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Case Law Database

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

Case No. MISSING
Regular Panel Decision
Jul 27, 2001

Claim of Losurdo v. Asbestos Free, Inc.

The case involves a claimant appealing a Workers’ Compensation Board decision. The Board ruled that the claimant violated Workers’ Compensation Law § 114-a by failing to disclose prior left and right knee injuries to physicians and under oath, leading to disqualification from future wage replacement benefits. Although a Workers’ Compensation Law Judge initially found no fraud, the Board reversed this determination on administrative appeal, concluding the claimant knowingly made false statements. The Appellate Division affirmed the Board's decision, finding it supported by substantial evidence, emphasizing the Board's authority as the sole arbiter of witness credibility. The court rejected the claimant's explanations of forgetting the prior incidents as not credible.

Workers' Compensation FraudMisrepresentation of Medical HistoryFalse Statements Under OathWage Replacement Benefits DisqualificationWorkers' Compensation Law Section 114-aAppellate Review of Board DecisionWitness CredibilitySubstantial EvidencePrior Knee InjuriesAdministrative Appeal
References
11
Case No. MISSING
Regular Panel Decision

Claim of Jacob v. New York City Transit Authority

Claimant sustained work-related injuries in January 2000 and later sought workers’ compensation benefits alleging recurrence. An issue arose regarding the veracity of the medical history provided to the employer’s independent medical examiners, specifically concerning undisclosed prior similar injuries. A workers’ compensation law judge and subsequently the Workers’ Compensation Board found that the claimant violated Workers’ Compensation Law § 114-a, leading to disqualification from wage replacement benefits. However, the Board authorized medical treatment for the January 2000 injuries. On cross appeals, the Board’s determination was affirmed, finding substantial evidence supported the violation and the appropriateness of the penalties imposed.

Workers' Compensation Law Section 114-aMedical MisrepresentationWage Replacement Benefits DisqualificationMedical Treatment AuthorizationPrior Injuries DisclosureSubstantial Evidence ReviewIndependent Medical ExaminationWorkers' Compensation Board DecisionAppellate ReviewAffirmed Decision
References
4
Case No. ADJ1384238 (SAC 0366460)
Regular
Oct 09, 2017

ROSA VIRGEN vs. MACY'S WEST, MACY'S CORPORATE SERVICES-RISK MANAGEMENT DEPARTMENT

The Workers' Compensation Appeals Board denied Macy's West's petition for removal, upholding the WCJ's decision not to grant a replacement Qualified Medical Evaluator (QME). The Board found that a late supplemental report alone does not mandate a replacement QME under LC 4062.5 or AD Rule 31.5(a)(12). Granting a replacement QME for untimely supplemental reporting is discretionary and requires a showing of good cause, which Macy's failed to demonstrate. The Appeals Board retains exclusive jurisdiction over the validity of replacement panels.

Workers' Compensation Appeals BoardPetition for RemovalQualified Medical EvaluationPQMEReplacement PanelMedical DirectorTimelinessSupplemental ReportGood CausePrejudice
References
4
Case No. ADJ15951486, ADJ15951487
Regular
Aug 25, 2025

JEFF CRAIL vs. AMTRUST NORTH AMERICA, HARTFORD FIRE INSURANCE COMPANY

The defendant, Amtrust North America and Hartford Fire Insurance Company, filed a Petition for Reconsideration of a Joint Findings of Fact and Orders (F&O) issued on May 20, 2025. The F&O had ordered the replacement of Panel Qualified Medical Examiner (PQME) Dr. Wiseman due to his failure to properly serve his report. The defendant argued that the court improperly interpreted Administrative Director Rule 31.5(a)(12) and that a Declaration of Readiness (DOR) does not constitute both an objection and a request for a replacement panel. The Appeals Board denied the Petition for Reconsideration, affirming the WCJ's decision to replace Dr. Wiseman. The Board's decision cited its en banc ruling in Vazquez v. Inocensio Renteria, reinforcing that a QME's failure to timely issue and serve a report, and engaging in ex parte communication by serving only one party, grants a party the right to seek replacement. The Board also emphasized the informal nature of pleadings in workers' compensation proceedings, as established in Perez v. Chicago Dogs, when addressing the applicant's DOR.

