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Case Law Database

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

Case No. ADJ7184508
Regular
Nov 15, 2011

LEWIS DALE CUNNINGHAM vs. COUNTY OF SAN BERNARDINO

This case involves a defendant's petitions to disqualify the judge or remove him from the case due to alleged ex parte communications with the Qualified Medical Evaluator (QME). The Workers' Compensation Appeals Board (WCAB) denied both petitions. The WCAB found the defendant failed to provide grounds for judicial disqualification and that the alleged ex parte communications with the QME were insignificant and did not cause substantial prejudice. Furthermore, the defendant failed to timely petition for removal of an earlier order allowing the QME's deposition.

WORKERS' COMPENSATION APPEALS BOARDPetition for DisqualificationPetition for RemovalJudge Robert PuseyPermissibly Self-InsuredQualified Medical EvaluatorQMEDr. Stanley J. MajcherEx Parte CommunicationsWCJ
References
2
Case No. ADJ3763910 (STK 0195200) ADJ6626980
Regular
Feb 06, 2015

JOHN ALARCON vs. PACIFIC GAS & ELECTRIC

This case involves an applicant seeking to modify deposition and Qualified Medical Evaluation (QME) orders due to alleged severe medical conditions. While the applicant agrees to the deposition and QME, they claim their health prevents travel and request these be held at their home. The Appeals Board granted the Petition for Removal, finding the medical record requires further development regarding the alleged travel limitations. The orders for deposition and QME are amended to defer the time and place, returning the matter to the trial level for proceedings on accommodation issues.

Petition for RemovalOrder Compelling DepositionQualified Medical Evaluation (QME)Administrative Law Judge (WCJ)Industrial InjuriesPolymyositisTreating PhysicianMedical ReportTravel LimitationsAccommodation
References
2
Case No. ADJ7555685
Regular
Apr 02, 2012

RAHUL ROY vs. GALLO SALES COMPANY INC.

This case concerns the admissibility of a Qualified Medical Evaluator's (QME) reports due to alleged violations of Labor Code section 4062.3 and AD Rule 35. The defendant, Gallo Sales Company, Inc., sent medical information and sub rosa films to the QME without timely providing copies or notice of objection rights to the applicant, Rahul Roy. The Workers' Compensation Appeals Board affirmed the finding that the QME's reports were inadmissible due to these ex parte communications, disqualifying the QME. The applicant is entitled to a new QME panel.

PQMEAD Rule 35Ex parte communicationLabor Code section 4062.3Medical informationNon-medical recordsSupplemental reportSub rosa filmsQME panelAdmissibility
References
12
Case No. 2016 NY Slip Op 02654
Regular Panel Decision
Apr 06, 2016

Matter of Dayannie I. M. (Roger I. M.)

The Appellate Division, Second Department, affirmed a Family Court order which found Roger I.M. abused and neglected his daughter, Eyllen I.M., and derivatively abused his other children: Dayannie I.M., Hillary I.M., Keyri I.M., and Jackzenny I.M. The court found that the Suffolk County Department of Social Services presented sufficient evidence, including Eyllen's consistent out-of-court statements, expert testimony, and Roger I.M.'s written confession of sexual abuse. The Appellate Division upheld the Family Court's credibility assessment, rejecting the appellant's and the children's mother's disputes. The court also affirmed the derivative abuse findings for the other children, noting that a child's recantation does not necessarily invalidate prior abuse allegations, especially when pressured or if there is expert testimony indicating a false recantation.

Child AbuseChild NeglectFamily LawAppellate ReviewSexual AbuseCredibilityRecantationExpert TestimonyParental RightsSuffolk County Family Court
References
26
Case No. SAL SJO 252436 (MF); SJO 246192
Regular
Jul 02, 2007

NIHAL HORDAGODA vs. State Compensation Insurance Fund

This case involves an employer's petition for reconsideration of an order authorizing medical treatment and admitting the Qualified Medical Examiner's (QME) reports. The employer argued the QME reports were inadmissible due to an alleged ex parte communication between the applicant and the QME, and that the awarded treatments were improper. The report recommends denying the petition, finding the communication was permissible under LC § 4062.3(h) and that the QME's opinions and awarded treatments for chronic pain were reasonable and not governed by ACOEM guidelines.

