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Case Law Database

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

Case No. ADJ8835727
Regular
Oct 05, 2015

ELVIRA MAYA vs. WENTE VINEYARDS, ZENITH INSURANCE COMPANY

This case concerns the timeliness of a defendant's strike of a Qualified Medical Evaluator (QME) panel. The Appeals Board determined that the ten-day period to strike a QME from a panel, as per Labor Code section 4062.2(c), is extended by five days when service is by U.S. mail, consistent with Code of Civil Procedure section 1013(a). Consequently, the defendant's strike of Dr. Boyd was deemed timely, and the applicant must now be examined by the remaining panel member, Dr. Gardner. The prior WCJ decision finding the strike untimely was rescinded.

WCABReconsiderationRemovalPetition for RemovalPetition for ReconsiderationPQMEPanel QMELabor Code section 4062.2(c)Code of Civil Procedure section 1013(a)WCAB Rule 10507(a)(1)
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 The Appeals Board granted removal, rescinded the WCJ's order, and remanded the case.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
Case No. ADJ9287010
Regular
Oct 22, 2015

Esther Rodriguez vs. MANUEL VILLA ENTERPRISE, NORGUARD INSURANCE COMPANY

The Workers' Compensation Appeals Board granted the applicant's petition for removal, reversing a previous order that deemed her strike from a Qualified Medical Evaluator (QME) panel untimely. The Board found that the applicant's strike was timely under Labor Code section 4062.2(c) and Code of Civil Procedure section 1013(a), which extends the 10-day striking period by five days when the panel assignment is mailed. Consequently, Dr. James Shaw was designated as the proper QME, and the WCJ's prior order was rescinded.

Petition for RemovalQME paneluntimely strikesubstantial prejudiceirreparable harmLabor Code section 4062.2(c)Senate Bill 863Messele v. Pitco FoodsInc.Agreed Medical Evaluator
References
7
Case No. ADJ19417386
Regular
Mar 17, 2025

LOURDES AVILA vs. PRIORITY WORKFORCE, MVP PAYROLL FINANCING, LLC, SUNZ INSURANCE COMPANY

The Workers' Compensation Appeals Board denied the defendant's Petition for Removal regarding a WCJ's order to replace a Qualified Medical Evaluator (QME) panel. The defendant argued that their due process rights were violated and that they were entitled to an additional strike due to an initial double strike of a QME. The Board found that removal is an extraordinary remedy, and the petitioner failed to demonstrate substantial prejudice or irreparable harm. They upheld the WCJ's decision, emphasizing that the subsequent strikes by both parties were untimely and the order to obtain a replacement panel did not determine substantive rights.

Removal PetitionPanel StrikesQualified Medical EvaluatorIrreparable AmbiguityDue ProcessMailbox RuleTimelinessLabor Code Section 4062.2(c)Agreed Medical EvaluatorAlvarado v. WCAB
References
4
Case No. ADJ8381652
Regular
Feb 07, 2014

CARLOS CABRERA RAZO vs. LAS POSAS COUNTRY CLUB, HARTFORD INSURANCE CO.

This case concerns the timeliness of an applicant's strike from a Qualified Medical Evaluator (QME) panel. The Appeals Board vacated its previous grant of reconsideration, dismissed the defendant's Petition for Reconsideration, and denied their Petition for Removal. The Board determined that Labor Code section 4062.2, as amended by SB 863 effective January 1, 2013, applies to pending matters, including this case with a 2012 date of injury. Applying the amended statute and Code of Civil Procedure section 1013(a), the applicant had 15 days from the Administrative Director's assignment of the QME panel to strike a name. The applicant's strike on the 12th day was therefore timely, affirming the Workers' Compensation Judge's decision.

