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

Case No. ADJ8606940
Regular
Apr 18, 2013

ANGELICA PEREZ vs. PERMANENTE MEDICAL GROUP, INC.

The Workers' Compensation Appeals Board denied defendant's petition for removal or reconsideration regarding the applicant's entitlement to multiple Panel Qualified Medical Examiners (PQMEs). The defendant contested the procedural validity of the applicant's PQME requests, while the applicant asserted proper procedure was followed due to the defendant's lack of response to an Agreed Medical Examiner offer. The Board found that the February 4, 2013 notation was not a final order, as PQME requests remained pending with the Medical Unit. Therefore, the petition was denied without prejudice to the Medical Unit's future determination on the propriety of the PQME requests.

Panel Qualified Medical ExaminersPQMEPetition for RemovalPetition for ReconsiderationIndustrial InjuryCumulative InjuryAgreed Medical ExaminerAMEMedical UnitAdministrative Law Judge
References
0
Case No. ADJ9527444
Regular
May 23, 2018

, REYES P. HERNANDEZ, vs. , QUALI RUN RANCH; STATE COMPENSATION INSURANCE FUND; OMA OJAI PACIFIC; ZENITH INSURANCE COMPANY; ACE USA INSURANCE COMPANY, Administered By ESIS; MICHAEL AND JODY CROMER, Homeowners; STATE FARM INSURANCE,

The Workers' Compensation Appeals Board granted ESIS's Petition for Removal because the WCJ's order denying ESIS a panel Qualified Medical Evaluator (PQME) evaluation was found to cause significant prejudice and irreparable harm. ESIS was not a party to the original Agreed Medical Examiner (AME) agreement between the applicant and SCIF, and the WCJ's decision unfairly bound ESIS to the AME's findings and effectively closed ESIS's discovery rights. The Board rescinded the WCJ's decision and ordered a PQME evaluation for ESIS, recognizing the denial violated ESIS's due process rights.

Petition for RemovalQualified Medical EvaluatorAgreed Medical ExaminerDue ProcessSignificant PrejudiceIrreparable HarmDiscoveryFindings and OrderWorkers' Compensation Appeals BoardCumulative Trauma
References
6
Case No. ADJ8189240
Regular
Mar 04, 2013

MARY VAN RYN vs. BEJO SEEDS, INC., INSURANCE COMPANY OF THE WEST/EXPLORER INSURANCE COMPANY

The Workers' Compensation Appeals Board (WCAB) granted reconsideration and rescinded a prior award, finding the medical evidence insufficient. The WCAB determined that the Panel Qualified Medical Evaluator's (PQME) opinion, which formed the basis of the award for industrial injury, lacked substantial evidence. Specifically, the PQME's supplemental report was based on inadequate history and examination, failing to consider crucial factors like job activities and non-work history. The case is returned to the trial level for further development of the record, including potential re-evaluation by the PQME with a job analysis or examination by a regular physician.

WCABReconsiderationFindings and AwardPQMESubstantial EvidenceIndustrial InjuryCumulative TraumaMedical OpinionLabor Code Section 5701EDD Lien
References
6
Case No. ADJ10363674
Regular
Nov 17, 2016

RUBY BRADLEY vs. COUNTY OF SACRAMENTO DEPARTMENT OF HUMAN ASSISTANCE; Permissibly SelfInsured, Adjusted By COUNTY OF SACRAMENTO WORK COMP

The Workers' Compensation Appeals Board denied Ruby Bradley's petition for removal, upholding an order compelling her to attend a medical examination with a panel qualified medical evaluator (PQME). Bradley claimed due process violations regarding notice and a replacement PQME panel, but the Board found she failed to demonstrate significant prejudice or irreparable harm. The WCJ's report, incorporated by the Board, noted Bradley's own admission contradicted her claim of premature scheduling and highlighted a prior agreement to proceed with the original PQME. The Board also admonished Bradley's counsel for misleadingly omitting material facts, potentially constituting an abuse of the system.

Petition for RemovalCompelling AttendanceMedical ExaminationPanel Qualified Medical EvaluatorPQMEIndustrial InjuryNervous SystemPsychiatric InjuriesDue ProcessReplacement Panel
References
4
Case No. MISSING
Regular Panel Decision

Main Evaluations, Inc. v. State

The claimant, Main Medical Evaluations, entered into contracts with the New York State Office of Temporary and Disability Assistance (OTDA) to perform consultative medical evaluations. OTDA terminated these contracts, alleging the claimant failed to disclose professional disciplinary proceedings against its chief medical officer, Arvinder Sachdev, and submitted false information during the bidding process. Following the dismissal of its claim in the Court of Claims, the claimant appealed. The appellate court affirmed the lower court's judgment, concluding that OTDA had legitimate grounds for termination due to the claimant's misrepresentations and failure to report substantial contract-related issues concerning Sachdev's integral role. Additionally, the court rejected the claimant's equal protection argument, finding no evidence of selective enforcement based on impermissible considerations.