Workers' Compensation Appeals BoardPetition for ReconsiderationQualified Medical EvaluatorLabor Code Section 4062.3Ophthalmological evaluationFunctional capacity evaluationUtilization ReviewACOEM GuidelinesChronic spinal conditionTreating physician
References
0
Case No. ADJ1692556 (STIK 0207020) ADJ2977889 (STK 0208240)
Regular
Aug 06, 2009

CATHY HAWKINS vs. SUTTER HEALTH CORPORTION (dba) SUTTER TRACY COMMUNITY HOSPITAL

The Workers' Compensation Appeals Board (WCAB) granted removal and reversed a WCJ's order to appoint a new QME. The WCAB found the WCJ erred in concluding the applicant was entitled to a new QME panel for a slight delay in scheduling an examination. They reasoned that the applicant's allegations did not definitively prove Dr. Choi "could not" schedule an earlier appointment or that a waiver was violated. The WCAB determined that requiring a new QME process for minor scheduling delays, especially with an established QME, would be wasteful.

Petition for removalQualified Medical Evaluator (QME)60-day time limitappointment schedulingwaiverprejudiceirreparable harmfinal orderreconsiderationsubstantiative issue
References
4
Case No. ADJ4052884 (AHM 0136124) ADJ6520242
Regular
Feb 20, 2014

EMILIO EDDIE ROMERO (Deceased) SARA ROMERO (Widow) vs. CLOROX PRODUCTS MANUFACTURING

The Appeals Board granted the defendant's petition for removal, rescinding an order to replace a Qualified Medical Evaluator (QME). The WCJ had terminated the QME believing his partial review and stated refusal to review more records showed prejudgment on causation. However, the Appeals Board found it premature to disqualify the QME, noting his opinion of idiopathic pulmonary fibrosis as an unknown cause of disease could render additional MSDS irrelevant if correct. The Board ordered a deposition of the QME to explore his opinions and any alleged bias before deciding on a replacement, allowing further record development.

Petition for RemovalPQMEPanel Qualified Medical EvaluatorCausationIdiopathic Pulmonary FibrosisMaterial Safety Data SheetsMSDSSubstantial Medical EvidenceDepositionMcDuffie v. Los Angeles County Metropolitan Transit District
References
1
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
10
Case No. ADJ15539216, ADJ15538700
Regular
Oct 03, 2025

THOMAS GALLEGOS vs. CALIFORNIA DEPARTMENT OF CORRECTIONS AND REHABILITATION, CALIFORNIA HEALTH CARE FACILITY STATE OF CALIFORNIA

Applicant sought reconsideration of an order requiring an additional Qualified Medical Evaluator (QME) panel for alleged back and neck injuries, arguing it would cause undue delay as another QME had already addressed these parts. The Workers' Compensation Appeals Board dismissed the petition for reconsideration, treating it as a petition for removal, which was subsequently granted. The Board rescinded the underlying decision and returned the case to the trial level, instructing for further proceedings to properly develop the medical record. It also emphasized the importance of correct QME panel procedures and noted the defendant's waiver regarding a second QME.

Workers Compensation Appeals BoardPetition for ReconsiderationPetition for RemovalQualified Medical EvaluatorAdditional PanelSpecialty PanelSpineNeckUpper ExtremityWrist
References
18
Case No. ADJ11255791
Regular
Nov 02, 2019

MARIA FRANCISCA JIMENEZ vs. J. RODRIGUEZ FARM LABOR CONTRACTOR, INC., ZENITH INSURANCE COMPANY

In this workers' compensation case, the defendant sought removal of a trial setting order due to an alleged ex parte communication between the applicant's attorney and the Qualified Medical Evaluator (QME). The Appeals Board granted removal, finding that the issue of the QME's report admissibility must be resolved before proceeding to trial on all issues. The Board rescinded the prior orders and remanded the matter for adjudication of the QME dispute first, noting that prejudice is not necessarily required for a violation of ex parte communication rules. This bifurcated approach aims for judicial efficiency, preventing potentially unnecessary trials if a new QME is ultimately required.

Petition for RemovalEx Parte CommunicationQualified Medical Evaluator (QME)Admissibility of ReportsPre-Trial ConferenceDiscoveryCase LawLabor CodeAppeals BoardRemoval Order
References
6
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