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Case Law Database

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

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. 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. ADJ12080707
Regular
Sep 04, 2019

MICHAEL OLAGUE vs. CITY SECURITY COMPANY, NATIONAL LIABILITY & FIRE INSURANCE COMPANY

The Appeals Board granted applicant's petition for removal, rescinding the trial judge's order to take the case off calendar. The applicant requested additional Qualified Medical Evaluator (QME) panels, but the judge deferred this due to pending AOE/COE issues and an initial QME exam being set. The Board found that Labor Code section 5502 mandates an expedited hearing for disputes involving medical-legal examinations, entitling the applicant to a hearing on the request for additional panels. The case is returned to the trial level for further proceedings, potentially including placement back on the expedited hearing calendar.

Petition for RemovalExpedited HearingAOE/COEInitial Physical AggressorQualified Medical Evaluator (QME)PQME panelsMedical-legal evaluationLabor Code Section 5502Off-calendarRescind Order
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. 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
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. ADJ6816825
Regular
Jun 14, 2010

KAI CHRISTOPHER vs. TIME WARNER CABLE, ESIS

The Appeals Board granted defendant's petition for removal, finding the WCJ erred in denying a QME panel request. This denial was based on Administrative Director Rule 30(d)(3), which previously stated only the employee could request a QME panel after a total denial of injury. However, the Board's recent en banc decision in *Mendoza v. Huntington Hospital* invalidated this rule as conflicting with Labor Code sections 4060(c) and 4062.2, which allow either party to request a QME panel. Therefore, the prior order was rescinded, and the matter returned to the trial level with instructions to issue a QME panel.

Petition for RemovalQualified Medical Evaluator (QME)Administrative Director RuleInvalid RuleMendoza v. Huntington HospitalLabor Code sections 4060(c)Labor Code sections 4062.2Denial of InjuryEither Party RequestMedical Director
References
1
Case No. ADJ11446545
Regular
Dec 03, 2019

ROSA LOPEZ RODRIGUEZ vs. UNIVERSAL BUILDING SERVICES SUPPLY COMPANY, INSURANCE COMPANY OF THE WEST

This case concerns a dispute over the appropriate medical specialty for a Qualified Medical Evaluator (QME) panel. The applicant, Rosa Lopez Rodriguez, initially requested a chiropractic QME panel, which was issued first. The defendant objected, arguing that chiropractic was inappropriate due to the applicant's prior surgery and lack of full recovery. The Medical Unit then invalidated the chiropractic panel and issued an orthopedic surgery panel. The Workers' Compensation Appeals Board granted reconsideration, overturning the WCJ's decision. The Board held that the party who first requests a QME panel has the right to designate the specialty and that the defendant failed to provide sufficient grounds to invalidate the chiropractic panel. Therefore, the Board amended the findings to sustain the applicant's objection and affirm chiropractic as the appropriate panel specialty.

AD Rule 31.5(a)(10)AD Rule 31.5(a)(9)AD Rule 31.1(b)Labor Code section 4062Labor Code section 4062.2Qualified Medical Evaluator (QME)QME panel specialtyPetition for RemovalPetition for ReconsiderationMedical Unit determination
References
1
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. 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
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