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Case Law Database

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

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
5
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
14
Case No. ADJ9604444
Regular
Aug 14, 2017

MANUELA BALDERAMA vs. DEPARTMENT OF SOCIAL SERVICES IHSS, YORK RISK SERVICES GROUP

The Workers' Compensation Appeals Board granted the defendant's Petition for Reconsideration to amend a prior finding. The Board removed the administrative law judge's determination that the PQME's March 20, 2015 report was not substantial medical evidence, as this issue was not properly raised by the parties. However, the Board affirmed the judge's prior order that the PQME improperly canceled the applicant's reevaluation without good cause, necessitating the issuance of a replacement PQME. All other aspects of the original decision, including the denial of sanctions, were upheld.

Workers' Compensation Appeals BoardPetition for ReconsiderationPanel Qualified Medical EvaluatorPQME cancellationgood causesubstantial medical evidencesanctionsAdministrative Law JudgeFindings of Fact and OrderReplacement Panel Order
References
0
Case No. ADJ10363674
Regular
Nov 17, 2016

RUBY BRADLEY vs. COUNTY OF SACRAMENTO DEPARTMENT OF HUMAN ASSISTANCE; Permissibly SelfInsured, Adjusted By COUNTY OF SACRAMENTO WORK COMP

The Workers' Compensation Appeals Board denied Ruby Bradley's petition for removal, upholding an order compelling her to attend a medical examination with a panel qualified medical evaluator (PQME). Bradley claimed due process violations regarding notice and a replacement PQME panel, but the Board found she failed to demonstrate significant prejudice or irreparable harm. The WCJ's report, incorporated by the Board, noted Bradley's own admission contradicted her claim of premature scheduling and highlighted a prior agreement to proceed with the original PQME. The Board also admonished Bradley's counsel for misleadingly omitting material facts, potentially constituting an abuse of the system.

Petition for RemovalCompelling AttendanceMedical ExaminationPanel Qualified Medical EvaluatorPQMEIndustrial InjuryNervous SystemPsychiatric InjuriesDue ProcessReplacement Panel
References
4
Case No. ADJ13119496
Regular
Sep 29, 2025

Ariel Prudente vs. RJP Framing, Inc., Alaska National Insurance Company

Applicant Ariel Prudente sought removal of a WCJ's order to replace psychiatric Qualified Medical Evaluator (PQME) Dr. Peter Turek. The WCJ's decision stemmed from applicant's attorney providing "summaries and excerpts from the Kite decisions" to Dr. Turek, which was deemed a violation of Labor Code section 4062.3(b). The Appeals Board found that the WCJ's order lacked sufficient rationale and evidence of prejudice to justify Dr. Turek's replacement. Consequently, the Board granted the petition for removal, rescinded the WCJ's June 18, 2025 Findings and Order, and remanded the matter for further proceedings, emphasizing the need for less drastic measures than QME replacement.

PQMEPetition for RemovalLabor Code section 4062.3(b)Kite decisionsVigil v. County of KernSuon v. California DairiesMaxham v. California Department of Corrections and Rehabilitationex parte communicationsubstantial justiceAOE/COE
References
11
Case No. ADJ10166295 ADJ10166294
Regular
Jun 22, 2016

ANGELICA NAVARRO vs. TAYLOR FRESH FOODS; Permissibly Self-Insured

The Workers' Compensation Appeals Board denied the defendant's petition for reconsideration. The Board adopted the WCJ's report, which found the defendant waived their right to request a replacement QME panel by previously agreeing to use a specific physician. The Board also noted the Medical Unit's decision to issue a replacement panel was based on incomplete information and did not comply with regulations. While the WCJ misidentified the physician as an Agreed Medical Examiner instead of a PQME, this error did not affect the outcome.

