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

Case No. ADJ8045455; ADJ8045600
Regular
Sep 14, 2012

ELSIE PENA CLARK ROSAS vs. SUTTER GENERAL HOSPITAL, SUTTER HEALTH

Here's a summary for a lawyer: The Workers' Compensation Appeals Board denied the defendant's Petition for Removal, which sought to compel applicant's examination by the same Qualified Medical Examiner (QME) for two distinct injuries. The Board affirmed the WCJ's decision, holding that separate QME panels are permissible for distinct injuries to different body parts. This ruling establishes that a second injury does not constitute a "new medical issue" or a "follow-up/supplemental evaluation" requiring the original QME. Therefore, the applicant is entitled to a new QME panel for the second injury.

Petition for RemovalPQMEMedical Unitdistinct injuriesbody partsnew medical issuefollow-up evaluationsupplemental evaluationsecond panel of QMEsLabor Code section 4062.3(j)
References
0
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 The Appeals Board granted removal, rescinded the order for a new QME panel, and returned the matter for further development of the record.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. ADJ7436407, ADJ1895040 (FRE 0238028)
Regular
Feb 04, 2015

Colleen Newby vs. Fresno Community Medical Center, St. Agnes Medical Center, State Compensation Insurance Fund

The Workers' Compensation Appeals Board denied Colleen Newby's Petition for Removal, upholding the denial of her petition to quash a Qualified Medical Evaluator (QME) request. The Board found that the prior employer, Fresno Community Medical Center, was authorized to file an application for adjudication of claim for Newby's subsequent employment with St. Agnes Medical Center. Crucially, the Board determined that a claim form is not a prerequisite for St. Agnes to request a QME panel in this specific scenario, where a second injury is claimed by a prior employer. Newby's due process claim was rejected as she had an opportunity to present her arguments on removal.

Petition for RemovalPetition to QuashQME RequestQualified Medical EvaluatorClaim FormDue ProcessAgreed Medical EvaluatorApplication for AdjudicationTemporary DisabilityPermanent Disability
References
1
Case No. ADJ9683216
Regular
Sep 30, 2016

DUNIA DE LA CRUZ vs. SOOD ENTERPRISES, INC. dba JACK IN THE BOX, SECURITY NATIONAL INSURANCE COMPANY ADMINISTERED BY AMTRUST NORTH AMERICA

The Workers' Compensation Appeals Board (WCAB) denied defendant's petition for reconsideration and dismissed its petition for removal. The WCAB found that an additional Qualified Medical Examiner (QME) panel in rheumatology was appropriate to further develop the medical record on causation, as recommended by the initial orthopedic QME. Defendant argued the WCJ erred by ordering this without first determining applicant's credibility and AOE/COE, but the Board deemed the need for a rheumatological evaluation a critical issue justifying reconsideration. Therefore, the WCAB upheld the WCJ's order for an additional QME panel.

QME panelrheumatologyAOE/COEcredibilitymedical causationdepositionsupplemental evaluationgood causethreshold issuesreconsideration
References
17
Case No. ADJ6597934
Regular
Apr 23, 2010

BEVERLY WASHINGTON vs. COUNTY OF LOS ANGELES, Permissibly Self-Insured, c/o ACCLAMATION INSURANCE MANAGEMENT SERVICES

The Workers' Compensation Appeals Board dismissed the defendant's petition for reconsideration because it was filed from an interlocutory order. However, the Board granted removal, rescinded the WCJ's finding that the defendant was not entitled to a Qualified Medical Examiner (QME) panel, and returned the matter for further proceedings. This was based on the reasoning that the defendant had a right to a QME panel under Labor Code section 4060 and relevant regulations, particularly as the defendant properly requested the panel before a potentially conflicting administrative rule became effective and before the 90-day rejection period expired. The Board found the WCJ's order prejudiced the defendant's ability to obtain medical evidence on the compensability of the claim.

Workers' Compensation Appeals BoardPermissibly Self-InsuredQualified Medical ExaminerQME panelLabor Code Section 4060Administrative Director Rule 30AOE/COEremovalFindings of Factrescinded
References
12
Case No. ADJ18724961; ADJ15255319
Regular
Nov 03, 2025

Tina Garza vs. County of Kern

Defendant County of Kern sought reconsideration of a WCJ's Findings of Fact and Discovery Order which determined that Dr. Scott Graham was the Agreed Medical Evaluator (AME) for both claims and that defendant waived its right to a Qualified Medical Evaluator (QME) examination. The defendant argued that the waiver finding was improper and they were entitled to a new medical-legal evaluation panel. The Appeals Board granted reconsideration, rescinded the WCJ's decision, and returned the matter for further proceedings, primarily due to an inadequate record and deficiencies in the minutes of hearing. The Board also noted that based on current Labor Code interpretations, the parties' agreement to an AME once initiated, generally precludes subsequent QME panel requests for submitted issues.

Workers' Compensation Appeals BoardPetition for ReconsiderationAgreed Medical Evaluator (AME)Qualified Medical Evaluator (QME)Panel QMEMedical-Legal ExaminationWaiver of RightLabor Code Section 4062.2Labor Code Section 4062.3Navarro v. City of Montebello
References
9
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. 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. 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. 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
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