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

Case No. ADJ3133261 (VNO 0400017)
Regular
Aug 17, 2010

FELIPE TOLENTINO vs. CONCO CEMENT, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION, XCHANGING INC., FREMONT COMPENSATION

The Workers' Compensation Appeals Board (WCAB) dismissed the lien claimant's petition for reconsideration as premature. The WCAB granted the defendant's petition for reconsideration regarding the temporary disability overpayment issue, deferring it for further proceedings. The Board affirmed the WCJ's findings on injury causation and permanent disability but amended the decision to clarify the overpayment issue. Finally, the WCAB issued a notice of intention to sanction defendant's counsel for attaching and citing unadmitted evidence.

Workers' Compensation Appeals BoardFELIPE TOLENTINOCONCO CEMENTCALIFORNIA INSURANCE GUARANTEE ASSOCIATIONXCHANGING INC.FREMONT COMPENSATIONliquidationADJ3133261VNO 0400017OPINION AND ORDERS DISMISSING PETITION FOR RECONSIDERATION AND GRANTING PETITION FOR RECONSIDERATION
References
Case No. ADJ2154380 (SAC 0363541)
Regular
Jul 21, 2010

Spencer Davis vs. Clark & Sullivan, Inc., LWP Claims Sacramento, Berkshire Hathaway San Francisco, Berkshire Hathaway Pasadena

The defendant sought to disqualify the Qualified Medical Evaluator (QME) due to their unavailability for deposition within the regulatory 120-day timeframe. The Workers' Compensation Appeals Board (WCAB) denied the petition for removal, affirming the lower order. The WCAB found that Administrative Director (AD) Rule 31.5, concerning replacement panels, does not apply to QME unavailability for deposition. Furthermore, the Board found no demonstrable prejudice or irreparable harm, noting the defendant's own rescheduling of the deposition.

Petition for RemovalQualified Medical EvaluatorQME UnavailabilityDeposition SchedulingAdministrative Director RulesAD Rule 35.5(f)AD Rule 31.5(a)(5)AD Rule 33PrejudiceIrreparable Harm
References
Case No. ADJ7232076
En Banc
Sep 26, 2011

Tsegay Messele vs. Pitco Foods, Inc.; California Insurance Company

The Appeals Board holds that the 10-day period for agreeing on an AME under Labor Code § 4062.2(b) is extended by five days when the initial proposal is served by mail, and clarifies the method for calculating this time period, finding both parties' panel requests premature.

Workers' Compensation Appeals BoardTsegay MesselePitco FoodsInc.California Insurance CompanyADJ7232076Opinion and Decision After ReconsiderationOrder Granting RemovalDecision After RemovalEn Banc
References
Case No. ADJ6535347, ADJ6534384
Regular
Nov 02, 2015

CHRISTINE KNAPP vs. COUNTY OF FRESNO

The Workers' Compensation Appeals Board denied the applicant's Petition for Reconsideration. The applicant sought to overturn findings of $53\%$ permanent disability and disputed the exclusion of vocational expert reports and a claim of $100\%$ disability. The Board found the petition contained numerous factual misrepresentations and violations of WCAB rules and professional conduct by the applicant's attorney. The Board adopted the WCJ's report, which recommended denial due to the petition's legal defects and factual inaccuracies.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings of Fact and AwardOccupational Group NumberIndustrial InjuryRight ShoulderMigraine HeadachesPermanent DisabilityAgreed Medical ExaminerQualified Medical Examiner
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. 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. ADJ11446545
Regular
Dec 03, 2019

ROSA LOPEZ RODRIGUEZ vs. UNIVERSAL BUILDING SERVICES SUPPLY COMPANY, INSURANCE COMPANY OF THE WEST

This case concerns a dispute over the appropriate medical specialty for a Qualified Medical Evaluator (QME) panel. The applicant, Rosa Lopez Rodriguez, initially requested a chiropractic QME panel, which was issued first. The defendant objected, arguing that chiropractic was inappropriate due to the applicant's prior surgery and lack of full recovery. The Medical Unit then invalidated the chiropractic panel and issued an orthopedic surgery panel. The Workers' Compensation Appeals Board granted reconsideration, overturning the WCJ's decision. The Board held that the party who first requests a QME panel has the right to designate the specialty and that the defendant failed to provide sufficient grounds to invalidate the chiropractic panel. Therefore, the Board amended the findings to sustain the applicant's objection and affirm chiropractic as the appropriate panel specialty.

AD Rule 31.5(a)(10)AD Rule 31.5(a)(9)AD Rule 31.1(b)Labor Code section 4062Labor Code section 4062.2Qualified Medical Evaluator (QME)QME panel specialtyPetition for RemovalPetition for ReconsiderationMedical Unit determination
References
Case No. ADJ9997985, ADJ9997986, ADJ10037755
Regular
Apr 10, 2017

DAVID LIVINGSTON vs. SOUTHEAST PERSONNEL LEASING, INC.;, PACKARD CLAIMS ADMINISTRATION;, STATE NATIONAL INSURANCE

The Workers' Compensation Appeals Board (WCAB) dismissed a petition for removal filed by the defendant. The WCAB found the petition was untimely because it was filed one day after the 20-day deadline for removal following personal service. This deadline is jurisdictional, and the WCAB cannot consider petitions filed outside this timeframe. Therefore, the petition was dismissed with no request for supplemental pleading granted.

Petition for RemovalUntimely FilingPersonal ServiceWCJ DecisionAppeals Board RuleJurisdictional Time LimitSupplemental PleadingWCAB Rule 10848WCAB Rule 10843WCAB Rule 10507
References
Case No. ADJ8937901
Regular
Mar 03, 2016

SANDRA DELAO vs. MARTIN TRANSPORTATION, LTD., CANNON COCHRAN

The Workers' Compensation Appeals Board dismissed Sandra Delao's petition for reconsideration because it was untimely filed. The petition was filed over 25 days after the WCJ's December 10, 2015 decision, exceeding the statutory filing deadline. Additionally, the petition was not verified and was not served on applicant's attorney or defendant's attorney, providing further grounds for dismissal. Therefore, the Board had no jurisdiction to consider the petition's merits.

Petition for ReconsiderationTimelinessJurisdictionalVerificationServiceLabor Code Section 5902Labor Code Section 5903Rule 10507Rule 10508Rule 10845
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
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