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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 The Board granted removal, rescinded the order, and ruled the applicant was not entitled to a replacement QME.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. 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. 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. ADJ7643460
Regular
May 01, 2017

Tracy Lee vs. XCHANGING, GRANITE STATES INSURANCE COMPANY, SEDGWICK CLAIMS MANAGEMENT SERVICES, INC.

This case concerns Defendant's Petition for Removal seeking a new Qualified Medical Evaluator (QME) panel due to a QME's untimely supplemental report. The Appeals Board denied the petition, finding Defendant failed to demonstrate substantial prejudice or irreparable harm. While the QME's report was late, Labor Code Section 4062.5 and Rule 31.5(a)(12) do not mandate replacement for untimely supplemental reports, making the decision discretionary. The WCJ's decision not to order a replacement was reasonable given the QME's extensive involvement and the lack of a mandatory replacement provision.

Workers' Compensation Appeals BoardPetition for RemovalQualified Medical EvaluatorQME panelsupplemental reportuntimelysubstantial prejudiceirreparable harmLabor Code section 4062.5Rule 31.5(a)(12)
References
Case No. ADJ11802539
Regular
Dec 03, 2019

LA TONYA RIDER vs. PRIDE INDUSTRIES, NORTH RIVER INSURANCE

The Appeals Board granted removal and rescinded the WCJ's order denying a replacement QME panel. Defendant sought a replacement due to the current QME's unavailability for deposition. The Board found the original order lacked an evidentiary basis, necessitating a return to the trial level. Further proceedings will establish an evidentiary record to adjudicate the QME replacement issue, considering relevant Administrative Director Rules.

Petition for RemovalQualified Medical Evaluator paneldeposition unavailabilityevidentiary recordsubstantial evidenceAdministrative Director Rule 31.5(a)Administrative Director Rule 35.5(f)trial levelrescinded orderReturn to trial
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. ADJ11230683, ADJ11233335
Regular
Sep 04, 2019

WANDA YONGE vs. LOS ANGELES COMMUNITY COLLEGE DISTRICT

The Workers' Compensation Appeals Board granted the defendant's petition for removal, rescinded a prior order, and returned the case to the trial level. The WCJ had ordered a replacement QME panel because the current QME could not schedule a deposition within 120 days, a reason not explicitly listed in the regulations for a replacement panel. The Board found the WCJ's order was issued without an evidentiary record, preventing proper review. Further proceedings are required to establish an evidentiary basis for any decision regarding a replacement QME.

Petition for RemovalReplacement QME panelWCJ Order8CCR 35.5120-day deposition ruleevidentiary recordsubstantial evidenceAdministrative Director Rule 31.5(a)Mandatory Settlement ConferenceDeclaration of Readiness to Proceed
References
Case No. ADJ6627019
Regular
May 06, 2013

SANDRA BERKENSTOCK vs. AGILENT TECHNOLOGIES

The defendant sought reconsideration of an order denying their request for a replacement Qualified Medical Evaluator (QME) panel in psychiatry/psychology. The applicant sustained industrial injuries including to her psyche. The administrative law judge denied the replacement panel because the QME's report was eventually received. However, the Workers' Compensation Appeals Board dismissed the defendant's petition. The Board ruled that the denial of a replacement QME panel is an interim, procedural order not subject to reconsideration under Labor Code section 5900(a).

WCABAgilent TechnologiesADJ6627019Petition for ReconsiderationQualified Medical EvaluatorQME panelpsychiatrypsychologyFlorence Thomas-RiddleLabor Code section 139.2(j)(1)(A)
References
Case No. ADJ10397155
Regular
Mar 09, 2018

ENA CARDOZA vs. UC BERKELEY, SEDGWICK CLAIMS MANAGEMENT SERVICES, INC.

The Appeals Board granted the applicant's Petition for Removal, rescinding the WCJ's order for a replacement QME and returning the matter for further proceedings. Applicant contended the prior order prejudiced her due process rights and right to trial by addressing QME replacement without sufficient evidence or a proper hearing. The Board found substantial prejudice and irreparable harm would result if removal were denied. The WCJ must now hold a hearing to establish evidence and determine if a replacement QME is warranted under Rule 31.5.

Petition for RemovalWCJ OrderQualified Medical Evaluator (QME)Due ProcessArbitrary DecisionAOE/COEMandatory Settlement Conference (MSC)Rule 31.5Substantial PrejudiceIrreparable Harm
References
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