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

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. ADJ8173186
Regular
Jun 07, 2013

NATHAN LITTLE vs. DIVERSIFIED UTILITY SERVICES, OLD REPUBLIC GENERAL INSURANCE CORPORATION

The Workers' Compensation Appeals Board denied Nathan Little's Petition for Removal concerning a Qualified Medical Examiner (QME) panel. The Board adopted the WCJ's report, which found the QME process was initiated correctly under Labor Code section 4062.2 while the applicant was represented. Although the applicant later became unrepresented, the Board stated the original procedure should be followed for this QME panel. The denial means the applicant must proceed with the designated QME process.

Petition for RemovalQME PanelLabor Code section 4062.1Labor Code section 4062.2unrepresented applicantrepresented applicantsubstantial prejudiceirreparable harmpanel QMEdermatology
References
Case No. ADJ9834159 (MF) ADJ9834161
Regular
Jul 30, 2018

ESAU HERNANDEZ vs. D.L. BONE AND SONS PAINTING, ICW GROUP/EXPLORER INSURANCE COMPANY, STATE COMPENSATION INSURANCE FUND

This case concerns a defendant's attempt to obtain a replacement Qualified Medical Evaluator (QME) panel after the applicant initially objected to the timeliness of the original QME's report. The Appeals Board treated the defendant's petition as one for removal and denied it. The Board found that the defendant, having failed to timely object to the QME's report itself, could not rely on the applicant's subsequent objection to request a new panel. The Board concluded that the defendant's failure to act promptly meant they were not entitled to a replacement QME panel, and no substantial prejudice or irreparable harm warranting removal was demonstrated.

Workers' Compensation Appeals BoardReconsiderationRemovalQualified Medical EvaluatorQME panelAdministrative Director RuleTimeliness objectionReplacement QME panelLabor CodeFindings of Fact
References
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. ADJ9854681
Regular
May 29, 2018

MARK DE PETRO vs. NAPACABS/ITALIANTE, INC., REPUBLIC INDEMNITY COMPANY OF AMERICA

The Workers' Compensation Appeals Board (WCAB) granted reconsideration, rescinded the trial judge's order to strike QME Dr. Lal's reports, and denied the request for a replacement QME panel. The WCAB found that Dr. Lal's insistence on the applicant either undergoing or formally deferring surgery before issuing a permanent and stationary report constituted an incorrect legal theory. The Board determined the medical record was deficient and ordered further development of the record with Dr. Lal, preferring to return to the existing physician. The WCAB affirmed the finding of injury AOE/COE to the applicant's back.

Petition for ReconsiderationQualified Medical Evaluator (QME)Permanent and Stationary ReportSubstantial EvidenceFurther Development of RecordMedical Treatment DisputeReplacement QME PanelMedical Unit JurisdictionUtilization Review (UR)Independent Medical Review (IMR)
References
Case No. ADJ11861160
Regular
Oct 25, 2019

ADRIANA MARTINEZ vs. AVITUS, AMERICAN ZURICH INSURANCE COMPANY, GALLAGHER BASSETT SERVICES

This case involves a dispute over the selection of Qualified Medical Evaluator (QME) panels for an applicant with claimed injuries to multiple body parts. The Workers' Compensation Appeals Board (WCAB) granted the applicant's petition for removal, rescinded the prior decision, and found that the applicant's chiropractic QME panel request was proper while the defendant's orthopedic surgery panel request was improper. The WCAB determined that chiropractic medicine is the appropriate specialty and struck the orthopedic surgery panel, ordering the parties to proceed with the chiropractic QME. The WCAB clarified that while chiropractors cannot perform surgery or prescribe medication, they are qualified to evaluate injuries within their scope of practice.

QME panel disputeremoval petitionchiropractic specialtyorthopedic surgery specialtyLabor Code 4062.2Medical Directoradministrative law judgeWorkers' Compensation Appeals Boardproper panel selectioninvalid panel request
References
Case No. ADJ7712746
Regular
Dec 08, 2015

Glen Rizuto vs. United Parcel Service, Gallagher Bassett

The Appeals Board granted UPS's Petition for Removal, rescinding the WCJ's order to negotiate a QME selection. The Board found the WCJ erred by not addressing UPS's contentions regarding the validity of the second QME panel issued over 24 months after the first. UPS successfully argued they would be prejudiced if forced to negotiate when the second panel was allegedly the only valid one. The Board ordered parties to select a QME from the July 2, 2014 panel, allowing each to strike one name.

Petition for RemovalQualified Medical Evaluator (QME)Panel SelectionCumulative Trauma InjuryLabor Code Section 4062.1Labor Code Section 4062.2Romero v. Costco WholesaleIrreparable HarmPrejudiceMedical Unit
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. ADJ3218661 (OAK 0339889)
Regular
Feb 07, 2011

CHANCE ROLLINS vs. JOHN MARTIN STABLES, INC.; AMERICAN HOME ASSURANCE administered by AIG, CLAIMS SERVICES

The Appeals Board vacated its prior order granting reconsideration and dismissed the defendant's petition for reconsideration, finding the WCJ's ruling was not a final order. However, the Board granted removal, rescinded the WCJ's order, and denied the applicant's request for a neurology consultation under Labor Code §4601(a). The matter was returned to the trial level with instructions to issue an order for a new QME panel in neurology, as Dr. Jamasbi's request for a consultative neurological evaluation constituted good cause for a new panel under 8 Cal. Code Regs. §31.7. Attorney fees for the ex parte communication were upheld.

WCABPetition for ReconsiderationPetition for RemovalLabor Code 4601(a)Labor Code 4062.3QMEAgreed Medical EvaluatorNeurological ConsultMedical DirectorSpecialty Panel
References
Case No. ADJ9581070; ADJ10207290
Regular
Sep 12, 2016

LETICIA ORNELAS vs. NORTHSTAR GROUP SERVICES, INC., NEW HAMPSHIRE INSURANCE COMPANY

The Workers' Compensation Appeals Board (WCAB) denied the defendant's petition for reconsideration or removal of a prior order. The WCAB affirmed the finding that Dr. David Teicheira was the properly designated Qualified Medical Evaluator (QME) for the applicant's cumulative trauma claim. This decision was based on the understanding that a new QME panel is validly obtained for a subsequent claim, even if an Agreed Medical Evaluator (AME) was previously used for a different injury. The prior AME agreement did not preclude the use of a QME for the distinct cumulative trauma claim.

WCABPetition for ReconsiderationQME PanelAgreed Medical EvaluatorCumulative TraumaSpecific InjuryFindings and OrderWCJLabor CodeNavarro v. City of Montebello
References
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