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Case Law Database

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. 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The Workers' Compensation Appeals Board (WCAB) granted reconsideration and rescinded a prior award, finding the medical evidence insufficient.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. ADJ16528931
Regular
Apr 25, 2025

Marisa Kelly vs. Sacramento County Child Protective Services, PSI, County of Sacramento

Defendant sought reconsideration of a Findings of Fact, Awards and Orders (F&O) issued on February 5, 2025, which found that the applicant, Marisa Kelly, sustained a work-related psychiatric injury. The defendant contended that the medical evidence supporting this finding, specifically from the Panel Qualified Medical Examiner (PQME), was not substantial. The Workers' Compensation Appeals Board, after reviewing the petition and the WCJ's report, determined that the PQME's reasoning clearly supported the causation of the applicant's temporary disability and need for medical treatment. The Board concluded that the PQME's use of 'exacerbation' instead of 'aggravation' was immaterial, and therefore, the petition for reconsideration was denied.

Workers' Compensation Appeals BoardSacramento County Child Protective ServicesMarisa KellyPetition for ReconsiderationFindings of Fact Awards and OrdersInjury Arising Out of and Occurring in the Course of EmploymentAOE/COEPsycheMedical EvidencePanel Qualified Medical Examiner
References
6
Case No. ADJ10335205
Regular
Feb 16, 2017

BARNARD VILLAR vs. STATE OF CALIFORNIA, CDCR, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board denied the applicant's Petition for Reconsideration. The Board found the medical opinion of the panel Qualified Medical Examiner (PQME) to be substantial medical evidence, based on an adequate examination and supported by reasoning. This opinion was relied upon by the workers' compensation administrative law judge. Consequently, the applicant's petition was denied.

Petition for ReconsiderationDeniedWorkers' Compensation Appeals BoardWCJ ReportAdopted and IncorporatedSubstantial Medical EvidenceReasonable Medical ProbabilityPanel Qualified Medical ExaminerPQMEBarry Gwartz M.D.
References
2
Case No. ADJ6552578
Regular
Sep 12, 2016

ARDELL MOORE vs. FASTRIP FOOD STORE, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board denied reconsideration of the decision regarding applicant Ardell Moore's permanent disability. The Board adopted the findings of the workers' compensation administrative law judge, who determined that the Panel Qualified Medical Examiner's (PQME) opinions on apportionment were not substantial medical evidence. The PQME's reports lacked sufficient reasoning and scientific basis to support conclusions regarding the apportionment of permanent disability between industrial and non-industrial causes, particularly concerning the applicant's obesity. Therefore, the Board found the PQME's apportionment opinions to be speculative and not in compliance with legal requirements for substantial evidence.

Permanent disabilityApportionmentCausationMedical opinionSubstantial evidencePanel Qualified Medical Examiner (PQME)Industrial causationNon-industrial causesPhysician's reasoningObesity
References
5
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. ADJ9319284
Regular
Jun 21, 2016

RYAN COPP vs. SCHIMMICK CONSTRUCTION COMPANY, AMERICAN CONTRACTORS INSURANCE GROUP

The Workers' Compensation Appeals Board denied the applicant's petition for reconsideration and dismissed their petition for removal. The WCAB affirmed the WCJ's decision that the applicant was not temporarily disabled, relying on the panel qualified medical examiner's (PQME) opinion as substantial evidence. The WCAB found the PQME's opinion persuasive regarding the applicant's permanent and stationary status and ability to return to usual work without restrictions, despite conflicting medical reports and the applicant's testimony. The WCAB also ruled that removal was an improper remedy as reconsideration was appropriate for a final order regarding temporary disability.

Petition for ReconsiderationPetition for RemovalTemporary DisabilityPermanent and Stationary DateQualified Medical Examiner (PQME)Panel Qualified Medical Examiner (PQME)Treating Physician (PTP)Res JudicataSubstantial EvidenceIndustrial Injury
References
6
Case No. MISSING
Regular Panel Decision

Equal Employment Opportunity Commission v. Grief Bros.

This employment discrimination case, filed July 1, 2002, involves Michael Sabo (Plaintiff) who alleges constructive discharge based on sexual harassment and claims severe emotional pain and suffering. The Defendant moved for a mental examination of Sabo under Fed.R.Civ.P. 35 and to compel the production of his medical records. Sabo alleged severe humiliation, anxiety, depression, loss of self-esteem, sleeplessness, and weight gain, and admitted to a history of depression, past suicide attempts, and current psychiatric treatment with prescribed medications. The court granted the Defendant's motions, finding that Sabo had placed his mental condition in controversy due to the nature and severity of his claims and his medical history, justifying both the examination and the production of relevant medical records. The court also granted Defendant's request for costs associated with compelling the medical records, but denied the request for costs related to the Rule 35 motion itself, and denied Plaintiff's request for counsel or recording during the examination.

Employment DiscriminationSexual HarassmentConstructive DischargeEmotional DistressMental ExaminationRule 35Medical RecordsDepressionSuicide AttemptsCompensatory Damages
References
11
Case No. ADJ8106886
Regular
Sep 12, 2013

HECTOR VAZQUEZ vs. DEUEL VOCATIONAL INSTITUTION, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board denied reconsideration of an administrative law judge's decision that applicant Hector Vazquez's heart disease was not industrially caused. The majority adopted the judge's report, noting a clerical error in identifying the medical examiner as an Agreed Medical Examiner (AME) instead of a Panel Qualified Medical Examiner, but found this did not affect the judge's analysis. Commissioner Brass dissented, arguing the record was undeveloped regarding job stress's contribution to the heart disease, and that the medical examiner's opinion was not substantial evidence to rebut the statutory presumption of industrial causation for correctional officers.

Workers' Compensation Appeals BoardPetition for ReconsiderationQualified Medical ExaminerAgreed Medical Examinerheart diseasejob stresscorrectional officerpresumptionrebuttalsubstantial evidence
References
3
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