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

Case No. ADJ4461663 (VNO 0501542)
Regular
Oct 01, 2014

JONATHAN TRASK, vs. BLOOMINGDALE'S, INC., permissibly selfinsured, administered by MACY'S CORPORATE SERVICES

The Workers' Compensation Appeals Board denied lien claimant Dr. Silver's petition for reconsideration. The Board found that Bloomingdale's timely paid the negotiated lien settlement by issuing a check within 30 days, and when it was not received, a stop payment was placed and a replacement check issued promptly. The Board affirmed the administrative law judge's decision to admit bank records supporting timely payment, despite procedural objections regarding disclosure. Therefore, penalties, sanctions, and costs sought by the lien claimant were denied.

Lien claimantPetition for ReconsiderationStipulation and OrderTimely PaymentPenaltiesSanctionsFeesCostsComputer screen shotsSubstantial Evidence
References
Case No. ADJ7347492
Regular
Aug 20, 2012

EDWARD ZEPEDA vs. CARNATION CO., METLIFE INS. CO. OF CONNECTICUT, Administered by TRAVELERS

Here's a summary of the case for a lawyer, in four sentences: The Board granted reconsideration to rescind the WCJ's decision, finding no unreasonable delay in the defendant's payment of a Compromise and Release settlement. The Board determined the delay was due to an inadvertent typographical error in the address for one of three settlement checks, not bad faith or intentional delay by the defendant. Consequently, penalties and attorney fees related to the alleged delay were denied. The Board also found no basis for sanctions under Labor Code section 5813.

Labor Code Section 5814Labor Code Section 5813Compromise and ReleasePetition for ReconsiderationUnreasonable DelayPenaltyAttorney FeesApplicant's CostsTypographical ErrorInadvertent Error
References
Case No. SRO 0135735
Regular
Nov 06, 2007

ROBERT ANUSEWICZ vs. JOINT INDUSTRY BOARD OF PLUMBING, dba KONOCTI HARBOR INN AND RESORT, STATE COMPENSATION INSURANCE FUND

This case concerns an applicant's entitlement to temporary disability indemnity beyond the standard 104-week limit. The Appeals Board rescinded the prior award, ruling that the applicant's hip and knee replacement surgeries did not constitute "amputations" as defined by Labor Code section 4656(c)(2)(C). Therefore, the applicant is limited to 104 weeks of temporary disability indemnity from the commencement of payments, precluding indemnity beyond January 31, 2007.

Workers' Compensation Appeals BoardRobert AnusewiczJoint Industry Board of PlumbingKonocti Harbor Inn and ResortState Compensation Insurance FundSRO 0135735Opinion and Decision After Reconsiderationtemporary disability indemnityindustrial injuryleft knee
References
Case No. ADJ1384238 (SAC 0366460)
Regular
Oct 09, 2017

ROSA VIRGEN vs. MACY'S WEST, MACY'S CORPORATE SERVICES-RISK MANAGEMENT DEPARTMENT

The Workers' Compensation Appeals Board denied Macy's West's petition for removal, upholding the WCJ's decision not to grant a replacement Qualified Medical Evaluator (QME). The Board found that a late supplemental report alone does not mandate a replacement QME under LC 4062.5 or AD Rule 31.5(a)(12). Granting a replacement QME for untimely supplemental reporting is discretionary and requires a showing of good cause, which Macy's failed to demonstrate. The Appeals Board retains exclusive jurisdiction over the validity of replacement panels.

Workers' Compensation Appeals BoardPetition for RemovalQualified Medical EvaluationPQMEReplacement PanelMedical DirectorTimelinessSupplemental ReportGood CausePrejudice
References
Case No. ADJ15951486, ADJ15951487
Regular
Aug 25, 2025

JEFF CRAIL vs. AMTRUST NORTH AMERICA, HARTFORD FIRE INSURANCE COMPANY

The defendant, Amtrust North America and Hartford Fire Insurance Company, filed a Petition for Reconsideration of a Joint Findings of Fact and Orders (F&O) issued on May 20, 2025. The F&O had ordered the replacement of Panel Qualified Medical Examiner (PQME) Dr. Wiseman due to his failure to properly serve his report. The defendant argued that the court improperly interpreted Administrative Director Rule 31.5(a)(12) and that a Declaration of Readiness (DOR) does not constitute both an objection and a request for a replacement panel. The Appeals Board denied the Petition for Reconsideration, affirming the WCJ's decision to replace Dr. Wiseman. The Board's decision cited its en banc ruling in Vazquez v. Inocensio Renteria, reinforcing that a QME's failure to timely issue and serve a report, and engaging in ex parte communication by serving only one party, grants a party the right to seek replacement. The Board also emphasized the informal nature of pleadings in workers' compensation proceedings, as established in Perez v. Chicago Dogs, when addressing the applicant's DOR.

PQMEPetition for ReconsiderationJoint Findings of Fact and OrdersAdministrative Director RuleDeclaration of ReadinessIrreparable HarmMandatory Settlement ConferenceOncology PanelQualified Medical ExaminerProof of Service
References
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. ADJ9186134
Regular
Oct 01, 2019

KARLA SARABIA vs. COUNTY OF SAN BERNARDINO

The Workers' Compensation Appeals Board dismissed the applicant's petition for reconsideration because the order to replace a Qualified Medical Evaluator (QME) was not a final order. The Board also denied the applicant's petition for removal, adopting the judge's report which found no basis for removal. The applicant sought to challenge the replacement of a QME, alleging prejudice and irreparable harm. The Board found no substantive right or liability determined by the QME replacement order.

Workers' Compensation Appeals BoardPetition for ReconsiderationPetition for RemovalQualified Medical EvaluatorPQMEReplacement PQMEFindings and OrderVocational NurseIndustrial InjuryNeck Injury
References
Case No. ADJ6754074
Regular
Dec 14, 2010

BARBARA JACOME vs. DURHAM SCHOOL SERVICES, OLD REPUBLIC, SEDGWICK CMS

This case involves an applicant's petition for removal challenging a WCJ's order granting the defendant's request for a replacement Qualified Medical Evaluator (QME). The applicant argued the defendant's objection to the QME's report timeliness was conditional and not properly served, thereby waiving their right to a replacement. The Appeals Board granted removal, finding the defendant's objection, made after receiving the report, was insufficient and void. Therefore, the defendant was not entitled to a replacement panel, and the QME's report was deemed admissible.

Petition for RemovalQualified Medical EvaluatorReplacement PanelTimeliness ObjectionConditional ObjectionLabor Code SectionsCalifornia Code of RegulationsMedical DirectorAdministrative DirectorComprehensive Medical-Legal Evaluation
References
Case No. ADJ8233060, ADJ8237202
Regular
Aug 23, 2013

SYLVIA TORRES vs. TODD MACKEY dba CAREFREE PLANTS & DESIGN, PREFERRED EMPLOYER'S INSURANCE CO.

The Workers' Compensation Appeals Board dismissed the applicant's petition for reconsideration because the WCJ's order regarding a replacement panel was not a final decision. The Board denied the petition for removal, finding no substantial prejudice or irreparable harm, despite the PQME's late supplemental report. Applicant failed to formally request a replacement panel from the Medical Director as required by regulation. Therefore, the Board affirmed the WCJ's decision not to order a replacement panel and to schedule a supplemental evaluation with the original PQME.

WCABPetition for ReconsiderationPetition for RemovalPanel Qualified Medical EvaluatorPQMESupplemental ReportFindings of Fact and OrderWCJDeclaration of ReadinessReplacement Panel
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
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