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

Case No. ADJ6627019
Regular
May 06, 2013

SANDRA BERKENSTOCK vs. AGILENT TECHNOLOGIES

The defendant sought reconsideration of an order denying their request for a replacement Qualified Medical Evaluator (QME) panel in psychiatry/psychology. The applicant sustained industrial injuries including to her psyche. The administrative law judge denied the replacement panel because the QME's report was eventually received. However, the Workers' Compensation Appeals Board dismissed the defendant's petition. The Board ruled that the denial of a replacement QME panel is an interim, procedural order not subject to reconsideration under Labor Code section 5900(a).

WCABAgilent TechnologiesADJ6627019Petition for ReconsiderationQualified Medical EvaluatorQME panelpsychiatrypsychologyFlorence Thomas-RiddleLabor Code section 139.2(j)(1)(A)
References
7
Case No. ADJ9606568
Regular
Oct 12, 2017

Rodrigo Bautista vs. SA RECYCLING, CORVEL CORPORATION

The Workers' Compensation Appeals Board affirmed a prior decision, amending it only to correct a clerical error regarding injured body parts. The defendant sought reconsideration, arguing they were entitled to a replacement Qualified Medical Evaluator (QME) panel due to an incorrect address being used for appointment notification to their attorney. The Board found that this de minimis error did not warrant a replacement panel, especially since the insurer received proper notice and the defendant otherwise participated in discovery with the QME. Therefore, the original finding that the defendant was not entitled to a replacement QME panel was upheld.

WCABReconsiderationQME PanelAppointment NoticeClerical ErrorDe Minimis MistakeAOE/COEFindings and OrderPetition for ReconsiderationMedical Unit
References
5
Case No. ADJ6794293
Regular
Jul 29, 2011

SHARON HIRONYMOUS vs. CENTRAL ANESTHESIA SERVICE, EMPLOYERS COMPENSATION INSURANCE COMPANY

The Workers' Compensation Appeals Board dismissed the defendant's petition for reconsideration of an order allowing a replacement QME panel. The Board granted removal, rescinded the order, and ruled the applicant was not entitled to a replacement QME. This decision was based on the applicant's failure to object to the QME's conduct during the examination itself, instead waiting until after reviewing the QME's report. Allowing a replacement panel under these circumstances was deemed prejudicial to the defendant.

QMEreplacement panelPetition for ReconsiderationPetition for Removalindustrial injurycarpal tunnel syndromeAdministrative Law JudgeQualified Medical Evaluator Complaint FormTitle 8 California Code of Regulationsinterlocutory procedural order
References
16
Case No. ADJ9834159 (MF) ADJ9834161
Regular
Jul 30, 2018

ESAU HERNANDEZ vs. D.L. BONE AND SONS PAINTING, ICW GROUP/EXPLORER INSURANCE COMPANY, STATE COMPENSATION INSURANCE FUND

This case concerns a defendant's attempt to obtain a replacement Qualified Medical Evaluator (QME) panel after the applicant initially objected to the timeliness of the original QME's report. The Appeals Board treated the defendant's petition as one for removal and denied it. The Board found that the defendant, having failed to timely object to the QME's report itself, could not rely on the applicant's subsequent objection to request a new panel. The Board concluded that the defendant's failure to act promptly meant they were not entitled to a replacement QME panel, and no substantial prejudice or irreparable harm warranting removal was demonstrated.

Workers' Compensation Appeals BoardReconsiderationRemovalQualified Medical EvaluatorQME panelAdministrative Director RuleTimeliness objectionReplacement QME panelLabor CodeFindings of Fact
References
1
Case No. ADJ11230683, ADJ11233335
Regular
Sep 04, 2019

WANDA YONGE vs. LOS ANGELES COMMUNITY COLLEGE DISTRICT

The Workers' Compensation Appeals Board granted the defendant's petition for removal, rescinded a prior order, and returned the case to the trial level. The WCJ had ordered a replacement QME panel because the current QME could not schedule a deposition within 120 days, a reason not explicitly listed in the regulations for a replacement panel. The Board found the WCJ's order was issued without an evidentiary record, preventing proper review. Further proceedings are required to establish an evidentiary basis for any decision regarding a replacement QME.

