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

Case No. ADJ7692621; ADJ7687042
Regular
May 17, 2012

FREDDY TORRES vs. SCOTT BROS DAIRY INC.; ILLINOIS MIDWEST SPRINGFIELD

This case involves a dispute over the selection of a Qualified Medical Evaluator (QME). The defendant attempted to strike a QME from the panel prematurely, violating Labor Code section 4062.2(c). The applicant's subsequent strike was timely, leaving only Dr. Katz on the panel. The Appeals Board denied the defendant's Petition for Removal, upholding the WCJ's order for an evaluation by Dr. Katz. The Board warned the defendant that denying benefits based on Dr. Katz's report would be at their peril.

Petition for RemovalQualified Medical EvaluationLabor Code Section 4062.2(c)QME PanelAgreed Medical EvaluatorStrike a NameTimely StrikePremature StrikeMedical DirectorDivision of Workers' Compensation
References
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 The prior WCJ decision finding the strike untimely was rescinded.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
Case No. ADJ11136283
Regular
Apr 15, 2019

JOSE ALFREDO SOLORZA vs. STERLING MACHINERY, BERKSHIRE HATHAWAY HOMESTATE COMPANIES, THE HARTFORD

The Workers' Compensation Appeals Board granted the applicant's Petition for Removal, rescinding the WCJ's order striking the QME panel. The Board found the WCJ's order lacked an evidentiary basis, as no evidence was admitted into the record to support the premature finding. The case is returned to the trial level for further proceedings to establish a proper evidentiary record. The merits of the QME panel dispute were not decided at this stage.

Petition for RemovalQualified Medical EvaluatorQME panelpremature panel requestPetition to StrikeWCJ Orderevidentiary recordadmitted evidencesubstantial evidenceLabor Code section 4060
References
Case No. ADJ7651955
Regular
Nov 08, 2012

ARTHUR LUCERO vs. CITY OF FRESNO, Permissibly Self-Insured, Administered by AMERICAN ALL RISK LOSS ADMINISTRATORS

This case concerns a dispute over the selection of a Qualified Medical Evaluator (QME) panelist in a workers' compensation claim. The applicant sought to remove Dr. Arora, arguing the defendant's notice to strike Dr. Cayton was insufficient. The applicant, a firefighter, alleged a heart and hernia injury. The Appeals Board denied the petition, agreeing with the WCJ that the defendant's notice of intent to strike was sufficient and timely under Labor Code section 4062.2(c).

Petition for RemovalPanel Qualified Medical EvaluatorNotice of Intent to StrikeLabor Code Section 4062.2Agreed Medical EvaluatorIndustrial InjuryHeart InjuryCardiovascular System InjuryHernia InjuryFirefighter
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. ADJ8026817
Regular
Apr 22, 2013

MARIA OCHOA vs. RANGERS DIE CASTING COMPANY, COMPWEST INSURANCE COMPANY

The Workers' Compensation Appeals Board (WCAB) granted reconsideration of a decision finding the applicant sustained injury to her respiratory system and psyche AOE/COE. The WCAB rescinded the decision and returned the case to the trial level, finding the medical opinions of Dr. Lipper and Dr. Curtis lacked substantiality. Specifically, the physicians failed to provide clear diagnoses, quantify exposures, or adequately explain causation. The Board noted contradictory testimony from the applicant's supervisor and insufficient evidence to support the initial findings.

Workers' Compensation Appeals BoardMaria OchoaRangers Die Casting CompanyCOMPWEST INSURANCE COMPANYADJ8026817Los Angeles District OfficeOpinion and Order Granting ReconsiderationDecision After ReconsiderationFindings of FactWorkers' Compensation Administrative Law Judge (WCJ)
References
Case No. ADJ6786901
Regular
Aug 24, 2010

IDELFONSO RODRIGUEZ vs. GARDEN FRESH RESTAURANTS CORPORATION, TRAVELERS PROP. CASUALTY COMPANY OF AMERICA

This case involves a defendant's premature petition for dismissal of a workers' compensation claim. The Workers' Compensation Appeals Board (WCAB) dismissed the defendant's Petition for Reconsideration because the prior order was interlocutory and not a final determination of substantive rights. Furthermore, the WCAB denied the defendant's request for removal, finding no basis for extraordinary relief due to lack of demonstrated prejudice. The WCAB affirmed the judge's denial of dismissal as premature under Board Rule 10582.

Workers' Compensation Appeals BoardPetition for ReconsiderationDismissalRemovalInterlocutory OrderFinal OrderLabor CodeSubstantive RightLiabilityApplication for Adjudication
References
Case No. ADJ1316873 (LBO 0325861)
Regular
May 16, 2012

MIGUEL LOPEZ vs. TRI-STATE RESTORATIONS, INC., CREDIT GENERAL INSURANCE

This case concerns Miguel Lopez's appeal regarding inadequate notice of his employer's Medical Provider Network (MPN) and denial of treatment requests. The Workers' Compensation Appeals Board (WCAB) denied his petition for reconsideration. The WCAB found that the applicant received adequate notice of the MPN and was treated by an MPN physician for over three years. Furthermore, issues regarding specific treatment denials were not properly raised at trial and can be addressed in a new filing. The applicant's motion to strike was deemed premature given the procedural posture of the case.

Workers' Compensation Appeals BoardTri-State RestorationsInc.California Insurance Guarantee AssociationMiguel LopezPetition to StrikeMedical Provider NetworkMPNDr. Mark GreenspanDr. Domenick Sisto
References
Case No. ADJ7923937; ADJ7923917
Regular
May 26, 2016

JASON TESTA vs. STATE OF CALIFORNIA, PELICAN BAY STATE PRISON, STATE COMPENSATION INSURANC FUND

The Workers' Compensation Appeals Board (WCAB) rescinded the original Findings and Award, returning the case to the WCJ for further proceedings. The Board found that the trial prematurely addressed the industrial causation and need for surgery, despite parties agreeing to limit trial to the applicant's petition to strike the Agreed Medical Evaluator's (AME) reports. This shift violated the defendant's due process rights by limiting their opportunity to present evidence. The WCAB also clarified that Utilization Review (UR) is not required when an employer disputes the industrial nature of an injury or treatment.

WCA BReconsiderationOpinion and DecisionAOE/COELeft Shoulder InjuryTreating PhysicianAgreed Medical EvaluatorSubstantial Medical EvidenceUtilization ReviewPetition to Strike
References
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
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