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Case Law Database

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

Case No. ADJ3778927 (SFO 0460851) ADJ334222 (OAK 0285716) ADJ2101319 (SFO 0437718) ADJ4065670 (OAK 0285715)
Regular
Jan 23, 2012

KIMBERLY ROBERTS vs. CITY AND COUNTY OF SAN FRANCISCO, INTERCARE INSURANCE SERVICES

The defendant sought reconsideration or removal of a WCJ's order directing a new psychiatric QME panel due to a perceived conflict of interest with Dr. Hank Sigal, who was associated with the defendant's prior QME. The Appeals Board dismissed the Petition for Reconsideration, finding the WCJ's order was not a final appealable decision. The Board denied the Petition for Removal, concluding the defendant failed to demonstrate the order would result in significant prejudice or irreparable harm. Consequently, the original order requiring a new QME panel stands.

Workers' Compensation Appeals BoardPetition for ReconsiderationPetition for RemovalWCJ Orderconflict of interestQME panelpsychiatric QMEreplacement QMEstipulationsinterim order
References
Case No. ADJ10237267
Regular
Jan 31, 2018

KENNETH ANGEL vs. ABLE ENGINEERING, ZURICH NORTH AMERICA

This Workers' Compensation Appeals Board case concerns applicant Kenneth Angel's request for a replacement Qualified Medical Evaluator (QME) in dentistry. Angel argued that the assigned QME, Dr. David Polushkin, was not licensed to practice at the West Covina location where the evaluation occurred. The Board denied reconsideration, finding insufficient evidence that Dr. Polushkin was ineligible to practice at that location, as "address of record" does not necessarily preclude other authorized practice sites. Furthermore, the Board noted that issues of QME eligibility are within the purview of the Administrative Director, not the Appeals Board.

QME panelreplacement QMEdental QMEWCJPetition for ReconsiderationAmended Findings of FactverificationwaivereligibilityAdministrative Director
References
Case No. ADJ12910087
Regular
Dec 28, 2020

ESTHER LEMUS SALDANA vs. TAO TAI HOMES CORPORATION, INSURANCE COMPANY OF THE WEST

This case concerns a dispute over the correct Qualified Medical Evaluator (QME) panel for applicant Esther Lemus Saldana. The defendant sought reconsideration of an order finding the applicant's chiropractic QME panel valid and the defendant's orthopedic panel invalid. The Workers' Compensation Appeals Board denied the petition, upholding the administrative law judge's decision. The Board found the applicant properly requested a new panel after retaining counsel, and despite a service error on the chiropractic panel, the defendant had opportunity to contest the specialty. Therefore, the applicant's chiropractic QME panel remains the correct one for the medical-legal evaluation.

QME PanelChiropractic QMEOrthopedic QMEPetition for ReconsiderationFindings of Fact and OrdersMedical-Legal EvaluationQualified Medical EvaluatorAdministrative Director RuleRomero v. Costco WholesaleLabor Code Section 4062.1
References
Case No. ADJ7578707; ADJ7578722
Regular
Jul 06, 2011

Melissa Voisenat vs. COUNTY OF FRESNO

This case involves a dispute over the specialty of a Qualified Medical Evaluator (QME) for applicant Melissa Voisenat, who claims industrial injuries as a police officer. Defendant County of Fresno seeks to remove an administrative order denying their request for an orthopedic QME panel. The Appeals Board granted removal due to an insufficient record, lacking crucial documents needed to assess compliance with QME panel selection rules. The case is returned to the trial level for further proceedings to allow parties to submit relevant evidence on the QME specialty issue.

Petition for RemovalQualified Medical Evaluator (QME) panelspecialty disputeorthopedic QMEchiropractic QMEAdministrative Director's Medical Unit (MU)EAMSrescinded ordertrial levelindustrial injuries
References
Case No. ADJ9491221
Regular
May 23, 2017

JESUS DORANTES vs. DIRITO BROTHERS, INSURANCE CO. OF THE WEST

The Workers' Compensation Appeals Board (WCAB) dismissed the applicant's Petition for Reconsideration and denied his Petition for Removal. The applicant sought a replacement Qualified Medical Evaluator (QME) due to delays in receiving a supplemental report and alleged issues with the existing QME's reporting and deposition response. The WCAB found that the decision regarding the replacement QME was an interlocutory procedural ruling, not a final order from which reconsideration could be taken. Furthermore, the applicant failed to demonstrate substantial prejudice or irreparable harm necessary for removal, and did not meet the criteria for a mandatory replacement QME under the applicable regulations.