Workers' Compensation Appeals BoardQualified Medical EvaluatorPetition for ReconsiderationPetition for RemovalLabor Code Section 4062.2(c)Senate Bill 863Administrative DirectorCumulative Trauma InjuryQME Panel AssignmentCode of Civil Procedure 1013
References
6
Case No. MISSING
Regular Panel Decision

In re the Claims of Noss

Claimants, employees of Lawrence Aviation Industries, Inc. and union members, commenced a strike in 1984. During the strike, they received weekly strike benefits from their union and later unemployment insurance benefits. The employer challenged these benefits, arguing that strike benefits were contingent on performing union duties, making claimants not 'totally unemployed,' and alleged willful misrepresentation. Both the Administrative Law Judge and the Unemployment Insurance Appeal Board found that the strike benefits were not conditional and no misrepresentation occurred. The appellate court affirmed the Board's decision, emphasizing that strike benefits not conditioned on services are not considered remuneration under 12 NYCRR 490.2 (b) and that the Board's factual findings, supported by substantial evidence, should not be disturbed.

Unemployment BenefitsStrike BenefitsTotal UnemploymentWillful MisrepresentationLabor UnionAdministrative LawJudicial ReviewSubstantial EvidenceConditional PaymentsNew York Labor Law
References
4
Case No. MISSING
Regular Panel Decision
Feb 28, 1977

Staten Island Rapid Transit Operating Authority v. International Brotherhood of Electrical Workers, Local 922

This case involves an appeal from a judgment that enjoined unions representing employees of the Staten Island Rapid Transit Operating Authority (SIRTOA) from striking. SIRTOA, a public benefit corporation operating a commuter rail line in New York, argued that its employees, as public employees, are prohibited from striking under the New York State Taylor Law. The defendant unions contended they were governed by the federal Railway Labor Act, which permits strikes. The court affirmed the injunction, determining that SIRTOA's minimal connection to interstate commerce, primarily a single daily freight run, was outweighed by the State's compelling interest in preventing public employee strikes and ensuring essential commuter rail service for Staten Island residents.

Strike InjunctionPublic EmployeesRailway Labor ActTaylor LawInterstate CommerceState SovereigntyCommuter RailCollective BargainingNew York State LawFederal Preemption
References
7
Case No. G107 435
Regular Panel Decision
Jun 02, 2023

Matter of Marku v. ABM Industries

This case concerns the claim of Denise Perry under the Workers' Compensation Law. The Workers' Compensation Law Judge (WCLJ) previously found that the employer, Adventist Home Care, established a violation of Workers' Compensation Law § 114-a by the claimant for willfully making false statements to obtain benefits. Consequently, the WCLJ disallowed indemnity benefits and imposed both mandatory and discretionary penalties. A Board Panel decision filed on February 17, 2022, affirmed the WCLJ's findings. The claimant subsequently filed an application for reconsideration on March 18, 2022, which the Board Panel reviewed. After considering the claimant’s arguments, the Board Panel determined that the application did not raise new issues or present new material evidence, nor did it demonstrate an erroneous statement of material fact or law in the prior decision. Therefore, the Board Panel, by a majority vote, affirmed its prior decision.

Workers' Compensation FraudFalse RepresentationIndemnity Benefits DisallowanceWCL § 114-a PenaltyApplication for Reconsideration DeniedBoard Panel AffirmationWillful MisrepresentationWorkers' Compensation Law Judge DecisionEmployer Established Violation
References
0
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. ADJ11139513
Regular
Jul 23, 2018

TEMPE EVERSON vs. STATE OF CALIFORNIA, CTF SOLEDAD, STATE COMPENSATION INSURANCE FUND

This case concerns the proper Qualified Medical Evaluator (QME) panel selection after an applicant became represented by an attorney. Initially unrepresented, applicant received QME panel #2194142, but no evaluation occurred before she retained counsel. A new panel, #2200955, was issued for represented cases, from which applicant timely struck a physician. However, the defendant's strike from this second panel was found to be untimely. The Appeals Board granted removal, amended the prior order, and directed the parties to proceed with an evaluation by Dr. Scheinbaum from the second panel, deeming it the appropriate one.

Petition for RemovalQualified Medical Evaluator (QME) panelrepresented vs. unrepresentedtimely strikeRomero v. CostcoLabor Code section 4062.1Labor Code section 4062.2Code of Civil Procedure section 1013Razo v. Las Posas Country Clubcomprehensive medical-legal evaluation
References
3
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