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

Case No. ADJ7673518, ADJ7647749
Regular
Jan 23, 2015

ANA DE AYALA vs. AO-THE UNIVERSITY CORPORATION / CALIFORNIA STATE UNIVERSITY NORTHRIDGE

The Workers' Compensation Appeals Board granted reconsideration and reversed a prior ruling, finding the applicant sustained industrial injury to her neck. While the applicant testified to injuring her neck in a workplace incident and this was partially corroborated, the Board found insufficient evidence for other claimed injuries. The Board specifically disagreed with the administrative law judge's credibility assessment concerning the neck injury itself, relying on medical reports and testimony supporting the neck injury claim. The Board affirmed the denial of claims for all other alleged injuries, finding insufficient medical evidence to link them to the incident.

Petition for ReconsiderationFindings and OrderIndustrial InjuryNeck InjuryBack InjurySpine InjuryUpper ExtremitiesPsycheGastroesophageal SystemInternal System
References
Case No. ADJ8668832
Regular

BACILIO ANGEL SALAZAR vs. SAN DIEGO PERSONNEL AND EMPLOYMENT AGENCY, INC., AMTRUST NORTH AMERICA for CASTLEPOINT NATIONAL INSURANCE COMPANY

The Workers' Compensation Appeals Board granted the defendant's petition for removal, rescinding a prior order that deemed a QME report timely. The Board found Dr. Tahami's psychiatric evaluation report was untimely served on the defendant. As the defendant objected prior to receiving the report, they are entitled to a replacement QME panel in psychiatry.

Petition for RemovalQualified Medical EvaluatorQME paneluntimely reportreplacement QMEAdministrative Director RuleLabor Codepsychiatric injurymedical-legal evaluationsubstantial prejudice
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The Workers' Compensation Appeals Board (WCAB) granted reconsideration, rescinded the trial judge's order to strike QME Dr.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. ADJ9491221
Regular
May 23, 2017

JESUS DORANTES vs. DIRITO BROTHERS, INSURANCE CO. OF THE WEST

The Workers' Compensation Appeals Board (WCAB) dismissed the applicant's Petition for Reconsideration and denied his Petition for Removal. The applicant sought a replacement Qualified Medical Evaluator (QME) due to delays in receiving a supplemental report and alleged issues with the existing QME's reporting and deposition response. The WCAB found that the decision regarding the replacement QME was an interlocutory procedural ruling, not a final order from which reconsideration could be taken. Furthermore, the applicant failed to demonstrate substantial prejudice or irreparable harm necessary for removal, and did not meet the criteria for a mandatory replacement QME under the applicable regulations.

QME panelsupplemental reporttimely issuancereplacement QMEAdministrative Director Rule 38Petition for ReconsiderationPetition for RemovalLabor Code § 4062.5Rule 31.5(a)(12)substantial prejudice
References
Case No. ADJ8814212
Regular
Sep 08, 2017

VICTORIA LEWIS vs. LOS ANGELES UNIFIED SCHOOL DISTRICT

The Workers' Compensation Appeals Board granted the defendant's petition for removal, rescinding the administrative law judge's order for a replacement Qualified Medical Evaluator (QME). The Board found the judge did not properly consider if good cause existed for replacement, particularly regarding an untimely supplemental report. The Board remanded the case to the trial level for further proceedings, requiring evaluation of factors like prejudice and efforts to remedy delays before a replacement QME is ordered. The ultimate decision will hinge on a comprehensive analysis of these factors, not solely the untimeliness of the report.

