CompFox Logo
AboutWorkflowFeaturesPricingCase LawInsights

Updated Daily

Case Law Database

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

Case No. ADJ9834159 (MF) ADJ9834161
Regular
Jul 30, 2018

ESAU HERNANDEZ vs. D.L. BONE AND SONS PAINTING, ICW GROUP/EXPLORER INSURANCE COMPANY, STATE COMPENSATION INSURANCE FUND

This case concerns a defendant's attempt to obtain a replacement Qualified Medical Evaluator (QME) panel after the applicant initially objected to the timeliness of the original QME's report. The Appeals Board treated the defendant's petition as one for removal and denied it. The Board found that the defendant, having failed to timely object to the QME's report itself, could not rely on the applicant's subsequent objection to request a new panel. The Board concluded that the defendant's failure to act promptly meant they were not entitled to a replacement QME panel, and no substantial prejudice or irreparable harm warranting removal was demonstrated.

Workers' Compensation Appeals BoardReconsiderationRemovalQualified Medical EvaluatorQME panelAdministrative Director RuleTimeliness objectionReplacement QME panelLabor CodeFindings of Fact
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The Workers' Compensation Appeals Board (WCAB) granted reconsideration, rescinded the trial judge's order to strike QME Dr.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. ADJ8022096
Regular
Apr 09, 2013

CLISE MARTINEZ vs. GOLDEN VALLEY HEALTH CENTER, AMTRUST NORTH AMERICA

The Appeals Board dismissed the Applicant's Petition for Reconsideration because it was not taken from a "final" order, but rather an interlocutory procedural decision. The Applicant sought to strike a Qualified Medical Examiner's report and obtain a replacement panel, alleging violations of administrative regulations regarding notice periods and office standards. The Board found that the Applicant's motion was untimely, having been filed after the QME report was issued, and that the alleged violations did not warrant a replacement panel, especially as they appeared to be attempts at "doctor shopping." Therefore, both the Petition for Reconsideration and the Petition for Removal were denied.

Petition for ReconsiderationPetition for RemovalFinal OrderInterlocutory OrderSubstantive RightLiabilityMedical-Legal EvaluationQualified Medical Examiner (QME)Panel QMEReplacement Panel
References
Case No. ADJ12347424
Regular
Nov 09, 2020

DANIELLE LOOMIS-LYONS vs. COUNTY OF MENDOCINO

This case concerns applicant Danielle Loomis-Lyons' injury to her right knee. The WCJ initially found injury AOE/COE, ordered a replacement QME panel in orthopedic surgery, and deemed the prior pain management QME report inadmissible. The Appeals Board granted reconsideration, affirming the injury finding and the need for a replacement panel, but corrected the panel specialty to pain medicine. The Board rescinded findings regarding the appropriate panel specialty due to lack of notice and opportunity to be heard.

QME panelpain managementorthopedic surgeryAOE/COEinadmissible reportPetition for ReconsiderationremovalLabor Code section 4062.1AD Rule 31.3AD Rule 31.5
References
Case No. ADJ10473588, ADJ10473600
Regular
Jul 12, 2018

ANGEL MORAN vs. SELECT STAFFING, administered by CORVEL

The Workers' Compensation Appeals Board granted the applicant's petition for removal, rescinded the WCJ's order denying a replacement QME panel, and returned the matter to the trial level. The Board found that the WCJ's order was not based on admitted evidence, hindering meaningful review. Applicant alleged QME bias based on deposition testimony, which the Board noted could constitute a disqualifying conflict of interest under relevant regulations. The case requires further proceedings at the trial level to properly consider the applicant's request for a replacement QME based on an evidentiary record.

Petition for RemovalReplacement QME PanelDisqualifying Conflict of InterestWCJ OrderBiasDeposition TestimonyEvidentiary RecordLabor Code Section 5313Rule 31.5Rule 41.5
References
Case No. ADJ3778927 (SFO 0460851) ADJ334222 (OAK 0285716) ADJ2101319 (SFO 0437718) ADJ4065670 (OAK 0285715)
Regular
Jan 23, 2012

KIMBERLY ROBERTS vs. CITY AND COUNTY OF SAN FRANCISCO, INTERCARE INSURANCE SERVICES

The defendant sought reconsideration or removal of a WCJ's order directing a new psychiatric QME panel due to a perceived conflict of interest with Dr. Hank Sigal, who was associated with the defendant's prior QME. The Appeals Board dismissed the Petition for Reconsideration, finding the WCJ's order was not a final appealable decision. The Board denied the Petition for Removal, concluding the defendant failed to demonstrate the order would result in significant prejudice or irreparable harm. Consequently, the original order requiring a new QME panel stands.

Workers' Compensation Appeals BoardPetition for ReconsiderationPetition for RemovalWCJ Orderconflict of interestQME panelpsychiatric QMEreplacement QMEstipulationsinterim order
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. ADJ11350784
Regular
Jan 13, 2020

LUIS RODRIGUEZ vs. BRAD NYMAN DBA LIVE OAK DAIRY, ZENITH INSURANCE COMPANY

This case concerns a workers' compensation applicant challenging a finding that he waived his right to a replacement Qualified Medical Evaluator (QME) panel. The applicant requested a replacement panel after the initially appointed QME could not schedule an exam within 60 days, but the exam was ultimately scheduled within 90 days. The Workers' Compensation Appeals Board denied the applicant's petition, finding that by accepting an appointment within the 90-day window, he waived his right to a replacement panel. The Board also found the applicant's due process claims unpersuasive, as he had a full opportunity to litigate the issue.

QME panel disputewaiver of replacement panelAOE/COEdue processthreshold issueinterlocutory decisionremoval standardirreparable harmsignificant prejudiceAD Rule 31.3
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. ADJ10237267
Regular
Jan 31, 2018

KENNETH ANGEL vs. ABLE ENGINEERING, ZURICH NORTH AMERICA

This Workers' Compensation Appeals Board case concerns applicant Kenneth Angel's request for a replacement Qualified Medical Evaluator (QME) in dentistry. Angel argued that the assigned QME, Dr. David Polushkin, was not licensed to practice at the West Covina location where the evaluation occurred. The Board denied reconsideration, finding insufficient evidence that Dr. Polushkin was ineligible to practice at that location, as "address of record" does not necessarily preclude other authorized practice sites. Furthermore, the Board noted that issues of QME eligibility are within the purview of the Administrative Director, not the Appeals Board.

QME panelreplacement QMEdental QMEWCJPetition for ReconsiderationAmended Findings of FactverificationwaivereligibilityAdministrative Director
References
Showing 1-10 of 1,995 results

Ready to streamline your practice?

Apply these legal strategies instantly. CompFox helps you find decisions, analyze reports, and draft pleadings in minutes.

CompFox Logo

The AI standard for workers' compensation professionals. Faster research, deeper analysis, better outcomes.

Product

  • Platform
  • Workflow
  • Features
  • Pricing

Solutions

  • Defense Firms
  • Applicants' Attorneys
  • Insurance carriers
  • Medical Providers

Company

  • About
  • Insights
  • Case Law

Legal

  • Privacy
  • Terms
  • Trust
  • Cookies
  • Subscription

© 2026 CompFox Inc. All rights reserved.

Systems Operational