QME panelsupplemental reporttimely issuancereplacement QMEAdministrative Director Rule 38Petition for ReconsiderationPetition for RemovalLabor Code § 4062.5Rule 31.5(a)(12)substantial prejudice
References
Case No. ADJ9975590; ADJ9976116
Regular
Feb 25, 2016

Ana Nieto vs. Avitus, Inc., American Zurich Insurance Company

The Workers' Compensation Appeals Board (WCAB) dismissed the defendant's petition for reconsideration, finding the appealed order was interlocutory and not subject to reconsideration. The WCAB treated the petition as one for removal and denied it, as the defendant failed to demonstrate substantial prejudice or irreparable harm. The defendant's contention that their trial exhibits and an orthopedic QME panel were erroneously stricken was rejected, as was their claim that the orthopedic QME panel was improperly denied. The defendant failed to provide sufficient evidence to support their request for an orthopedic QME panel over a chiropractic one.

Workers' Compensation Appeals BoardPetition for ReconsiderationPetition for RemovalJoint Findings of Fact & OrdersQualified Medical Evaluator (QME)Orthopedic Surgery QMEChiropractic QMETrial ExhibitsAdministrative Law Judge (WCJ)Labor Code § 4062.2
References
Case No. ADJ438881 (LAO 0803997) ADJ524371 (LAO 0803998) ADJ4280229 (LAO 0842506) ADJ3118948 (LAO 0887798)
Regular
Jun 22, 2011

Shirley Brown vs. Los Angeles Department of Water and Power

The Workers' Compensation Appeals Board dismissed the defendant's petition for reconsideration because the appealed order was not a final order, but rather a discovery-related ruling. The Board also denied the defendant's petition for removal, adopting the reasoning of the Workers' Compensation Judge. The defendant's core arguments, including bias of the defense QME and the denial of an additional QME, were thus rejected by the Board. This decision upholds the non-final nature of the WCJ's order and denies further review or intervention based on the defendant's claims.

Workers' Compensation Appeals BoardPetition for ReconsiderationPetition for RemovalJoint Findings and OrderQualified Medical Evaluator (QME)Defense QMEDr. David DavidBias AllegationsDiscovery OrderFinal Order
References
Case No. ADJ9099536
Regular
Sep 09, 2014

MARIA SOTO vs. CCC HOSPITALITY PISMO, LLC dba SEACREST OCEANFRONT HOTEL, STAR INSURANCE COMPANY

In this case, the defendant hospital sought removal after the WCJ ordered a chiropractic QME panel, arguing chiropractors were unqualified for the applicant's knee injury. The defendant had initially requested an orthopedic surgeon QME, but their request was rejected by the Medical Unit as incomplete. The Appeals Board found the defendant's initial request substantially complied with regulations and was improperly rejected. Therefore, the Board granted removal, rescinded the WCJ's order, and directed the Medical Unit to issue a panel of orthopedic surgery QMEs.

Petition for RemovalPQMEMedical UnitChiropractic QMEOrthopedic Surgery QMERequest for QME PanelAdministrative Director Rule 30(b)Labor Code section 4062.2Messele v. Pitco FoodsInc.
References
Case No. ADJ7873790
Regular
Jun 27, 2013

LAURA BERNAL vs. RINCON TAURINO RESTAURANT, INC., CALIFORNIA RESTAURANT MUTUAL BENEFIT CORPORATION

The Workers' Compensation Appeals Board (WCAB) granted the defendant's petition for removal, overturning a prior ruling that allowed the applicant to refuse a Qualified Medical Evaluator (QME) examination based on the QME's refusal to allow audio recording. The WCAB found the applicant's attorney had made "unusual efforts to obstruct the QME process." Applicant is now ordered to attend the QME examination with a court reporter present at the defendant's expense. Failure to comply will result in suspension or barring of disability payments.

QMEAMEremovalreconsiderationtape recordingcourt reporterobstructionsanctionsLabor Code section 4062.2Labor Code section 5813
References
Case No. ADJ7787692, ADJ7787693
Regular
Jan 14, 2016

Elizabeth Sauseda vs. The Permanente Medical Group, Inc.

This case involves the defendant's petition for removal, seeking to replace a Qualified Medical Evaluator (QME) in psychology due to alleged reporting delays. The Workers' Compensation Appeals Board (WCAB) denied the petition, upholding the administrative law judge's (WCJ) decision. The WCAB adopted the WCJ's recommendation, finding that a new QME examination would not proceed and the existing QME would remain. The issue of the defendant's personnel actions as a good faith defense remains for the trial judge's determination.

Petition for RemovalQualified Medical EvaluatorPanel QMEAdministrative Law JudgeSupplemental ReportReplacement QME PanelMandatory Settlement ConferenceGood Faith Personnel DefenseWCJ ReportMedical Unit
References
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