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

Case No. ADJ2001631 (LAO 0876091)
Regular
Oct 01, 2010

SALVADOR AGUAYO, JR. vs. AMERICAN GOLF CORPORATION, ARCH INSURANCE COMPANY

The Workers' Compensation Appeals Board granted reconsideration to address an attorney's fee award of $4,500.00. This fee was awarded for services related to alleged prohibited ex parte communications with Qualified Medical Evaluators (QMEs), as per Labor Code section 4062.3. The Board rescinded the award, finding no explicit determination of prohibited communication occurred as the prior WCJ's orders were voided. The matter was returned to the trial level to first determine if prohibited ex parte communication occurred, and if so, to award fees based on incurred costs and attorney fees for related discovery.

Salvador Aguayo Jr.American Golf CorporationArch Insurance CompanyWorkers' Compensation Appeals BoardreconsiderationFindings and Awardattorney's feeprohibited communicationsQualified Medical EvaluatorsQME
References
1
Case No. ADJ7452503
Regular
Sep 26, 2011

PATRICIA MAYORGA vs. MOUNT DIABLO UNIFIED SCHOOL DISTRICT, TRISTAR

The Appeals Board denied the defendant's Petition for Removal, which sought to overturn an order quashing the deposition of a treating physician. The defendant argued the communication wasn't an ex parte communication and was necessary for their defense and fraud investigation. However, the Board found the defendant failed to show substantial prejudice or irreparable harm. While ex parte communications with QMEs/AMEs are prohibited, they are not with treating physicians, and the communication was not barred by statute or case law.

Petition for RemovalPetition to Quash DepositionTreating PhysicianEx Parte CommunicationAgreed Medical EvaluatorQualified Medical EvaluatorSubstantial PrejudiceIrreparable HarmWorkers' Compensation Appeals BoardWCJ
References
4
Case No. ADJ8363948
Regular
Oct 19, 2012

NICOLE NELSON vs. COUNTY OF SOLANO, INTERCARE HOLDINGS INSURANCE SERVICES

The defendant County of Solano sought removal to obtain a new panel of Qualified Medical Evaluators (QMEs) due to alleged ex parte communications between the applicant and the current QME. The Appeals Board denied this petition, finding that the communications were either insignificant and inconsequential or related to the QME examination itself. Specifically, emails concerning necessary forms and an insignificant mention of a claims adjuster's number did not violate the ex parte communication prohibition. Therefore, the WCJ's denial of the defendant's request for a new QME panel was upheld.

Petition for RemovalQualified Medical Evaluator (QME)ex parte communicationLabor Code section 4062.3termination of evaluationreplacement panelinsignificant communicationinconsequential communicationindustrial injurypsyche
References
1
Case No. ADJ10452831
Regular
Nov 09, 2018

CAROLINE DOLLEMORE vs. WAYNE PERRY, INC.; STARR SURPLUS LINES, administered by YORK RISK SERVICES GROUP

The Appeals Board granted the applicant's petition for removal, rescinding the WCJ's findings. The WCJ had improperly stricken the QME's reports due to an ex parte communication from the applicant inquiring about her pain impairment rating. While ex parte communications with a QME are prohibited, the Board found that the applicant's communication was not insignificant and could not be categorized as such. However, the Board remanded the case to the trial level to determine if the defendant elected to terminate the evaluation within a reasonable time or engaged in conduct inconsistent with that election, as required by recent en banc precedent.

ex parte communicationqualified medical evaluatorremovalfindings and orderstricken reportsagreed medical evaluatorpetition for removaldefendant's answertrial levelsupplemental report
References
5
Case No. ADJ7257372
Regular
Dec 14, 2015

Joshua Geiger vs. George Geiger, State Farm Insurance Bakersfield

This case concerns a defendant's petition for reconsideration of a Workers' Compensation Appeals Board (WCAB) decision. The defendant argued that applicant's spouse had improper ex parte communication with the Agreed Medical Examiner (AME) by providing video and notes of the applicant's seizures. The WCAB denied reconsideration, finding that the communication occurred at the AME's request during the examination and was therefore exempt from statutory ex parte communication prohibitions. The Board concluded that the information provided was de minimis and did not warrant removal of the AME or striking of reports, especially since the seizure disorder was not a disputed issue.

Ex parte communicationAgreed Medical Examiner (AME)Labor Code Section 4062.3Rule 35Petition for ReconsiderationFindings and AwardWCJ ReportEpilepsySeizuresHome health care
References
4
Case No. ADJ6778298
Regular
Jul 14, 2010

STEPHANIE KOENIG vs. AT&T MOBILITY, INC., SEDGWICK CLAIMS MANAGEMENT SERVICES, INC.

