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Case Law Database

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

Case No. ADJ7532290
Regular
Aug 28, 2012

MAXINE BROWN VIRGIL vs. LUNCH STOP, INC., EMPLOYERS COMPENSATION INSURANCE

This case involves a dispute over obtaining a Qualified Medical Evaluator (QME) panel. The applicant requested a new panel because a QME on the initial panel could not provide an appointment within 60 days. However, the applicant failed to properly strike a physician from the original panel after the defendant did. As a result, the defendant was authorized to schedule an appointment with a remaining physician, and the applicant was not entitled to a new QME panel. The Appeals Board granted removal to amend the prior order to reflect a rescheduled appointment with the original QME.

Workers' Compensation Appeals BoardPetition for RemovalQualified Medical EvaluatorpanelstrikeLabor Code section 4062Administrative Director Rule 31.5section 4062.2(c)medical evaluatorappointment
References
1
Case No. ADJ11350784
Regular
Jan 13, 2020

LUIS RODRIGUEZ vs. BRAD NYMAN DBA LIVE OAK DAIRY, ZENITH INSURANCE COMPANY

This case concerns a workers' compensation applicant challenging a finding that he waived his right to a replacement Qualified Medical Evaluator (QME) panel. The applicant requested a replacement panel after the initially appointed QME could not schedule an exam within 60 days, but the exam was ultimately scheduled within 90 days. The Workers' Compensation Appeals Board denied the applicant's petition, finding that by accepting an appointment within the 90-day window, he waived his right to a replacement panel. The Board also found the applicant's due process claims unpersuasive, as he had a full opportunity to litigate the issue.

QME panel disputewaiver of replacement panelAOE/COEdue processthreshold issueinterlocutory decisionremoval standardirreparable harmsignificant prejudiceAD Rule 31.3
References
5
Case No. ADJ9606568
Regular
Oct 12, 2017

Rodrigo Bautista vs. SA RECYCLING, CORVEL CORPORATION

The Workers' Compensation Appeals Board affirmed a prior decision, amending it only to correct a clerical error regarding injured body parts. The defendant sought reconsideration, arguing they were entitled to a replacement Qualified Medical Evaluator (QME) panel due to an incorrect address being used for appointment notification to their attorney. The Board found that this de minimis error did not warrant a replacement panel, especially since the insurer received proper notice and the defendant otherwise participated in discovery with the QME. Therefore, the original finding that the defendant was not entitled to a replacement QME panel was upheld.

WCABReconsiderationQME PanelAppointment NoticeClerical ErrorDe Minimis MistakeAOE/COEFindings and OrderPetition for ReconsiderationMedical Unit
References
5
Case No. ADJ1692556 (STIK 0207020) ADJ2977889 (STK 0208240)
Regular
Aug 06, 2009

CATHY HAWKINS vs. SUTTER HEALTH CORPORTION (dba) SUTTER TRACY COMMUNITY HOSPITAL

The Workers' Compensation Appeals Board (WCAB) granted removal and reversed a WCJ's order to appoint a new QME. The WCAB found the WCJ erred in concluding the applicant was entitled to a new QME panel for a slight delay in scheduling an examination. They reasoned that the applicant's allegations did not definitively prove Dr. Choi "could not" schedule an earlier appointment or that a waiver was violated. The WCAB determined that requiring a new QME process for minor scheduling delays, especially with an established QME, would be wasteful.

Petition for removalQualified Medical Evaluator (QME)60-day time limitappointment schedulingwaiverprejudiceirreparable harmfinal orderreconsiderationsubstantiative issue
References
4
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
Case No. ADJ7087412; ADJ7087413
Regular
Feb 19, 2014

MARCOS MORALES vs. THE KROGER CO. dba RALPH'S; SEDGWICK CMS

This case concerns a dispute over the selection of a Qualified Medical Evaluator (QME) to determine industrial injuries related to diabetes and cardiovascular issues. The defendant, Kroger Co., objected to the WCJ's order for a replacement QME panel in internal medicine, arguing they had selected endocrinology and would be prejudiced. The Appeals Board granted the defendant's Petition for Removal, finding the WCJ erred by ordering a QME panel after trial when the parties had waived their right to that procedure. The Board rescinded the WCJ's order and remanded the case with instructions for the WCJ to appoint a "regular physician" to develop the medical record.

Petition for RemovalQualified Medical Evaluator (QME)Agreed Medical Evaluator (AME)Regular PhysicianLabor Code Section 4062.2Medical Record DevelopmentVocational Produce WorkerDiabeticCardiovascularWaiver
References
2
Case No. ADJ6502775, ADJ6498620, ADJ8109003, ADJ8115890
Regular
May 09, 2014

MARIA POHYAR vs. DEY LP, AMERICAN ZURICH INSURANCE COMPANY, LIBERTY MUTUAL INSURANCE COMPANY

The Workers' Compensation Appeals Board (WCAB) dismissed the applicant's Petition for Reconsideration because the challenged order was not a "final order" subject to reconsideration. The WCAB also denied the Petition for Removal, agreeing with the Administrative Law Judge that the issue of whether the defendant Zurich is entitled to a new Qualified Medical Evaluator (QME) panel was only before the WCJ based on a procedural rule regarding appointment notification forms, not ex parte communications. The WCAB clarified that issues of ex parte communications and the applicability of related statutes and rules were not yet properly before the Board. Therefore, the applicant's request for the WCAB to assert jurisdiction and rule against Zurich on the QME panel issue was denied.

Workers' Compensation Appeals BoardPetition for ReconsiderationPetition for RemovalJurisdictionQualified Medical Evaluator (QME)Panel QMEDivision of Workers' Compensation (DWC) RulesLabor Code section 4062.3Ex parte communicationMedical Director
References
7
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. ADJ9 636706; ADJ9636707 ADJ9447837
Regular
Aug 09, 2016

RICK PARKER vs. DSC LOGISTICS, ZURICH NORTH AMERICA

This case concerns whether a Qualified Medical Evaluator (QME) must address all claimed industrial injuries filed prior to their initial evaluation. The Workers' Compensation Appeals Board (WCAB) rescinded a prior order that denied the defendant's petition to vacate new QME panels. The WCAB held that Labor Code section 4062.3(j) requires a QME to evaluate all contested medical issues arising from injuries reported on one or more claim forms prior to the employee's initial appointment. Therefore, the applicant must return to the original QME, Dr. Steinmann, to evaluate the disputed medical issues in all relevant case numbers.

Workers' Compensation Appeals BoardReconsiderationPetition to Vacate QME PanelsLabor Code section 4062.3Qualified Medical EvaluatorPanel QMEDuplicative Medical EvaluationsDoctor ShoppingNavarro v. City of MontebelloContested Medical Issues
References
1
Case No. ADJ12550205
Regular
Apr 06, 2020

OLGA PLASCENCIA vs. ADECCO USA, INC

This case involves a dispute over a Qualified Medical Evaluator (QME) panel request. The applicant sought a chiropractic QME panel, while the defendant later denied liability for certain injuries. The Workers' Compensation Appeals Board (WCAB) rescinded the prior ruling and returned the case to the trial judge. This decision was based on the need to further develop the record regarding the applicant's DWC-1 form filing and the effect of the defendant's partial acceptance of liability on the QME panel process. The WCAB emphasized that the validity of the QME panel needs resolution before further proceedings.

Workers' Compensation Appeals BoardReconsiderationFindings and OrderDelay LetterMedical EvaluationQME PanelChiropracticOrthopedicLabor Code Section 4060Causation Dispute
References
5
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