Petition for RemovalQualified Medical EvaluatorQME panelFindings of Fact and Orderreplacement QMEuntimely reportgood causesupplemental reportMedical UnitAdministrative Director Rule 31.5
References
Case No. ADJ8092835
Regular
Mar 04, 2016

Dane Hayes vs. California Dairies, Hartford Fire Insurance Company

The Workers' Compensation Appeals Board denied a petition for removal, affirming the WCJ's decision to deny the defendant's motion to strike a QME's supplemental report. The Board found the supplemental report was timely served, as the 60-day period for completion concluded on the next business day after the Saturday deadline. Furthermore, the defendant failed to object to the report's alleged untimeliness *prior* to its service, which is a prerequisite for obtaining a new QME panel under the regulations. Therefore, the defendant failed to demonstrate the substantial prejudice and irreparable harm required for removal.

Petition for RemovalFindings and AwardQualified Medical Evaluator (QME)Supplemental ReportTimelinessObjection to ReportNew QME PanelLabor Code Section 4062.3Labor Code Section 4062.5California Code of Regulations Title 8 Section 38(i)
References
Case No. ADJ815944
Regular
Jan 14, 2010

LINDALAIVAREZ vs. BLUE DIAMOND GROWERS, TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICA

The Workers' Compensation Appeals Board denied a Petition for Removal, upholding the WCJ's decision to deny a new QME panel. The applicant's attempt to obtain a new panel was deemed impermissible "doctor-shopping" by delaying objection to a late supplemental QME report until after receiving and reviewing it, and finding it favorable. The Board applied the principle that parties cannot exploit delays in medical reports for strategic advantage. Therefore, removal was denied as the conduct did not justify a new panel appointment.

Petition for RemovalQME panelmedical-legal reportdoctor-shoppinguntimely reportsupplemental reportobjectionwrit deniedAppeals Board panel decisionadministrative law judge
References
Case No. ADJ7242422
Regular
Sep 24, 2013

TRACIE WHITE vs. COUNTY OF SACRAMENTO, DEPARTMENT OF FINANCE

The Workers' Compensation Appeals Board denied the County of Sacramento's Petition for Removal. The County sought to replace a Qualified Medical Evaluator (QME) due to an allegedly untimely supplemental report. The Board affirmed the administrative law judge's denial, interpreting Administrative Director Rule 38(h) to grant QMEs sixty days for supplemental reports. The Board also noted the County objected to the report before receiving it.

Petition for RemovalQualified Medical EvaluatorQME panelsupplemental reportuntimely reportAdministrative Director Rule 38Report and RecommendationFajardo v. Workers' Comp. Appeals Bd.WCJoff calendar
References
Case No. ADJ8931511
Regular
Sep 04, 2014

DOUGLAS FEUTZ vs. COUNTY OF SACRAMENTO

The Workers' Compensation Appeals Board denied the applicant's petition for removal, affirming the WCJ's decision. The applicant's attorney objected to a supplemental QME report being untimely, but did not request a new QME panel until after reviewing the report. The Board found this action constituted a waiver of the objection because the request was not made contemporaneously with the objection to the violation. Allowing such a delay would undermine efficient dispute resolution and permit doctor shopping.

Petition for RemovalSupplemental ReportPanel Qualified Medical EvaluatorPQMEMedical UnitReplacement QME PanelTimely Supplemental ReportProcedural ViolationWaiverDoctor-Shopping
References
Case No. ADJ7787692, ADJ7787693
Regular
Jan 14, 2016

Elizabeth Sauseda vs. The Permanente Medical Group, Inc.

This case involves the defendant's petition for removal, seeking to replace a Qualified Medical Evaluator (QME) in psychology due to alleged reporting delays. The Workers' Compensation Appeals Board (WCAB) denied the petition, upholding the administrative law judge's (WCJ) decision. The WCAB adopted the WCJ's recommendation, finding that a new QME examination would not proceed and the existing QME would remain. The issue of the defendant's personnel actions as a good faith defense remains for the trial judge's determination.

Petition for RemovalQualified Medical EvaluatorPanel QMEAdministrative Law JudgeSupplemental ReportReplacement QME PanelMandatory Settlement ConferenceGood Faith Personnel DefenseWCJ ReportMedical Unit
References
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