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

Case No. ADJ6640151
Regular
May 12, 2011

CHERYL CIENFUEGOS vs. FOUNTAIN VALLEY SCHOOL DISTRICT, KEENAN & ASSOCIATES

The Workers' Compensation Appeals Board granted the defendant's Petition for Removal, rescinding an order compelling the applicant to see a second Qualified Medical Evaluator (QME), Dr. Dao. The Board found that the applicant was not entitled to a second QME solely due to a delay in scheduling a supplemental examination with the first QME, Dr. Chiu. The Board reasoned that administrative rules regarding QME availability do not apply to supplemental evaluations. Consequently, the applicant must attend the rescheduled examination with Dr. Chiu.

Petition for RemovalQualified Medical EvaluatorPanel QMELabor Code sections 4060 and 4062.2Industrial injuryNeckShouldersUpper extremitiesPsycheAgreed Medical Evaluator
References
1
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
3
Case No. ADJ8045455; ADJ8045600
Regular
Sep 14, 2012

ELSIE PENA CLARK ROSAS vs. SUTTER GENERAL HOSPITAL, SUTTER HEALTH

Here's a summary for a lawyer: The Workers' Compensation Appeals Board denied the defendant's Petition for Removal, which sought to compel applicant's examination by the same Qualified Medical Examiner (QME) for two distinct injuries. The Board affirmed the WCJ's decision, holding that separate QME panels are permissible for distinct injuries to different body parts. This ruling establishes that a second injury does not constitute a "new medical issue" or a "follow-up/supplemental evaluation" requiring the original QME. Therefore, the applicant is entitled to a new QME panel for the second injury.

Petition for RemovalPQMEMedical Unitdistinct injuriesbody partsnew medical issuefollow-up evaluationsupplemental evaluationsecond panel of QMEsLabor Code section 4062.3(j)
References
0
Case No. ADJ11258859
Regular
Jan 23, 2020

Allen, Melanie vs. Stockton Unified School District

The Board rescinded the Finding of Fact, Order and Award due to the Qualified Medical Examiner's (QME) report's non-compliance with Labor Code section 4628. The QME falsely claimed to have personally reviewed all medical records when deposition testimony revealed a third party performed this task. This violation renders the QME's report inadmissible evidence. Consequently, the matter is returned to the WCJ for further proceedings, including potential re-trial and a new decision after a replacement QME evaluation or an agreed medical examiner. The WCJ must also address previously unresolved evidentiary issues.

Workers' Compensation Appeals BoardPetition for ReconsiderationFinding of Fact Order and AwardQualified Medical ExaminerLabor Code section 4628medical-legal reportsubstantial evidenceinadmissible evidenceAgreed Medical Examinerappointed physician
References
0
Case No. ADJ9060626
Regular
Oct 05, 2015

PATRICK SCHOLLER vs. TRINITY ALPS UNIFIED SCHOOL DISTRICT, SHASTA-TRINITY SCHOOLS INSURANCE GROUP, JPA-PSI, administered by SCHOOLS INSURANCE AUTHORITY

The Workers' Compensation Appeals Board granted the defendant's Petition for Removal. The Board rescinded the prior order allowing a new Qualified Medical Examiner (QME) panel due to a delay in a supplemental report. The Board sustained the defendant's objection, finding that disqualifying the original QME was not warranted. Defendant is authorized to request the replacement QME not prepare a report if an examination has already occurred.

Petition for RemovalQualified Medical Examiner panelSupplemental ReportMedical-Legal ExpensesPanel Qualified Medical ExaminerWCJPetition for RemovalMinutes of Hearing and OrderRescindedSustained Objection
References
0
Case No. ADJ9642652
Regular
Aug 23, 2018

ROSE CASADO vs. KAISER PERMANENTE, SEDGWICK

The Workers' Compensation Appeals Board rescinded the original Findings and Award, returning the case for further proceedings. The Board found the Qualified Medical Examiner's (QME) report inadmissible due to a violation of Labor Code section 4628 concerning the disclosure of individuals assisting in examinations. Additionally, the Board noted potential reliance on an incorrect legal theory by the QME regarding the rating of subjective complaints without objective findings. The matter is remanded for further development of the record, including a supplemental report from the QME that complies with legal requirements.