Contract TerminationProfessional MisconductFalse RepresentationEqual ProtectionGovernment ContractsAppellate ReviewBreach of ContractMedical LicensingAdministrative ProceedingsDue Diligence
References
5
Case No. ADJ7741851
Regular
Apr 22, 2013

SANDRA GALINDO vs. WARNER BROTHERS, INC.

Here's a summary of the case in four sentences for a lawyer: The defendant, Warner Brothers, seeks reconsideration of an order compelling payment for a panel Qualified Medical Evaluator's (PQME) second report, arguing it lacked substantial medical evidence. The Appeals Board denied reconsideration, adopting the WCJ's report which found no legal basis for the defendant's refusal to pay. The defendant's claims of inaccurate medical history in the PQME's report were unsubstantiated despite multiple opportunities to present evidence. The Board affirmed the obligation to pay the PQME's fees, penalties, and interest.

Panel QMEPetition for ReconsiderationOrder to PayMedical-legal costsSubstantial medical evidenceLabor Code Section 462260-day payment periodPenalty and interestFrivolous actionsDue process
References
6
Case No. ADJ6792760, ADJ9284465
Regular
May 11, 2016

VILMA ALEMAN vs. FREDERICK'S OF HOLLYWOOD, THE HARTFORD GROUP, NORTH RIVER INSURANCE COMPANY

The Workers' Compensation Appeals Board denied the defendant's Petition for Removal, upholding a prior order for a replacement Qualified Medical Evaluator (PQME). The Board found that the defendant failed to properly serve the applicant's attorney with the PQME panel notification, rendering the submitted medical reports inadmissible. This procedural defect meant the applicant was not afforded adequate time to strike a panel physician, thus violating statutory procedures. The Board emphasized that removal is an extraordinary remedy not to be granted without a showing of significant prejudice or irreparable harm.

Petition for RemovalJoint Findings and OrderPanel Qualified Medical EvaluatorPQMEDefective NoticeInadmissible Medical ReportsLabor Code Section 4062.2Improper ServiceAttorney NotificationStriking Process
References
2
Case No. ADJ11861160
Regular
Oct 25, 2019

ADRIANA MARTINEZ vs. AVITUS, AMERICAN ZURICH INSURANCE COMPANY, GALLAGHER BASSETT SERVICES

This case involves a dispute over the selection of Qualified Medical Evaluator (QME) panels for an applicant with claimed injuries to multiple body parts. The Workers' Compensation Appeals Board (WCAB) granted the applicant's petition for removal, rescinded the prior decision, and found that the applicant's chiropractic QME panel request was proper while the defendant's orthopedic surgery panel request was improper. The WCAB determined that chiropractic medicine is the appropriate specialty and struck the orthopedic surgery panel, ordering the parties to proceed with the chiropractic QME. The WCAB clarified that while chiropractors cannot perform surgery or prescribe medication, they are qualified to evaluate injuries within their scope of practice.

QME panel disputeremoval petitionchiropractic specialtyorthopedic surgery specialtyLabor Code 4062.2Medical Directoradministrative law judgeWorkers' Compensation Appeals Boardproper panel selectioninvalid panel request
References
9
Case No. ADJ7253987
Regular
Jun 29, 2012

Anna Medel vs. Employment Development Department, State Compensation Insurance Fund

The defendant sought reconsideration of an order granting the applicant a new Qualified Medical Evaluator (PQME). The defendant argued their communication with the PQME was not an ex parte violation and that the objection was untimely. The Board dismissed the reconsideration petition, finding the order was procedural, not final. The Board denied the removal petition, agreeing that the defendant's communication violated Labor Code Section 4062.3 by failing to serve the applicant 20 days prior to the PQME evaluation. Therefore, the applicant was correctly awarded a new PQME panel.

Workers' Compensation Appeals BoardPanel Qualified Medical EvaluatorPQMESection 4062.3Ex Parte CommunicationReconsiderationRemovalCumulative Trauma InjuryCervical SpineBilateral Upper Extremities
References
15
Case No. ADJ9163494, ADJ9163491
Regular
Dec 28, 2015

RIGOBERTO NORIEGA vs. BEST WESTERN TOWN AND COUNTRY

The Workers' Compensation Appeals Board granted reconsideration and rescinded the original decision due to an inadequate medical report from the panel qualified medical evaluator (PQME). The PQME's opinion was based on incomplete medical records, including a failure to review records related to the applicant's cancer treatment, and did not adequately address the applicant's claimed injuries or permanent disability according to AMA Guides. The case is returned to the trial level for further development of the medical record, including the potential appointment of a regular physician and consideration of a videotape of the injury.

Workers' Compensation Appeals BoardReconsiderationPanel Qualified Medical EvaluatorSubstantial Medical EvidenceCumulative Trauma InjuryIndustrial InjuryPermanent DisabilityFuture Medical TreatmentMedical Record DevelopmentAgreed Medical Evaluator
References
0
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