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

Case No. ADJ7688956
Regular
Jan 31, 2012

SHARON FRINK vs. SHASTA-TEHAMA-TRINITY JOINT COMMUNITY COLLEGE

The Workers' Compensation Appeals Board granted removal, rescinded prior orders, and returned the case for further proceedings. The issue was whether the applicant must attend a re-evaluation with the same Qualified Medical Evaluator (QME) after he moved his office a short distance. The Board found that Labor Code section 4062.3(j) requires parties to utilize the same QME for subsequent disputes if possible. They clarified that Administrative Director Rule 34(b) regarding the QME's office location applies only to initial evaluations, not re-evaluations. Therefore, the applicant's refusal to travel a short distance for re-evaluation was not grounds for a new panel QME.

Workers' Compensation Appeals BoardPetition for RemovalQualified Medical Examiner (QME)Re-evaluationLabor Code Section 4062.3(j)Administrative Director Rule 34(b)Administrative Director Rule 36(d)Medical Office LocationUnavailable QMECompel Attendance
References
9
Case No. ANA 394407
Regular
Feb 01, 2008

DEWAYNE TORRENCE vs. CITY OF LOS ANGELES

The Appeals Board denied the applicant's petition for removal, upholding the WCJ's order for a new Qualified Medical Evaluator (QME) panel. The applicant, previously examined by Dr. Flores as a QME while unrepresented and later treated by him, argued he should not undergo another QME evaluation. However, the Board found that since Dr. Flores also provided treatment, he was disqualified from conducting a subsequent QME evaluation under relevant regulations, necessitating a new panel when parties could not agree on an evaluator.

Petition for RemovalQualified Medical EvaluatorAgreed EvaluatorLabor Code Section 4062.2Labor Code Section 4062.3(j)Industrial Medical Council Rule 11(d)Rule 31(d)Primary Treating PhysicianSecondary PhysicianUnrepresented Employee
References
0
Case No. ADJ9 636706; ADJ9636707 ADJ9447837
Regular
Aug 09, 2016

RICK PARKER vs. DSC LOGISTICS, ZURICH NORTH AMERICA

This case concerns whether a Qualified Medical Evaluator (QME) must address all claimed industrial injuries filed prior to their initial evaluation. The Workers' Compensation Appeals Board (WCAB) rescinded a prior order that denied the defendant's petition to vacate new QME panels. The WCAB held that Labor Code section 4062.3(j) requires a QME to evaluate all contested medical issues arising from injuries reported on one or more claim forms prior to the employee's initial appointment. Therefore, the applicant must return to the original QME, Dr. Steinmann, to evaluate the disputed medical issues in all relevant case numbers.

Workers' Compensation Appeals BoardReconsiderationPetition to Vacate QME PanelsLabor Code section 4062.3Qualified Medical EvaluatorPanel QMEDuplicative Medical EvaluationsDoctor ShoppingNavarro v. City of MontebelloContested Medical Issues
References
1
Case No. ADJ7760776
Regular
Feb 24, 2012

SCOTT HARPER vs. ENTERTAINMENT PARTNERS, INSURANCE COMPANY OF THE STATE OF PENNSYLVANIA

This case concerns a defendant's petition for removal to obtain a Qualified Medical Evaluator (QME) report before proceeding to trial. The defendant argued they would be prejudiced by proceeding without a QME evaluation to address causation due to prior injuries. The Appeals Board granted the petition, finding the defendant had diligently attempted to obtain a QME and that delays were not their fault. Consequently, the trial date was rescheduled as a status conference to await the QME evaluation.

Petition for RemovalQualified Medical Evaluator (QME)Labor Code sections 40604062.2substantial prejudiceirreparable harmindustrial injurydenial of injuryAOE/COEMendoza v. Huntington Hospital
References
1
Case No. MISSING
Regular Panel Decision

Main Evaluations, Inc. v. State

The claimant, Main Medical Evaluations, entered into contracts with the New York State Office of Temporary and Disability Assistance (OTDA) to perform consultative medical evaluations. OTDA terminated these contracts, alleging the claimant failed to disclose professional disciplinary proceedings against its chief medical officer, Arvinder Sachdev, and submitted false information during the bidding process. Following the dismissal of its claim in the Court of Claims, the claimant appealed. The appellate court affirmed the lower court's judgment, concluding that OTDA had legitimate grounds for termination due to the claimant's misrepresentations and failure to report substantial contract-related issues concerning Sachdev's integral role. Additionally, the court rejected the claimant's equal protection argument, finding no evidence of selective enforcement based on impermissible considerations.

