoardPetition for ReconsiderationPetition for RemovalJoint Findings of Fact & OrdersQualified Medical Evaluator (QME)Orthopedic Surgery QMEChiropractic QMETrial ExhibitsAdministrative Law Judge (WCJ)Labor Code § 4062.2
References
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
Case No. ADJ7578707; ADJ7578722
Regular
Jul 06, 2011

Melissa Voisenat vs. COUNTY OF FRESNO

This case involves a dispute over the specialty of a Qualified Medical Evaluator (QME) for applicant Melissa Voisenat, who claims industrial injuries as a police officer. Defendant County of Fresno seeks to remove an administrative order denying their request for an orthopedic QME panel. The Appeals Board granted removal due to an insufficient record, lacking crucial documents needed to assess compliance with QME panel selection rules. The case is returned to the trial level for further proceedings to allow parties to submit relevant evidence on the QME specialty issue.

Petition for RemovalQualified Medical Evaluator (QME) panelspecialty disputeorthopedic QMEchiropractic QMEAdministrative Director's Medical Unit (MU)EAMSrescinded ordertrial levelindustrial injuries
References
Case No. ADJ9099536
Regular
Sep 09, 2014

MARIA SOTO vs. CCC HOSPITALITY PISMO, LLC dba SEACREST OCEANFRONT HOTEL, STAR INSURANCE COMPANY

In this case, the defendant hospital sought removal after the WCJ ordered a chiropractic QME panel, arguing chiropractors were unqualified for the applicant's knee injury. The defendant had initially requested an orthopedic surgeon QME, but their request was rejected by the Medical Unit as incomplete. The Appeals Board found the defendant's initial request substantially complied with regulations and was improperly rejected. Therefore, the Board granted removal, rescinded the WCJ's order, and directed the Medical Unit to issue a panel of orthopedic surgery QMEs.

Petition for RemovalPQMEMedical UnitChiropractic QMEOrthopedic Surgery QMERequest for QME PanelAdministrative Director Rule 30(b)Labor Code section 4062.2Messele v. Pitco FoodsInc.
References
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
Case No. ADJ10645876
Regular
Feb 07, 2023

GINA ROSALES vs. COUNTY OF RIVERSIDE

The Workers' Compensation Appeals Board (WCAB) reconsidered a case where the applicant claimed work injuries to her psyche, head, back, and body systems. The WCAB rescinded the original decision, finding insufficient development of the medical record regarding the applicant's claims of GERD and hypertension. However, the WCAB upheld the finding that the applicant did not sustain psyche or orthopedic injuries arising out of and in the course of employment. The case is remanded for further proceedings to obtain a supplemental medical opinion on the body systems injuries and then for a new decision by the WCJ.

AOE/COEPro PerFindings and OrderOpinion on DecisionReconsiderationWCJHealth Services AssistantPsyche InjuryBody Systems InjuryGERD
References
Case No. ADJ8491619 ADJ9586677
Regular
May 17, 2019

Edward GAA vs. Intercare Holdings Insurance, The Hartford

The Workers' Compensation Appeals Board granted applicant's petition for removal, overturning a prior order that denied a rheumatological evaluation. While dismissing the petition for reconsideration, the Board found good cause for an additional QME panel in rheumatology, acknowledging the orthopedic QME's limited expertise in this specialty. The applicant must still attend a re-evaluation with the orthopedic QME, who must review a job analysis.

Workers' Compensation Appeals BoardPetition for ReconsiderationPetition for RemovalQualified Medical Evaluator (QME)Rheumatological evaluationOrthopedic QMECumulative traumaIndustrial injuryMedical-legal issuesBias
References
Case No. ADJ9317724
Regular
Jul 23, 2015

JUAN TORRES vs. LINEAGE LOGISTICS COLD STORAGE, TRAVELERS INSURANCE COMPANY

The Workers' Compensation Appeals Board denied the applicant's Petition for Removal. The applicant sought to overturn a Minute Order compelling an orthopedic QME evaluation, arguing the existing orthopedic panel was improperly obtained and preferred a treating doctor. The Board adopted the WCJ's recommendation, finding no substantial prejudice or irreparable harm, as removal is an extraordinary remedy not warranted here. The applicant's preference for a treating doctor did not override the WCJ's order for a QME evaluation requested to clarify a prior medical opinion regarding potential knee surgery.

Petition for RemovalQualified Medical EvaluatorOrthopedic QMEChiropractic QMEKnee SurgeryIndependent Medical OpinionMPNMedical Treatment AuthorizationPrimary Treating PhysicianReconsideration
References
Case No. ADJ10800397
Regular
May 20, 2019

MARILYN RAMIREZ GALVEZ vs. NIAGARA BOTTLING LLC, SAFETY NATIONAL INSURANCE CO.

The applicant sought a QME panel in psychology for a claimed psychiatric injury after orthopedic and internal medicine evaluations. The WCJ denied the request, finding no substantial medical evidence for a psychological QME. The Appeals Board granted removal, rescinded the WCJ's order, and found good cause for a psychological QME panel. This decision allows the applicant to pursue necessary medical-legal discovery regarding her disputed psychological injury claim.

Petition for RemovalFindings and OrderQualified Medical EvaluatorQME panelpsychologypsychiatric injurydiscoveryinternal medicineorthopedic QMEhypertension
References
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