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

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
1
Case No. ADJ12557876
Regular
Nov 04, 2020

VERONICA MADRIGAL vs. MONTEREY COUNTY OFFICE OF EDUCATION, INTERCARE HOLDINGS INSURANCE SERVICES, INC.

Here is a summary of the case for a lawyer in four sentences: The defendant sought reconsideration of a WCJ's order denying their petition for a new QME panel and finding their objections to the existing panel harmless error. The Appeals Board denied the petition, agreeing that the applicant's counsel's communication with the QME, while a technical violation of Labor Code section 4062.3(b), did not result in prejudice warranting a new panel. The Board also found the defendant waived their right to object to the QME's report by relying on it to terminate temporary disability benefits. Furthermore, the defendant failed to provide evidence that the original QME panel was improperly issued, thus failing to prove entitlement to a new orthopedic panel.

QME panelLabor Code section 4062.3ex parte communicationadvocacy letterharmless errorstipulated findings and orderremovalreconsiderationmedical evaluatoragreed medical evaluator
References
5
Case No. ADJ11446545
Regular
Dec 03, 2019

ROSA LOPEZ RODRIGUEZ vs. UNIVERSAL BUILDING SERVICES SUPPLY COMPANY, INSURANCE COMPANY OF THE WEST

This case concerns a dispute over the appropriate medical specialty for a Qualified Medical Evaluator (QME) panel. The applicant, Rosa Lopez Rodriguez, initially requested a chiropractic QME panel, which was issued first. The defendant objected, arguing that chiropractic was inappropriate due to the applicant's prior surgery and lack of full recovery. The Medical Unit then invalidated the chiropractic panel and issued an orthopedic surgery panel. The Workers' Compensation Appeals Board granted reconsideration, overturning the WCJ's decision. The Board held that the party who first requests a QME panel has the right to designate the specialty and that the defendant failed to provide sufficient grounds to invalidate the chiropractic panel. Therefore, the Board amended the findings to sustain the applicant's objection and affirm chiropractic as the appropriate panel specialty.

AD Rule 31.5(a)(10)AD Rule 31.5(a)(9)AD Rule 31.1(b)Labor Code section 4062Labor Code section 4062.2Qualified Medical Evaluator (QME)QME panel specialtyPetition for RemovalPetition for ReconsiderationMedical Unit determination
References
1
Case No. ADJ9163491; ADJ9163494
Regular
Jan 09, 2015

RIGOBERTO NORIEGA vs. BEST WESTERN TOWN & COUNTRY

This case concerns an applicant's petition for removal after the WCJ denied his objection to a QME's report. The applicant argued the QME report was untimely and prejudicial because it issued a zero impairment rating. The Appeals Board denied removal, finding the applicant waived his objection by not requesting a replacement QME panel until after receiving the unfavorable report. The Board cited precedent preventing parties from waiting to see if a report is favorable before objecting to its timeliness. Commissioner Zalewski dissented, believing the applicant could object after receipt as long as the objection preceded the replacement panel request.

Petition for RemovalQualified Medical EvaluatorQME reportuntimely filingservice of reportreplacement panelobjectionstatutory timeframesLabor CodeAdministrative Director Rule
References
3
Case No. ADJ8529720
Regular
Feb 06, 2017

ALEJANDRA GONZALEZ vs. 3M COMPANY, OLD REPUBLIC INSURANCE

This case concerns whether an untimely supplemental Qualified Medical Evaluator (QME) report warrants a replacement panel. The applicant requested a new panel because the original QME's supplemental report was late. The WCJ denied the defendant's request to keep the original QME, finding the defendant waived objection by striking a name from the new panel. The Appeals Board granted removal, rescinded the WCJ's order, and remanded the case. The Board clarified that striking a name from a new panel does not automatically waive the right to object to its validity.

PQMESupplemental ReportReplacement PanelLabor Code 4062.5DWC Medical UnitDeclaration of ReadinessMSCWaiverAdministrative Director Rule 38Rule 31.5
References
0
Case No. ADJ9623223
Regular
Aug 04, 2015

KORI HARDING vs. ABM INDUSTRIES

The Workers' Compensation Appeals Board affirmed a finding that an applicant was entitled to a chiropractic QME panel. The Board found the defendant's objection and request for an orthopedic QME panel did not comply with Rule 31.5(10) as the Medical Unit did not determine the initial specialty was "medically or otherwise inappropriate for the disputed medical issue(s)." Newly discovered evidence of disc herniation was deemed insufficient to change this outcome, as the initial determination was flawed. The WCAB affirmed the original award directing use of the chiropractic QME panel.

