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

Case No. ADJ7294109
Regular
Jun 07, 2013

MANSOUREH AZIMZADEH vs. BURG & BROCK, EMPLOYERS COMPENSATION CO.

This case involves an applicant challenging a Workers' Compensation Judge's decision to disregard the Qualified Medical Examiner's (QME) reports due to flawed apportionment analysis and ordering a new QME panel. The Appeals Board granted removal, rescinded the order for a new QME panel, and returned the matter for further development of the record. The Board agreed that the QME's reports lacked substantial medical evidence due to a misunderstanding of apportionment law and that further development with the same QME would be unhelpful. The Board emphasized that new medical-legal reporting would be necessary to properly weigh evidence.

RemovalReconsiderationPetitionPanel Qualified Medical ExaminerPQMESubstantial Medical EvidenceApportionmentFindings and OrderMedical UnitDiscovery
References
9
Case No. ADJ4696795 (SJO 0266117)
Regular
Aug 10, 2012

RUDOLPH GARCIA vs. PEPSI BOTTLING GROUP, OLD REPUBLIC INSURANCE

The Workers' Compensation Appeals Board (WCAB) granted removal and rescinded a WCJ's order for a replacement QME panel. The WCAB found that the applicant's attorney erred in sending a request for a supplemental report to an incorrect address for the QME, despite the QME's report listing two addresses. Consequently, the QME did not receive the request and did not issue a supplemental report within 60 days. The WCAB determined that allowing a new panel would cause prejudice and unnecessary cost to the defendant.

Workers' Compensation Appeals BoardRemovalQME panelsupplemental reportcompensable consequenceindustrial injurydelivery driveradministrative law judgePetition for Removalfindings and order
References
4
Case No. ADJ8529720
Regular
Feb 06, 2017

ALEJANDRA GONZALEZ vs. 3M COMPANY, OLD REPUBLIC INSURANCE

This case concerns whether an untimely supplemental Qualified Medical Evaluator (QME) report warrants a replacement panel. The applicant requested a new panel because the original QME's supplemental report was late. The WCJ denied the defendant's request to keep the original QME, finding the defendant waived objection by striking a name from the new panel. The Appeals Board granted removal, rescinded the WCJ's order, and remanded the case. The Board clarified that striking a name from a new panel does not automatically waive the right to object to its validity.

PQMESupplemental ReportReplacement PanelLabor Code 4062.5DWC Medical UnitDeclaration of ReadinessMSCWaiverAdministrative Director Rule 38Rule 31.5
References
0
Case No. ADJ9163491; ADJ9163494
Regular
Jan 09, 2015

RIGOBERTO NORIEGA vs. BEST WESTERN TOWN & COUNTRY

This case concerns an applicant's petition for removal after the WCJ denied his objection to a QME's report. The applicant argued the QME report was untimely and prejudicial because it issued a zero impairment rating. The Appeals Board denied removal, finding the applicant waived his objection by not requesting a replacement QME panel until after receiving the unfavorable report. The Board cited precedent preventing parties from waiting to see if a report is favorable before objecting to its timeliness. Commissioner Zalewski dissented, believing the applicant could object after receipt as long as the objection preceded the replacement panel request.

Petition for RemovalQualified Medical EvaluatorQME reportuntimely filingservice of reportreplacement panelobjectionstatutory timeframesLabor CodeAdministrative Director Rule
References
3
Case No. ADJ9834159 (MF) ADJ9834161
Regular
Jul 30, 2018

ESAU HERNANDEZ vs. D.L. BONE AND SONS PAINTING, ICW GROUP/EXPLORER INSURANCE COMPANY, STATE COMPENSATION INSURANCE FUND

This case concerns a defendant's attempt to obtain a replacement Qualified Medical Evaluator (QME) panel after the applicant initially objected to the timeliness of the original QME's report. The Appeals Board treated the defendant's petition as one for removal and denied it. The Board found that the defendant, having failed to timely object to the QME's report itself, could not rely on the applicant's subsequent objection to request a new panel. The Board concluded that the defendant's failure to act promptly meant they were not entitled to a replacement QME panel, and no substantial prejudice or irreparable harm warranting removal was demonstrated.

