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

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. ADJ3355286 (SAC 0369062)
Regular
Jun 24, 2010

Dale E. Hansen vs. EL DORADO TRUSS COMPANY, INC., ZENITH INSURANCE COMPANY

The Workers' Compensation Appeals Board dismissed the applicant's petition for reconsideration, finding no final order existed subject to review. The Board also denied the applicant's petition for removal, as no significant prejudice or irreparable harm was demonstrated. The applicant had sought to disqualify a psychiatric QME and argued the WCJ erred on multiple procedural and evidentiary grounds. The WCJ's order for the parties to confer on an Agreed Medical Examiner was found not to be a final determination.

Workers Compensation Appeals BoardPetition for ReconsiderationPetition for RemovalQualified Medical Examiner (QME)Agreed Medical Examiner (AME)Reporting RequirementsFinal OrderSubstantive RightsPrejudiceIrreparable Harm
References
Case No. ADJ345248 (RDG 0128229)
Regular
Oct 26, 2011

JEREMY CHISSIE vs. REIBES AUTO PARTS, LLC, PACIFIC COMPENSATION INSURANCE COMPANY

The Workers' Compensation Appeals Board granted removal and rescinded the WCJ's order to appoint an Independent Medical Examiner (IME). The Board found the WCJ improperly bypassed the established procedure for selecting a Qualified Medical Evaluator (QME) when the original QME became unavailable. Instead, the matter must return to the trial level to follow the Administrative Director's rules for appointing a replacement QME. This ensures the defendant's right to participate in the physician selection process.

Workers' Compensation Appeals BoardPetition for ReconsiderationPetition for RemovalIndependent Medical Examiner (IME)Qualified Medical Evaluator (QME)Labor Code section 4062.2Administrative Director's Rule 31.5Rule 32.6Medical UnitPanel QME
References
Case No. ADJ6470549
Regular
Feb 27, 2012

KATHRYN BENSON vs. CITY OF SAN DIEGO

The Workers' Compensation Appeals Board granted reconsideration and reversed a prior decision, allowing a Qualified Medical Examiner's (QME) report into evidence. The original decision excluded the QME report, finding no ratable permanent disability based on the treating physician's opinion. The Appeals Board found the QME report should have been admitted, as there are no explicit time limits for objecting to a treating physician's report or obtaining a QME evaluation for permanent disability. The case is remanded for further proceedings on permanent disability and attorney's fees with the QME report now part of the record.

Workers Compensation Appeals BoardFindings and AwardPetition for ReconsiderationQualified Medical Examiner (QME)Permanent DisabilityFuture Medical TreatmentTreating PhysicianAgreed Medical Examiner (AME)Labor Code Section 4061Strawn v. Golden Eagle Insurance Co.
References
Case No. ADJ18724961; ADJ15255319
Regular
Nov 03, 2025

Tina Garza vs. County of Kern

Defendant County of Kern sought reconsideration of a WCJ's Findings of Fact and Discovery Order which determined that Dr. Scott Graham was the Agreed Medical Evaluator (AME) for both claims and that defendant waived its right to a Qualified Medical Evaluator (QME) examination. The defendant argued that the waiver finding was improper and they were entitled to a new medical-legal evaluation panel. The Appeals Board granted reconsideration, rescinded the WCJ's decision, and returned the matter for further proceedings, primarily due to an inadequate record and deficiencies in the minutes of hearing. The Board also noted that based on current Labor Code interpretations, the parties' agreement to an AME once initiated, generally precludes subsequent QME panel requests for submitted issues.

Workers' Compensation Appeals BoardPetition for ReconsiderationAgreed Medical Evaluator (AME)Qualified Medical Evaluator (QME)Panel QMEMedical-Legal ExaminationWaiver of RightLabor Code Section 4062.2Labor Code Section 4062.3Navarro v. City of Montebello
References
Case No. ADJ1436626 (VNO 0559475)
Regular
Dec 13, 2011

ROBERT JONES vs. COCA COLA ENTEPRISES INC, SEDGWICK CMS, INC

The Workers' Compensation Appeals Board dismissed the applicant's petition for reconsideration because it was not taken from a "final" order, but rather an interlocutory procedural decision. The Board also denied removal, finding no substantial prejudice or irreparable harm if removal were not granted, and adopted the WCJ's reasoning. The WCJ recommended denial because the applicant's attorney violated Labor Code section 4062.3(e) by providing information to a QME the day before an examination, thereby tainting the QME's report and deposition.

Petition for ReconsiderationPetition for RemovalFinal OrderInterlocutory OrderSubstantive RightLabor Code Section 4062.3Ex Parte CommunicationQualified Medical Examiner (QME)Tainted QMEPermanent Disability
References
Case No. ADJ19039281
Regular
Oct 28, 2025

JUAN SOSA vs. RC GREEN TOUCH INC.; INSURANCE COMPANY OF THE WEST; SECURITY NATIONAL INSURANCE COMPANY

Applicant Juan Sosa sought reconsideration of a Workers' Compensation Administrative Law Judge's (WCJ) order invalidating his requested Qualified Medical Examiner (QME) panel number 7774203. The Appeals Board, applying a removal standard, denied the petition. The Board affirmed the WCJ's decision, finding that the applicant failed to comply strictly with the requirements for requesting a QME panel, specifically regarding the correct claim number and proper service to the defendant AmTrust, consistent with prior case law.

WCABPetition for ReconsiderationPetition for RemovalQualified Medical Examiner (QME)QME panelLabor Code § 5909Adjudication NumberMandatory Settlement Conference (MSC)Declaration of Readiness to Proceed (DOR)Threshold Issue
References
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
Case No. ADJ8690817 ADJ8691038
Regular
Aug 19, 2013

ALEXANDER CASTILLO vs. AIRGAS, INC., INSURANCE COMPANY OF THE STATE OF PENNSYLVANIA, GALLAGHER BASSETT SERVICES, INC.

The Appeals Board denied the applicant's petition for removal to compel a Qualified Medical Examiner (QME) evaluation before trial. The Board found that the order setting the matter for trial on compensability was not a final order, and the applicant could renew the request for a QME at trial without suffering irreparable harm. Furthermore, the Board noted that the trial judge could order further development of the record, including a QME, after hearing evidence. Therefore, removal was deemed an inappropriate remedy.

Workers Compensation Appeals BoardPetition for RemovalOrder Denying PetitionWorkers' Compensation JudgeInjury Arising Out Of and Occurring In Course of EmploymentAOE/COECompensabilityQualified Medical ExaminerQMELabor Code Section 4060
References
Case No. ADJ6950792
Regular
Sep 01, 2015

LILLIAN DUNN vs. COUNTY OF SAN BERNARDINO

This case concerns a petition for reconsideration and removal from a Workers' Compensation Appeals Board order. The Board denied the petition, adopting the reasoning of the Workers' Compensation Administrative Law Judge (WCJ). The WCJ determined that a Qualified Medical Examiner's (QME) report was not substantial evidence due to a failure to issue a supplemental report after reviewing additional medical records. Because the QME was unavailable to provide a supplemental report, the WCJ ordered a replacement QME, a decision upheld by the Board.

Workers' Compensation Appeals BoardPetition for ReconsiderationRemovalReplacement PanelQualified Medical ExaminerQMESupplemental ReportLabor Code Section 4062.5Rule 38Apportionment
References
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