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

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 The Workers' Compensation Appeals Board (WCAB) granted the applicant's petition for removal, rescinded the prior decision, and found that the applicant's chiropractic QME panel request was proper while the defendant's orthopedic surgery panel request was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
Case No. ADJ7712746
Regular
Dec 08, 2015

Glen Rizuto vs. United Parcel Service, Gallagher Bassett

The Appeals Board granted UPS's Petition for Removal, rescinding the WCJ's order to negotiate a QME selection. The Board found the WCJ erred by not addressing UPS's contentions regarding the validity of the second QME panel issued over 24 months after the first. UPS successfully argued they would be prejudiced if forced to negotiate when the second panel was allegedly the only valid one. The Board ordered parties to select a QME from the July 2, 2014 panel, allowing each to strike one name.

Petition for RemovalQualified Medical Evaluator (QME)Panel SelectionCumulative Trauma InjuryLabor Code Section 4062.1Labor Code Section 4062.2Romero v. Costco WholesaleIrreparable HarmPrejudiceMedical Unit
References
Case No. ADJ8074524
Regular
Jan 17, 2013

Geoconda Acevedo vs. Reliable Caregivers, PEGASUS RISK MANAGEMENT

The Appeals Board dismissed the defendant's petition for reconsideration because the selection of a Qualified Medical Evaluator (QME) is not a final order. However, the Board granted removal to address issues with defective QME panels. The Board rescinded the prior award and ordered the WCJ to appoint a regular physician if the parties cannot agree on an Agreed Medical Examiner. This action aims to resolve the ongoing delays and procedural defects in selecting a QME for the applicant's evaluation.

QME panelremovalagreed medical examinerpanel qualified medical evaluatorWCJ authoritylabor code section 5701substantive right or liabilityprimary treating physicianindustrial injuryreconsideration
References
Case No. ADJ3006371 (LAO 0888849)
Regular
Aug 10, 2012

AMARILIS NAVARRO-PEREZ vs. THE CHEESECAKE FACTORY BAKERY, ZURICH AMERICAN INSURANCE CO.

The Workers' Compensation Appeals Board denied the defendant's petition for removal. The defendant sought to rescind an order requiring a new panel of Qualified Medical Evaluators (QMEs). The administrative law judge found that neither party properly complied with Labor Code section 4062.2(c) regarding QME selection. Removal is an extraordinary remedy requiring a showing of substantial prejudice or irreparable harm, which the defendant failed to demonstrate. Therefore, the defendant's petition was denied.

Workers' Compensation Appeals BoardPetition for RemovalQualified Medical EvaluatorsAgreed Medical EvaluatorLabor Code section 4062.2(c)striking from panelsubstantial prejudiceirreparable harmreconsiderationQME panel
References
Case No. ADJ7199986 ADJ7399845
Regular
Oct 03, 2011

ELMIRA SMITH vs. PACIFIC AUTISM CENTER FOR EDUCATION, TRI- STAR RISK MANAGEMENT

The applicant sought removal to challenge a finding that defendant's requested Qualified Medical Evaluator (QME) panel was properly assigned. The Appeals Board granted removal, rescinded the finding, and determined that *neither* panel was properly assigned. Both panel requests were found to be premature as they were made before the statutory 10-day period for agreeing on an Agreed Medical Evaluator had expired, plus an additional five days for mail service. This decision clarifies the timing requirements for QME panel requests following an unsuccessful attempt to select an AME.

Petition for RemovalQualified Medical Evaluator (QME)Agreed Medical Evaluator (AME)Labor Code section 4062.2(b)WCAB Rule 10507Messele v. Pitco FoodsInc.Premature RequestPanel AssignmentMedical Unit
References
Case No. ADJ19432813; ADJ19432814
Regular
Mar 24, 2025

Yeni Saenz vs. Kellermeyer Bergensons Services, LLC; Zurich American Dallas

Applicant Yeni Saenz sought reconsideration of a Workers' Compensation Administrative Law Judge's (WCJ) finding that her strike from a Qualified Medical Evaluator (QME) panel was untimely, granting the defendant the right to select the QME. The Workers' Compensation Appeals Board granted the petition for reconsideration, concluding that although the applicant's strike was indeed untimely, the defendant had subsequently waived its right to exclusively select a QME by failing to act within a reasonable time. Consequently, the Board rescinded the WCJ's decision and ordered the parties to proceed with Dr. Patrick S. Hill as the designated Qualified Medical Evaluator. Commissioner José H. Razo issued a dissenting opinion, arguing that the applicant had obfuscated the untimeliness of her strike and scheduled an appointment during the period when the defendant held the exclusive right to selection.

QME PanelUntimely StrikeLabor Code Section 4062.2WaiverTimely SelectionReconsiderationJoint Findings and OrderWCJAppeals BoardPetition for Reconsideration
References
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
Case No. ADJ10334253
Regular
Jun 06, 2017

TERESA CAMBEROS vs. LYON, ET AL., DBA TACO BELL, CYPRESS INS. CO.

The applicant sought reconsideration of a WCJ's order requiring compliance with Labor Code section 4062.2 for selecting a new QME panel now that she is represented by counsel. The Appeals Board dismissed the reconsideration petition as the order was procedural, not final. The Board also denied the petition for removal, finding no irreparable harm or prejudice, and affirming that represented workers must use the section 4062.2 striking process for new QME panels.

Workers' Compensation Appeals BoardQualified Medical EvaluatorQMEPetition for ReconsiderationPetition for RemovalLabor Code Section 4062.2Labor Code Section 4062.1Final OrderInterlocutory OrderMedical-Legal Evaluation
References
Case No. ADJ7232076
Regular
Nov 22, 2011

TSEGAY MESSELE vs. PITCO FOODS, INC., CALIFORNIA INSURANCE COMPANY

This case concerns a prior en banc decision that clarified timelines for selecting Agreed Medical Evaluators (AMEs) and Qualified Medical Evaluator (QME) panels. Due to confusion and potential for reopening cases, the Appeals Board granted reconsideration on its own motion. The Board ultimately modified its prior decision to apply prospectively from September 26, 2011, preventing challenges to previously obtained QME panels based on prematurity unless timely objected to before that date. This modification aims to avoid widespread reopening and preserve settlements based on prior interpretations.

WCABen bancreconsiderationprospective applicationQME panelagreed medical evaluatorAMEprematurityLabor Code section 4062.2(b)DWC Newsline
References
Case No. ADJ7232076
En Banc
Sep 26, 2011

Tsegay Messele vs. Pitco Foods, Inc.; California Insurance Company

The Appeals Board holds that the 10-day period for agreeing on an AME under Labor Code § 4062.2(b) is extended by five days when the initial proposal is served by mail, and clarifies the method for calculating this time period, finding both parties' panel requests premature.

Workers' Compensation Appeals BoardTsegay MesselePitco FoodsInc.California Insurance CompanyADJ7232076Opinion and Decision After ReconsiderationOrder Granting RemovalDecision After RemovalEn Banc
References
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