Workers' Compensation Appeals BoardReconsiderationRemovalQualified Medical EvaluatorQME panelAdministrative Director RuleTimeliness objectionReplacement QME panelLabor CodeFindings of Fact
References
1
Case No. ADJ9292791
Regular
Sep 29, 2015

HIEP LE NGOC NGUYEN vs. OAKS CLUB ROOM, NATIONAL CASUALTY COMPANY, NATIONWIDE AGRIBUSINESS INSURANCE COMPANY

This case concerns applicant's petition for removal after the WCJ denied their request for a new Qualified Medical Examiner (QME) panel. The denial was based on the original QME's failure to issue a timely supplemental report despite two requests. Although the QME claimed non-receipt of the requests, the supplemental report has now been provided. The Appeals Board denied removal, finding that issuing a new panel would only cause further delay given the report is now available.

Petition for RemovalQualified Medical ExaminerSupplemental ReportRule 38(i)Administrative Law JudgeWCJ ReportPrejudiceIrreparable HarmUntimely ReportPanel Qualified Medical Examiner
References
2
Case No. ADJ11280224
Regular
Oct 25, 2019

APRIL WILLIAMS vs. KERN COUNTY SUPERINTENDENT OF SCHOOLS

The Workers' Compensation Appeals Board granted reconsideration and amended a prior order, finding the applicant is not entitled to a replacement Qualified Medical Evaluator (QME) panel. The Board determined that the QME's supplemental report was timely because the initial request for the report was not received by the QME's office, and the subsequent fax request was within the statutory timeframe. Additionally, the Board revised a finding to reflect injury AOE/COE solely to the applicant's low back, deferring the issue of injury to other body parts. The Board noted that even if the report had been late, a replacement panel is not automatically mandated and requires a showing of good cause.

Workers' Compensation Appeals BoardPetition for ReconsiderationQualified Medical EvaluatorReplacement QME PanelFindings of FactOrder and Opinion on DecisionDue ProcessMedical UnitSupplemental ReportMailing Presumption
References
8
Case No. SAL SJO 252436 (MF); SJO 246192
Regular
Jul 02, 2007

NIHAL HORDAGODA vs. State Compensation Insurance Fund

This case involves an employer's petition for reconsideration of an order authorizing medical treatment and admitting the Qualified Medical Examiner's (QME) reports. The employer argued the QME reports were inadmissible due to an alleged ex parte communication between the applicant and the QME, and that the awarded treatments were improper. The report recommends denying the petition, finding the communication was permissible under LC § 4062.3(h) and that the QME's opinions and awarded treatments for chronic pain were reasonable and not governed by ACOEM guidelines.

Workers' Compensation Appeals BoardPetition for ReconsiderationQualified Medical EvaluatorLabor Code Section 4062.3Ophthalmological evaluationFunctional capacity evaluationUtilization ReviewACOEM GuidelinesChronic spinal conditionTreating physician
References
0
Case No. ADJ12557876
Regular
Nov 04, 2020

VERONICA MADRIGAL vs. MONTEREY COUNTY OFFICE OF EDUCATION, INTERCARE HOLDINGS INSURANCE SERVICES, INC.

Here is a summary of the case for a lawyer in four sentences: The defendant sought reconsideration of a WCJ's order denying their petition for a new QME panel and finding their objections to the existing panel harmless error. The Appeals Board denied the petition, agreeing that the applicant's counsel's communication with the QME, while a technical violation of Labor Code section 4062.3(b), did not result in prejudice warranting a new panel. The Board also found the defendant waived their right to object to the QME's report by relying on it to terminate temporary disability benefits. Furthermore, the defendant failed to provide evidence that the original QME panel was improperly issued, thus failing to prove entitlement to a new orthopedic panel.

QME panelLabor Code section 4062.3ex parte communicationadvocacy letterharmless errorstipulated findings and orderremovalreconsiderationmedical evaluatoragreed medical evaluator
References
5
Case No. ADJ815944
Regular
Jan 14, 2010

LINDALAIVAREZ vs. BLUE DIAMOND GROWERS, TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICA

The Workers' Compensation Appeals Board denied a Petition for Removal, upholding the WCJ's decision to deny a new QME panel. The applicant's attempt to obtain a new panel was deemed impermissible "doctor-shopping" by delaying objection to a late supplemental QME report until after receiving and reviewing it, and finding it favorable. The Board applied the principle that parties cannot exploit delays in medical reports for strategic advantage. Therefore, removal was denied as the conduct did not justify a new panel appointment.

Petition for RemovalQME panelmedical-legal reportdoctor-shoppinguntimely reportsupplemental reportobjectionwrit deniedAppeals Board panel decisionadministrative law judge
References
4
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