Contract TerminationProfessional MisconductFalse RepresentationEqual ProtectionGovernment ContractsAppellate ReviewBreach of ContractMedical LicensingAdministrative ProceedingsDue Diligence
References
5
Case No. ADJ9836001; ADJ9836002 ADJ9836004; ADJ9836542 ADJ10301695
Regular
Sep 28, 2016

BEATRIZ HERNANDEZ vs. RAMCO ENTERPRISES

This case concerns whether the applicant is entitled to a new Qualified Medical Evaluator (QME) for a later reported injury. The defendant argued that under *Navarro v. City of Montebello*, the same QME should evaluate all injuries reported prior to an initial evaluation. However, the Board found *Navarro* distinguishable because the applicant's fifth injury was reported *after* the initial QME evaluation, despite occurring earlier. Therefore, the applicant is entitled to a new PQME for the later reported injury, and the defendant's petition for reconsideration was denied.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and OrderQualified Medical Evaluator (QME)Panel QME (PQME)Navarro v. City of MontebelloLabor CodeMedical-Legal EvaluationsApplication for Adjudication of ClaimDeclaration of Readiness to Proceed
References
1
Case No. ADJ10917207
Regular
Aug 13, 2019

CARMEN ROJO vs. K & M MEAT COMPANY, STARR INDEMNITY & LIABILITY COMPANY

This case involves a dispute over the necessity of an additional Qualified Medical Evaluator (QME) panel in orthopedic surgery. The Applicant sought reconsideration of an administrative law judge's (ALJ) order for a new orthopedic QME panel, arguing it was an abuse of discretion and prejudicial. The Appeals Board granted reconsideration, finding the original QME's referral for an orthopedic evaluation was for treatment, not a recommendation for a new medical-legal evaluation. Consequently, the Board amended the ALJ's findings, holding there was no good cause for an additional orthopedic QME panel and denying the defendant's request.

QME panelorthopedic surgeryreconsiderationremovalFindings & Orderchiropractic QMEmedical-legal evaluationgood causesupplemental pleadingmedical dispute
References
9
Case No. ADJ9812433
Regular
Mar 10, 2016

HECTOR ORTIZ vs. WALGREENS FAMILY OF COMPANIES, dba TAKE CARE, ZURICH NORTH AMERICA INSURANCE COMPANY

The Workers' Compensation Appeals Board denied Walgreens' petition for removal, which challenged an order to take the case off calendar for a Qualified Medical Evaluator (QME) evaluation. The Board found that proceeding with the QME evaluation, which had been delayed due to clerical errors and physician availability, would not cause Walgreens irreparable harm. The Board emphasized that removal is an extraordinary remedy and that developing the record through a QME is essential for the orderly resolution of the applicant's alleged industrial injuries.

Petition for RemovalQualified Medical EvaluatorOff CalendarSignificant PrejudiceIrreparable HarmMedical UnitPanel RequestStrikeReplacement PanelDevelopment of the Record
References
2
Case No. ADJ6870507
Regular
Jun 24, 2010

ULISES FUENTES vs. DICKIE DOBINS CLEANERS, ILLINOIS WEST INSURANCE AGENCY, TOWER SELECT INSURANCE AGENCY

This case involves a dispute over the issuance of a Qualified Medical Evaluator (QME) panel in a workers' compensation claim. The applicant sought reconsideration of an order for a QME panel, alleging a deviation from an agreed medical evaluator process and lack of notice. The defendant presented a conflicting account of events, claiming the applicant's attorney conditioned the agreed medical evaluation on the defendant providing temporary disability benefits. The Appeals Board found the divergent factual accounts warranted removal and rescinded the QME panel order. The case is returned to the trial level for factual resolution and to determine if sanctions are appropriate.

WORKERS' COMPENSATION APPEALS BOARDRemovalQME PanelLabor Code § 4062.2Agreed Medical EvaluatorPetition to CompelEx parteNoticeSanctionsLabor Code § 5813
References
1
Case No. ADJ1934243 (FRE 0221043)
Regular
Apr 25, 2011

MARIA RAYOS vs. WALGREENS, ZURICH INSURANCE COMPANY

This case concerns a dispute over a second Qualified Medical Examiner (QME) for an applicant with a work-related knee, back, and hip injury. The defendant sought removal, arguing that allowing a second QME without striking the first QME's reports violated due process and would taint the new evaluation. The Appeals Board granted removal, amended the prior order, and clarified that a new QME is allowed. However, the admissibility of the first QME's reports is deferred to the trial judge, and those reports, unlike diagnostic study results, are not to be provided to the new evaluator.

Petition for RemovalQualified Medical Evaluator (QME)Admissibility of ReportsDue ProcessWorkers' Compensation Appeals Board (WCAB)Administrative Law Judge (WCJ)Industrial InjuryMedical EvaluationsDiscoveryMandatory Settlement Conference (MSC)
References
0
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