Petition for RemovalReplacement QME panelWCJ Order8CCR 35.5120-day deposition ruleevidentiary recordsubstantial evidenceAdministrative Director Rule 31.5(a)Mandatory Settlement ConferenceDeclaration of Readiness to Proceed
References
11
Case No. ADJ11350784
Regular
Jan 13, 2020

LUIS RODRIGUEZ vs. BRAD NYMAN DBA LIVE OAK DAIRY, ZENITH INSURANCE COMPANY

This case concerns a workers' compensation applicant challenging a finding that he waived his right to a replacement Qualified Medical Evaluator (QME) panel. The applicant requested a replacement panel after the initially appointed QME could not schedule an exam within 60 days, but the exam was ultimately scheduled within 90 days. The Workers' Compensation Appeals Board denied the applicant's petition, finding that by accepting an appointment within the 90-day window, he waived his right to a replacement panel. The Board also found the applicant's due process claims unpersuasive, as he had a full opportunity to litigate the issue.

QME panel disputewaiver of replacement panelAOE/COEdue processthreshold issueinterlocutory decisionremoval standardirreparable harmsignificant prejudiceAD Rule 31.3
References
5
Case No. ADJ7661001
Regular
Dec 10, 2012

ADRIAN ZAMORA vs. ROOFING SUPPLY GROUP, LLC, INSURANCE COMPANY OF THE STATE OF PENNSYLVANIA, GALLAGHER BASSETT SERVICES, INC.

This case involves a defendant's Petition for Removal seeking to rescind an order that took the matter off calendar pending the Medical Unit's action on a replacement QME panel request. The defendant claimed untimeliness and violations regarding QME reports and repeatedly requested a new panel from the Medical Unit without response. The Appeals Board denied the petition, adopting the WCJ's reasoning and noting the Medical Unit had no record of the defendant's requests.

Petition for RemovalWorkers' Compensation Appeals BoardQME PanelMedical UnitOff CalendarIndustrial InjuryLoaderOrthopedicsTimely ReportsStatutory Violations
References
0
Case No. ADJ12347424
Regular
Nov 09, 2020

DANIELLE LOOMIS-LYONS vs. COUNTY OF MENDOCINO

This case concerns applicant Danielle Loomis-Lyons' injury to her right knee. The WCJ initially found injury AOE/COE, ordered a replacement QME panel in orthopedic surgery, and deemed the prior pain management QME report inadmissible. The Appeals Board granted reconsideration, affirming the injury finding and the need for a replacement panel, but corrected the panel specialty to pain medicine. The Board rescinded findings regarding the appropriate panel specialty due to lack of notice and opportunity to be heard.

QME panelpain managementorthopedic surgeryAOE/COEinadmissible reportPetition for ReconsiderationremovalLabor Code section 4062.1AD Rule 31.3AD Rule 31.5
References
12
Case No. ADJ9163491; ADJ9163494
Regular
Jan 09, 2015

RIGOBERTO NORIEGA vs. BEST WESTERN TOWN & COUNTRY

This case concerns an applicant's petition for removal after the WCJ denied his objection to a QME's report. The applicant argued the QME report was untimely and prejudicial because it issued a zero impairment rating. The Appeals Board denied removal, finding the applicant waived his objection by not requesting a replacement QME panel until after receiving the unfavorable report. The Board cited precedent preventing parties from waiting to see if a report is favorable before objecting to its timeliness. Commissioner Zalewski dissented, believing the applicant could object after receipt as long as the objection preceded the replacement panel request.

Petition for RemovalQualified Medical EvaluatorQME reportuntimely filingservice of reportreplacement panelobjectionstatutory timeframesLabor CodeAdministrative Director Rule
References
3
Case No. ADJ11280224
Regular
Oct 25, 2019

APRIL WILLIAMS vs. KERN COUNTY SUPERINTENDENT OF SCHOOLS

The Workers' Compensation Appeals Board granted reconsideration and amended a prior order, finding the applicant is not entitled to a replacement Qualified Medical Evaluator (QME) panel. The Board determined that the QME's supplemental report was timely because the initial request for the report was not received by the QME's office, and the subsequent fax request was within the statutory timeframe. Additionally, the Board revised a finding to reflect injury AOE/COE solely to the applicant's low back, deferring the issue of injury to other body parts. The Board noted that even if the report had been late, a replacement panel is not automatically mandated and requires a showing of good cause.

Workers' Compensation Appeals BoardPetition for ReconsiderationQualified Medical EvaluatorReplacement QME PanelFindings of FactOrder and Opinion on DecisionDue ProcessMedical UnitSupplemental ReportMailing Presumption
References
8
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