PQMEPetition for ReconsiderationJoint Findings of Fact and OrdersAdministrative Director RuleDeclaration of ReadinessIrreparable HarmMandatory Settlement ConferenceOncology PanelQualified Medical ExaminerProof of Service
References
14
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. ADJ11802539
Regular
Dec 03, 2019

LA TONYA RIDER vs. PRIDE INDUSTRIES, NORTH RIVER INSURANCE

The Appeals Board granted removal and rescinded the WCJ's order denying a replacement QME panel. Defendant sought a replacement due to the current QME's unavailability for deposition. The Board found the original order lacked an evidentiary basis, necessitating a return to the trial level. Further proceedings will establish an evidentiary record to adjudicate the QME replacement issue, considering relevant Administrative Director Rules.

Petition for RemovalQualified Medical Evaluator paneldeposition unavailabilityevidentiary recordsubstantial evidenceAdministrative Director Rule 31.5(a)Administrative Director Rule 35.5(f)trial levelrescinded orderReturn to trial
References
4
Case No. ADJ9186134
Regular
Oct 01, 2019

KARLA SARABIA vs. COUNTY OF SAN BERNARDINO

The Workers' Compensation Appeals Board dismissed the applicant's petition for reconsideration because the order to replace a Qualified Medical Evaluator (QME) was not a final order. The Board also denied the applicant's petition for removal, adopting the judge's report which found no basis for removal. The applicant sought to challenge the replacement of a QME, alleging prejudice and irreparable harm. The Board found no substantive right or liability determined by the QME replacement order.

Workers' Compensation Appeals BoardPetition for ReconsiderationPetition for RemovalQualified Medical EvaluatorPQMEReplacement PQMEFindings and OrderVocational NurseIndustrial InjuryNeck Injury
References
4
Case No. ADJ6754074
Regular
Dec 14, 2010

BARBARA JACOME vs. DURHAM SCHOOL SERVICES, OLD REPUBLIC, SEDGWICK CMS

This case involves an applicant's petition for removal challenging a WCJ's order granting the defendant's request for a replacement Qualified Medical Evaluator (QME). The applicant argued the defendant's objection to the QME's report timeliness was conditional and not properly served, thereby waiving their right to a replacement. The Appeals Board granted removal, finding the defendant's objection, made after receiving the report, was insufficient and void. Therefore, the defendant was not entitled to a replacement panel, and the QME's report was deemed admissible.

Petition for RemovalQualified Medical EvaluatorReplacement PanelTimeliness ObjectionConditional ObjectionLabor Code SectionsCalifornia Code of RegulationsMedical DirectorAdministrative DirectorComprehensive Medical-Legal Evaluation
References
0
Case No. ADJ8233060, ADJ8237202
Regular
Aug 23, 2013

SYLVIA TORRES vs. TODD MACKEY dba CAREFREE PLANTS & DESIGN, PREFERRED EMPLOYER'S INSURANCE CO.

The Workers' Compensation Appeals Board dismissed the applicant's petition for reconsideration because the WCJ's order regarding a replacement panel was not a final decision. The Board denied the petition for removal, finding no substantial prejudice or irreparable harm, despite the PQME's late supplemental report. Applicant failed to formally request a replacement panel from the Medical Director as required by regulation. Therefore, the Board affirmed the WCJ's decision not to order a replacement panel and to schedule a supplemental evaluation with the original PQME.

WCABPetition for ReconsiderationPetition for RemovalPanel Qualified Medical EvaluatorPQMESupplemental ReportFindings of Fact and OrderWCJDeclaration of ReadinessReplacement Panel
References
5
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
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