This case involves a petition for removal regarding an applicant's ex parte communication with a Qualified Medical Evaluator (QME) after her psychiatric examination. The defendant argued the applicant's phone call, seeking advice for obsessive thoughts, violated Labor Code section 4062.3, which prohibits ex parte communications with QMEs. The Board majority found the communication was "in the course of the examination" due to its proximity in time and subject matter to the evaluation, thus denying the petition. A dissenting opinion argued the call, initiated six weeks post-examination for emergency advice, fell outside the statutory exceptions.

QMEex parte communicationLabor Code section 4062.3in the course of examinationindustrial injurypsyche injuryqualified medical evaluatorpetition for removalAppeals Boarddissenting opinion
References
1
Case No. ADJ2796539 (LAO 0840098) ADJ4363495 (LAO 0840099) ADJ7155229
Regular
Jun 15, 2010

Felix Aguilar vs. WAREHOUSE DISCOUNT CENTER; SCIF INSURED OXNARD

The Workers' Compensation Appeals Board dismissed the defendant's petition for removal as moot because the AME examination date had passed. The defendant sought to prevent the applicant's attorney from having ex parte communications with the AME. While dismissing the petition, the Board clarified that ex parte communications with an AME are prohibited under Labor Code section 4062.3(f) and can result in significant penalties. These penalties include the aggrieved party's ability to terminate the evaluation and seek a new one, as well as sanctions for costs and attorney's fees.

Workers' Compensation Appeals BoardPetition for RemovalProtective OrderAgreed Medical Evaluator (AME)Ex Parte CommunicationLabor Code Section 4062.3Moot PetitionIrreparable HarmContemptAggrieved Party
References
1
Case No. ADJ9180559
Regular
Sep 18, 2015

JACKIE SUEHIRO (Dec'd), ALVIN SUEHIRO (Husband) vs. RALPHS GROCERY COMPANY, permissibly self-insured, adjusted by SEDGWICK CLAIMS MANAGEMENT SERVICES, INC.

The Appeals Board granted the defendant's petition for removal, rescinding a prior Minute Order. The WCJ had found ex-parte communication by the defendant and ordered a new QME panel without a trial or sworn testimony. The Board found this violated the defendant's due process rights, as no evidence was presented to support the ex-parte communication finding. The case is returned to the trial level for a hearing on all issues, including alleged ex-parte communication, with parties afforded the chance to present evidence and witnesses.

Petition for RemovalMinute OrderQualified Medical EvaluatorEx-parte CommunicationDue ProcessWCJReplacement QME PanelLabor Code Section 5313Admitted EvidenceProof of Service
References
1
Case No. ADJ11584415
Regular
Sep 30, 2019

GUY SYLVA vs. CITY AND COUNTY OF SAN FRANCISCO

This case involves an applicant's petition for reconsideration of a Workers' Compensation Appeals Board (WCAB) decision that denied temporary disability benefits and a motion to strike a Qualified Medical Evaluator's (QME) reports. The applicant alleged ex parte communication between the defendant and the QME, violating Labor Code section 4062.3. The WCAB granted reconsideration, finding that the issue of ex parte communication was not adequately addressed due to conflicting dates and unadmitted evidence. The matter is remanded to the trial level for further proceedings to determine if ex parte communication occurred and to address the temporary disability issue.

WCABAOE/COEQMEex parte communicationLabor Code section 4062.3Petition for ReconsiderationFindings and Orderremovaltemporary disabilityprimary treating physician
References
15
Case No. MISSING
Regular Panel Decision
May 07, 1998

People v. Tullo

In this case, the court addresses an application for an ex parte order of protection against a defendant charged with aggravated harassment in the second degree, stemming from a single threatening telephone call. The Assistant District Attorney sought the order based on new facts not included in the original accusatory instrument. Judge Joel B. Gewanter denied the application, interpreting CPL 530.13 (2) to limit ex parte orders of protection solely to factual allegations present within the filed accusatory instrument. The court emphasized the necessity of proper notice and an opportunity for the defendant to be heard. It suggested that for new charges, a new complaint and arrest would be the appropriate procedure for issuing such an order.

Aggravated HarassmentSecond DegreeEx Parte Order of ProtectionCriminal Procedure LawCPL 530.13MisdemeanorFirst ImpressionTelephone CallThreatening StatementDue Process
References
0
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