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

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 The Board granted removal, rescinded the order, and ruled the applicant was not entitled to a replacement QME.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
Case No. ADJ4257489 (VNO 0545109) ADJ1819339 (VNO 0545111)
Regular
Apr 27, 2009

LUZ GALARZA vs. ADECCO EMPLOYMENT SERVICES, INSURANCE COMPANY OF THE STATE OF PENNSYLVANIA IN CARE OF BROADSPIRE SERVICES, INC.

The Workers' Compensation Appeals Board dismissed the defendant's Petition for Reconsideration and denied their Petition for Removal. The defendant sought these actions after the Administrative Law Judge (WCJ) continued the trial to await a Panel Qualified Medical Evaluator (Panel QME) chiropractic report. The defendant argued prejudice and due process violations regarding a psychiatric evaluation, but the Board found no final order was issued and no substantial prejudice warranted removal. The Board affirmed the WCJ's interlocutory procedural order allowing discovery to continue and found no error in the continuation of the trial.

Workers' Compensation Appeals BoardPetition for ReconsiderationPetition for RemovalPanel Qualified Medical EvaluatorChiropracticsPsychiatric EvaluationInterlocutory Procedural OrdersSubstantive Right or LiabilityExtraordinary RemedySubstantial Prejudice
References
Case No. ADJ1544900 (STK 0209146)
Regular
Feb 19, 2009

DARRYL CAETANO vs. STATE OF CALIFORNIA, DEPARTMENT OF WATER RESOURCES, Legally Uninsured; STATE COMPENSATION INSURANCE FUND/STATE CONTRACT SERVICES, Adjusting Agency

The Workers' Compensation Appeals Board (WCAB) dismissed the defendant's petition for reconsideration as the issued order for further record development was procedural, not a final determination of rights or liabilities. The defendant's petition for removal was also denied because they failed to demonstrate significant prejudice or irreparable harm, as the WCJ properly found the existing medical evidence inadequate for determining injury to additional body parts. The WCAB affirmed the WCJ's discretion in ordering supplemental reporting from the panel QME to develop the record. Therefore, the defendant's attempts to halt further investigation were unsuccessful.

Workers' Compensation Appeals BoardPetition for ReconsiderationPetition for RemovalFindings and Award OrderUtility Craft WorkerCervical SpineLeft KneeLow BackRight WristMandatory Settlement Conference
References
Case No. ADJ8418853
Regular
Oct 22, 2013

ANA ORELLANA vs. AMERIPRIDE SERVICES, INC., C.N.A.; administered by TRISTAR RISK MANAGEMENT

The Workers' Compensation Appeals Board dismissed the Defendant's Petition for Reconsideration because it was filed from a non-final interlocutory order regarding a Qualified Medical Examiner (QME) selection. The Board also denied the Defendant's request for removal, finding no showing of substantial prejudice or irreparable harm. The Defendant argued the Applicant should be re-evaluated by the same QME from a prior, unrepresented claim, but the Board adopted the Judge's reasoning that the Applicant, now represented, is entitled to a new QME panel for the distinct, current claim. The Board determined the distinction between represented and unrepresented employee QME procedures supported the entitlement to a new panel, overriding the Defendant's argument for re-evaluation by the prior QME.

Workers' Compensation Appeals BoardPetition for ReconsiderationDenial of RemovalFinal OrderInterlocutory OrderSubstantive RightIrreparable HarmCumulative TraumaPanel QMEUnrepresented Employee
References
Case No. ADJ6534990
Regular
Jun 08, 2012

Edward Williams vs. Barrett Business Services, Inc.

The Appeals Board dismissed the defendant's Petition for Reconsideration because the WCJ's order was not a final decision. Removal was granted on the Board's own motion to address procedural defects. The Board rescinded the WCJ's order and returned the matter to the trial level for further proceedings and a new decision regarding the admissibility of medical evidence. The issue centers on whether the defendant properly followed QME selection procedures given changes in applicant's counsel.

WCABPetition for ReconsiderationGrant RemovalDecision After RemovalOff CalendarFurther EvidenceMedical EvidencePanel Qualified Medical Evaluator (QME)Labor Code Section 4062.2Substitution of Attorney
References
Case No. ADJ7532290
Regular
Aug 28, 2012

MAXINE BROWN VIRGIL vs. LUNCH STOP, INC., EMPLOYERS COMPENSATION INSURANCE

This case involves a dispute over obtaining a Qualified Medical Evaluator (QME) panel. The applicant requested a new panel because a QME on the initial panel could not provide an appointment within 60 days. However, the applicant failed to properly strike a physician from the original panel after the defendant did. As a result, the defendant was authorized to schedule an appointment with a remaining physician, and the applicant was not entitled to a new QME panel. The Appeals Board granted removal to amend the prior order to reflect a rescheduled appointment with the original QME.

Workers' Compensation Appeals BoardPetition for RemovalQualified Medical EvaluatorpanelstrikeLabor Code section 4062Administrative Director Rule 31.5section 4062.2(c)medical evaluatorappointment
References
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
Case No. ADJ12550205
Regular
Apr 06, 2020

OLGA PLASCENCIA vs. ADECCO USA, INC

This case involves a dispute over a Qualified Medical Evaluator (QME) panel request. The applicant sought a chiropractic QME panel, while the defendant later denied liability for certain injuries. The Workers' Compensation Appeals Board (WCAB) rescinded the prior ruling and returned the case to the trial judge. This decision was based on the need to further develop the record regarding the applicant's DWC-1 form filing and the effect of the defendant's partial acceptance of liability on the QME panel process. The WCAB emphasized that the validity of the QME panel needs resolution before further proceedings.

Workers' Compensation Appeals BoardReconsiderationFindings and OrderDelay LetterMedical EvaluationQME PanelChiropracticOrthopedicLabor Code Section 4060Causation Dispute
References
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. ADJ6816825
Regular
Jun 14, 2010

KAI CHRISTOPHER vs. TIME WARNER CABLE, ESIS

The Appeals Board granted defendant's petition for removal, finding the WCJ erred in denying a QME panel request. This denial was based on Administrative Director Rule 30(d)(3), which previously stated only the employee could request a QME panel after a total denial of injury. However, the Board's recent en banc decision in *Mendoza v. Huntington Hospital* invalidated this rule as conflicting with Labor Code sections 4060(c) and 4062.2, which allow either party to request a QME panel. Therefore, the prior order was rescinded, and the matter returned to the trial level with instructions to issue a QME panel.

Petition for RemovalQualified Medical Evaluator (QME)Administrative Director RuleInvalid RuleMendoza v. Huntington HospitalLabor Code sections 4060(c)Labor Code sections 4062.2Denial of InjuryEither Party RequestMedical Director
References
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