Workers' Compensation Appeals BoardReconsiderationFindings and AwardPermanent DisabilityQualified Medical Evaluator (QME)Substantial EvidenceLabor Code Section 4628Jamar DynamometerMedical-Legal ReportsAMA Guides
References
12
Case No. ADJ8519763, ADJ8527545
Regular
Oct 28, 2014

SYLVIA KRESS vs. DALLCO, INC. and PROSIGHT GLOBAL, INC.

Defendant Prosight Global, Inc. petitioned for removal, challenging an order continuing a mandatory settlement conference (MSC) to address Qualified Medical Examiner (QME) replacement and medical record issues. Subsequent to the petition, the parties successfully resolved the QME dispute by agreeing to use an Agreed Medical Examiner (AME) and withdrew the QME replacement request at a later MSC. This resolution rendered the defendant's petition moot. Consequently, the Workers' Compensation Appeals Board dismissed the Petition for Removal as the underlying issues were resolved by the parties.

Petition for RemovalMandatory Settlement ConferenceWCJPanel Qualified Medical ExaminerAgreed Medical ExaminerMootDismissedProsight GlobalDallcoLWP Claims Solutions
References
0
Case No. ADJ7271031
Regular
Sep 21, 2012

THOMAS DACK vs. CEMEX, COMMERCE & INDUSTRY INSURANCE COMPANY administered by CHARTIS CLAIMS INC.

This case involves the defendant's Petition for Removal after the WCJ denied their request to compel the applicant's attendance at a QME examination. The applicant's attorney's office had previously stated the applicant would not attend QME evaluations until litigation was resolved and attempted to strike a QME. The Appeals Board is giving notice of its intention to grant the defendant's petition and compel the applicant's attendance, unless the applicant shows good cause within ten days. The Board finds the defendant has presented a prima facie case for compelling the examination, noting a lack of formal objection from the applicant.

Petition to CompelPanel QMELabor Code section 4062.2WCJPetition for RemovalApplicant objectionGood causeWorkers' Compensation Appeals BoardQualified Medical EvaluatorIndustrial injury
References
0
Case No. MISSING
Regular Panel Decision
Nov 03, 1967

Holloway v. Board of Examiners

The petitioner, a school social worker, initiated an Article 78 proceeding to compel the respondent to provide copies of medical and other reports that led to an unsatisfactory rating in an examination for a Supervisor of School Social Workers license. The Supreme Court, Kings County, initially dismissed the petition. However, the appellate court reversed this judgment, granting the petition to the extent of directing the respondent to furnish the reports to a physician designated by the petitioner, rather than directly to the petitioner. The case was remanded to the Special Term for further proceedings, including a determination on allowing the petitioner more time to appeal the unsatisfactory rating.

Article 78 CPLRLicense ExaminationSchool Social WorkerMedical ReportsDisclosureAdministrative AppealUnsatisfactory RatingAppellate ReversalRemandPhysician Disclosure
References
3
Case No. MISSING
Regular Panel Decision

Claim of Brian VV. v. Chenango Forks Central School District

Petitioners filed a notice of claim after their six-year-old daughter was allegedly sexually assaulted on a school bus. The respondent, a school district, subsequently served a notice to orally examine the infant and petitioners. While petitioners submitted to examination, they refused to produce their child. The Supreme Court initially granted petitioners’ motion to strike the notice to examine the infant, deeming prior informal interviews with the child as substantial compliance. However, the appellate court reversed this decision, emphasizing that General Municipal Law § 50-h mandates a pre-action examination as a condition precedent. The court ruled that the prior interviews did not fulfill the statutory purpose and that the child's submission to an examination is required. Due to the child's young age, the matter was remitted to the Supreme Court to conduct a hearing to determine the child's competency to testify under oath before the examination takes place.

General Municipal Law § 50-hEducation Law § 3813Infant examinationSexual assault claimCondition precedentAppellate procedureCompetency hearingSchool district liabilityPre-action discoveryOath requirement
References
13
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