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

Case No. ADJ7899192, ADJ7902366
Regular
Oct 21, 2019

VALERIE DAILEY vs. SCRIPPS HEALTH

The applicant sought reconsideration of a finding that her psychiatric injury was not a compensable consequence of her industrial neck and elbow injuries. The Board found that the prior QME's report, which applicant sought to admit, should have been considered as it was not properly excluded. The Board also noted that the subsequent QME's report did not review the prior QME's findings, potentially rendering it incomplete. Consequently, the Board rescinded the award and returned the matter for further proceedings to admit the prior QME's report and allow the subsequent QME to review it.

Workers Compensation Appeals BoardPsychiatric InjuryCompensable ConsequenceQualified Medical EvaluatorQME ReportAdmissibility of EvidenceMedical EvaluationFurther ProceedingsFindings and AwardReconsideration
References
9
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
1
Case No. ADJ1934243 (FRE 0221043)
Regular
Apr 25, 2011

MARIA RAYOS vs. WALGREENS, ZURICH INSURANCE COMPANY

This case concerns a dispute over a second Qualified Medical Examiner (QME) for an applicant with a work-related knee, back, and hip injury. The defendant sought removal, arguing that allowing a second QME without striking the first QME's reports violated due process and would taint the new evaluation. The Appeals Board granted removal, amended the prior order, and clarified that a new QME is allowed. However, the admissibility of the first QME's reports is deferred to the trial judge, and those reports, unlike diagnostic study results, are not to be provided to the new evaluator.

Petition for RemovalQualified Medical Evaluator (QME)Admissibility of ReportsDue ProcessWorkers' Compensation Appeals Board (WCAB)Administrative Law Judge (WCJ)Industrial InjuryMedical EvaluationsDiscoveryMandatory Settlement Conference (MSC)
References
0
Case No. ADJ7294109
Regular
Jun 07, 2013

MANSOUREH AZIMZADEH vs. BURG & BROCK, EMPLOYERS COMPENSATION CO.

This case involves an applicant challenging a Workers' Compensation Judge's decision to disregard the Qualified Medical Examiner's (QME) reports due to flawed apportionment analysis and ordering a new QME panel. The Appeals Board granted removal, rescinded the order for a new QME panel, and returned the matter for further development of the record. The Board agreed that the QME's reports lacked substantial medical evidence due to a misunderstanding of apportionment law and that further development with the same QME would be unhelpful. The Board emphasized that new medical-legal reporting would be necessary to properly weigh evidence.

RemovalReconsiderationPetitionPanel Qualified Medical ExaminerPQMESubstantial Medical EvidenceApportionmentFindings and OrderMedical UnitDiscovery
References
9
Case No. ADJ7555685
Regular
Apr 02, 2012

RAHUL ROY vs. GALLO SALES COMPANY INC.

This case concerns the admissibility of a Qualified Medical Evaluator's (QME) reports due to alleged violations of Labor Code section 4062.3 and AD Rule 35. The defendant, Gallo Sales Company, Inc., sent medical information and sub rosa films to the QME without timely providing copies or notice of objection rights to the applicant, Rahul Roy. The Workers' Compensation Appeals Board affirmed the finding that the QME's reports were inadmissible due to these ex parte communications, disqualifying the QME. The applicant is entitled to a new QME panel.

PQMEAD Rule 35Ex parte communicationLabor Code section 4062.3Medical informationNon-medical recordsSupplemental reportSub rosa filmsQME panelAdmissibility
References
12
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
12
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
Case No. ADJ7760776
Regular
Feb 24, 2012

SCOTT HARPER vs. ENTERTAINMENT PARTNERS, INSURANCE COMPANY OF THE STATE OF PENNSYLVANIA

This case concerns a defendant's petition for removal to obtain a Qualified Medical Evaluator (QME) report before proceeding to trial. The defendant argued they would be prejudiced by proceeding without a QME evaluation to address causation due to prior injuries. The Appeals Board granted the petition, finding the defendant had diligently attempted to obtain a QME and that delays were not their fault. Consequently, the trial date was rescheduled as a status conference to await the QME evaluation.

Petition for RemovalQualified Medical Evaluator (QME)Labor Code sections 40604062.2substantial prejudiceirreparable harmindustrial injurydenial of injuryAOE/COEMendoza v. Huntington Hospital
References
1
Case No. ADJ2500785 (MON 0261411)
Regular
Jan 30, 2009

Starr Olson vs. HACIENDA BRIDES INTERNATIONAL, INC., STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board granted reconsideration, rescinded the original award, and remanded the case for a new permanent disability rating. The Board found the original judge erred by relying on a QME's opinion of total permanent disability that was not based on an accurate history. Instead, the Board directed the new rating be based on the opinions of the Agreed Medical Examiners (AMEs), who found significant but less restrictive permanent disability. Additionally, the Board reinstated the AME psychiatrist's apportionment of 30% of the psychological disability to non-industrial factors.

Workers' Compensation Appeals BoardStarr OlsonHacienda Brides InternationalState Compensation Insurance Fundindustrial injurybilateral upper extremitiesRSDleft shoulderright kneepsyche
References
0
Case No. ADJ3225136
Regular
Apr 21, 2011

MICHAEL GIAMMONA vs. FISHER DEVELOPMENT AND TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICA

The Workers' Compensation Appeals Board granted removal and rescinded a prior order that denied the defendant's motion for a new Qualified Medical Examiner (QME). The Board found that the applicant's post-evaluation, unserved letter to the QME constituted an ex parte communication, which is prohibited by statute and requires a new QME panel. Consequently, the QME's reports were stricken, and a new panel was ordered. The defendant's petition for reconsideration was dismissed as the original order was procedural, not final.

Panel Qualified Medical ExaminerPQMEEx parte communicationLabor Code Section 4062.3RemovalReconsiderationAdministrative law judgeWCJPain managementAutomobile accident
References
0
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