Workers' Compensation Appeals BoardPetition for ReconsiderationPanel Qualified Medical EvaluatorPQMEMedical UnitAgreed Medical ExaminerLabor CodeDWC Medical UnitOrthopedic SurgeryPain Medicine
References
0
Case No. ADJ6792760, ADJ9284465
Regular
May 11, 2016

VILMA ALEMAN vs. FREDERICK'S OF HOLLYWOOD, THE HARTFORD GROUP, NORTH RIVER INSURANCE COMPANY

The Workers' Compensation Appeals Board denied the defendant's Petition for Removal, upholding a prior order for a replacement Qualified Medical Evaluator (PQME). The Board found that the defendant failed to properly serve the applicant's attorney with the PQME panel notification, rendering the submitted medical reports inadmissible. This procedural defect meant the applicant was not afforded adequate time to strike a panel physician, thus violating statutory procedures. The Board emphasized that removal is an extraordinary remedy not to be granted without a showing of significant prejudice or irreparable harm.

Petition for RemovalJoint Findings and OrderPanel Qualified Medical EvaluatorPQMEDefective NoticeInadmissible Medical ReportsLabor Code Section 4062.2Improper ServiceAttorney NotificationStriking Process
References
2
Case No. ADJ8507046
Regular
Oct 21, 2016

SANTIAGO RODRIGUEZ vs. VPM MANAGEMENT INC., ZURICH AMERICAN INSURANCE CO., AMERICAN CLAIMS MANAGEMENT, INC.

The Workers' Compensation Appeals Board granted applicant's petition for removal, finding that the WCJ denied applicant due process. The WCJ issued orders replacing three Qualified Medical Examiner (PQME) panels based on a petition filed shortly before a hearing, without allowing applicant a written response or a full hearing on the new contentions. The Board rescinded the replacement orders and returned the case for further proceedings, noting that reconsideration would be inadequate given the potential impossibility of restoring prior panels. This ensures applicant receives a fair hearing and the opportunity to present evidence.

Petition for RemovalPQME panelsdue processfair hearingadministrative law judgeDeclaration of Readinessreplacement paneldepositionprejudiceconstitutional guaranty
References
8
Case No. MISSING
Regular Panel Decision

Claim of Jacob v. New York City Transit Authority

Claimant sustained work-related injuries in January 2000 and later sought workers’ compensation benefits alleging recurrence. An issue arose regarding the veracity of the medical history provided to the employer’s independent medical examiners, specifically concerning undisclosed prior similar injuries. A workers’ compensation law judge and subsequently the Workers’ Compensation Board found that the claimant violated Workers’ Compensation Law § 114-a, leading to disqualification from wage replacement benefits. However, the Board authorized medical treatment for the January 2000 injuries. On cross appeals, the Board’s determination was affirmed, finding substantial evidence supported the violation and the appropriateness of the penalties imposed.

Workers' Compensation Law Section 114-aMedical MisrepresentationWage Replacement Benefits DisqualificationMedical Treatment AuthorizationPrior Injuries DisclosureSubstantial Evidence ReviewIndependent Medical ExaminationWorkers' Compensation Board DecisionAppellate ReviewAffirmed Decision
References
4
Case No. MISSING
Regular Panel Decision
Jul 27, 2001

Claim of Losurdo v. Asbestos Free, Inc.

The case involves a claimant appealing a Workers’ Compensation Board decision. The Board ruled that the claimant violated Workers’ Compensation Law § 114-a by failing to disclose prior left and right knee injuries to physicians and under oath, leading to disqualification from future wage replacement benefits. Although a Workers’ Compensation Law Judge initially found no fraud, the Board reversed this determination on administrative appeal, concluding the claimant knowingly made false statements. The Appellate Division affirmed the Board's decision, finding it supported by substantial evidence, emphasizing the Board's authority as the sole arbiter of witness credibility. The court rejected the claimant's explanations of forgetting the prior incidents as not credible.

Workers' Compensation FraudMisrepresentation of Medical HistoryFalse Statements Under OathWage Replacement Benefits DisqualificationWorkers' Compensation Law Section 114-aAppellate Review of Board DecisionWitness CredibilitySubstantial EvidencePrior Knee InjuriesAdministrative Appeal
References
11
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