Workers' Compensation Appeals BoardQualified Medical EvaluatorQME PanelMedical UnitPrimary Treating PhysicianChiropractic CareOrthopedicsRule 31.5(10)Industrial InjuryReplacement Panel
References
3
Case No. ADJ3155871
Regular
Sep 17, 2009

ANTO'NIO PAULO vs. SIENA IMPORTS, FIRST COMP OMAHA For ENDURANCE INSURANCE COMPANY

This case involves a dispute over the specialty of a Qualified Medical Evaluator (QME) panel. The applicant, Antonio Paulo, objected to the defendant's requested QME specialty, arguing the defendant failed to follow proper procedure by not providing supporting documentation for a specialty different from the treating physician's. The Workers' Compensation Appeals Board (WCAB) denied the defendant's petition for removal, upholding the decision to void the initial panel. The Board found the applicant's objections were timely and the defendant had not demonstrated significant prejudice.

Petition for RemovalQualified Medical EvaluatorPQME Panel SelectionMedical UnitWCAB JurisdictionSpecialty DisputePain ManagementSpinePrimary Treating Physician8 CCR 31.1
References
0
Case No. ADJ10885532
Regular
Aug 09, 2018

Carlos Valdiviezo vs. The Olympic Club, North River Insurance Company, Crum and Forster

The Workers' Compensation Appeals Board denied the applicant's petition for removal. The applicant sought to obtain a Qualified Medical Evaluator (QME) panel after objecting to a non-Medical Provider Network (MPN) physician's report. However, the Board found that the applicant failed to comply with Labor Code section 4062.2 by not serving the objection on the defendant at least 16 days prior to requesting the QME panel. Consequently, the applicant did not demonstrate substantial prejudice or irreparable harm, and reconsideration was deemed an adequate remedy.

RemovalFindings of Fact and OrderQualified Medical EvaluatorQME panelMedical Provider NetworkMPNObjectionPrimary Treating PhysicianLabor CodeExpedited Hearing
References
2
Case No. ADJ1211801
Regular
Apr 13, 2012

GUISELA REYNOSO vs. UNIVERSAL PROTECTION SERVICES, AMERICAN CASUALTY COMPANY OF READING, PENNSYLVANIA, CNA CLAIMPLUS

The Workers' Compensation Appeals Board dismissed the defendant's Petition for Reconsideration because the WCJ's decision denying a replacement QME was an intermediate procedural order, not a final determination of substantive rights. The defendant sought a new panel after the QME allegedly violated a regulation by evaluating the applicant at an unlisted address and missed a deposition. The Board found the defendant's objection to the evaluation was untimely and that the request for a new panel appeared to be an attempt to "doctor shop" after receiving unfavorable reports. Even if considered for removal, the petition would be denied due to the unreasonable delay in raising objections.

Workers' Compensation Appeals BoardQualified Medical EvaluatorQME panelindustrial injuryspider bitesecurity guardreplacement paneldepositiondiscovery ordersfinal order
References
4
Case No. ADJ6794293
Regular
Jul 29, 2011

SHARON HIRONYMOUS vs. CENTRAL ANESTHESIA SERVICE, EMPLOYERS COMPENSATION INSURANCE COMPANY

The Workers' Compensation Appeals Board dismissed the defendant's petition for reconsideration of an order allowing a replacement QME panel. The Board granted removal, rescinded the order, and ruled the applicant was not entitled to a replacement QME. This decision was based on the applicant's failure to object to the QME's conduct during the examination itself, instead waiting until after reviewing the QME's report. Allowing a replacement panel under these circumstances was deemed prejudicial to the defendant.

QMEreplacement panelPetition for ReconsiderationPetition for Removalindustrial injurycarpal tunnel syndromeAdministrative Law JudgeQualified Medical Evaluator Complaint FormTitle 8 California Code of Regulationsinterlocutory procedural order
References
16
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