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

Case No. ADJ10393776
Regular
Dec 28, 2020

VILMA PANAMENO vs. NORTHGATE GONZALEZ MARKET, SAFETY NATIONAL INSURANCE COMPANY

This case involves a defendant's request for a replacement Qualified Medical Evaluator (QME) panel after the original QME's appointment expired and they were allegedly unavailable for cross-examination. The Workers' Compensation Appeals Board (WCAB) denied the defendant's petition for reconsideration. The WCAB found insufficient evidence that the QME was not certified at the time of his reports or that he was truly unavailable. Furthermore, the defendant failed to demonstrate significant prejudice or irreparable harm, and the WCAB declined to consider evidence not presented to the trial judge.

RemovalPetition for ReconsiderationQualified Medical Evaluator (QME)Panel ReplacementCross-ExaminationMedical UnitThreshold IssueInterlocutory DecisionAdministrative Director (AD) Rule 31.5Judicial Notice
References
9
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
4
Case No. ADJ2154380
Regular
Jul 21, 2010

SPENCER DAVIS vs. CLARK & SULLIVAN, INC., LWP CLAIMS SACRAMENTO, BERKSHIRE HATHAWAY SAN FRANCISCO, BERKSHIRE HATHAWAY PASADENA

In this case, the defendant sought to disqualify a Qualified Medical Evaluator (QME) due to their alleged unavailability for deposition within 120 days as required by Administrative Director Rule 35.5(f). The Workers' Compensation Appeals Board (WCAB) denied the defendant's petition for removal. The WCAB found that Rule 31.5, which allows for replacement panels, does not apply to QME unavailability for deposition. Furthermore, the Board determined the defendant failed to demonstrate significant prejudice or irreparable harm, especially after rescheduling the deposition themselves.

Petition for RemovalQualified Medical EvaluatorDeposition UnavailabilityAdministrative Director RuleMandatory RegulationPrejudice and HarmReplacement PanelWCJ OrderUpper Extremities InjuryPsyche Injury
References
0
Case No. ADJ10691348
Regular
Sep 01, 2017

NICHOLAS THOMPSON vs. SHASTA COUNTY SHERIFF'S OFFICE

This case involved a petition for removal granted to the applicant, Nicholas Thompson, concerning an order for a replacement Qualified Medical Evaluator (QME). The applicant argued he would suffer irreparable harm as his evaluation was complete and a new QME would necessitate restarting the process. The Workers' Compensation Appeals Board found no evidence in the record regarding the current QME's unavailability or the defendant's due diligence in discovery efforts. Therefore, the Board rescinded the order for a replacement QME and returned the matter for further proceedings.

Petition for RemovalReplacement QMEQualified Medical EvaluatorUnavailabilityIrreparable HarmPrejudiceDue DiligenceDiscoveryAdmitted EvidenceWCAB Rule 33
References
1
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
4
Case No. ADJ345248 (RDG 0128229)
Regular
Oct 26, 2011

JEREMY CHISSIE vs. REIBES AUTO PARTS, LLC, PACIFIC COMPENSATION INSURANCE COMPANY

The Workers' Compensation Appeals Board granted removal and rescinded the WCJ's order to appoint an Independent Medical Examiner (IME). The Board found the WCJ improperly bypassed the established procedure for selecting a Qualified Medical Evaluator (QME) when the original QME became unavailable. Instead, the matter must return to the trial level to follow the Administrative Director's rules for appointing a replacement QME. This ensures the defendant's right to participate in the physician selection process.

Workers' Compensation Appeals BoardPetition for ReconsiderationPetition for RemovalIndependent Medical Examiner (IME)Qualified Medical Evaluator (QME)Labor Code section 4062.2Administrative Director's Rule 31.5Rule 32.6Medical UnitPanel QME
References
3
Case No. ADJ6950792
Regular
Sep 01, 2015

LILLIAN DUNN vs. COUNTY OF SAN BERNARDINO

This case concerns a petition for reconsideration and removal from a Workers' Compensation Appeals Board order. The Board denied the petition, adopting the reasoning of the Workers' Compensation Administrative Law Judge (WCJ). The WCJ determined that a Qualified Medical Examiner's (QME) report was not substantial evidence due to a failure to issue a supplemental report after reviewing additional medical records. Because the QME was unavailable to provide a supplemental report, the WCJ ordered a replacement QME, a decision upheld by the Board.

Workers' Compensation Appeals BoardPetition for ReconsiderationRemovalReplacement PanelQualified Medical ExaminerQMESupplemental ReportLabor Code Section 4062.5Rule 38Apportionment
References
1
Case No. ADJ8509489, ADJ8509492, ADJ8509493, ADJ8834631
Regular
Sep 17, 2019

Barbara Stewart vs. State of California, Department of Corrections & Rehabilitation

The Workers' Compensation Appeals Board granted reconsideration, reversing the WCJ's finding that the Agreed Medical Evaluator (AME) was not appropriately replaced. The Board found that due to the AME's impending retirement and unavailability for further discovery regarding the applicant's hypertension and sleep issues, a replacement Qualified Medical Evaluator (QME) panel was validly obtained. Consequently, the parties are ordered to utilize the new QME panel for further evaluation. This decision ensures the applicant's due process rights for discovery on internal medicine claims are protected.

Workers' Compensation Appeals BoardAgreed Medical EvaluatorQualified Medical EvaluatorPetition for ReconsiderationFindings and OrderDue ProcessDiscoveryInternal MedicineHypertensionCirculatory System
References
0
Case No. ADJ11017003
Regular
May 19, 2025

ABEL VAZQUEZ vs. INOCENSIO RENTERIA, ZENITH INSURANCE CO.

The Appeals Board, in an en banc decision, addressed the replacement of a Qualified Medical Evaluator (QME) when unable to schedule a re-evaluation within 120 days. It clarified that while Administrative Director Rules provide guidance, the Appeals Board retains discretionary power to order QME replacement for good cause, based on factors like delay, prejudice, and efforts to remedy unavailability. The Board granted the applicant's petition for reconsideration, rescinded the prior Findings and Order by the WCJ, and returned the matter for further proceedings, applying its new interpretation prospectively.

WCABen bancQME replacementAD Rule 31.3good causeprocedural issueremoval standardreconsiderationthreshold issuepermanent impairment
References
30
Case No. ADJ7899192, ADJ7902366
Regular
Oct 21, 2019

VALERIE DAILEY vs. SCRIPPS HEALTH

The applicant sought reconsideration of a finding that her psychiatric injury was not a compensable consequence of her industrial neck and elbow injuries. The Board found that the prior QME's report, which applicant sought to admit, should have been considered as it was not properly excluded. The Board also noted that the subsequent QME's report did not review the prior QME's findings, potentially rendering it incomplete. Consequently, the Board rescinded the award and returned the matter for further proceedings to admit the prior QME's report and allow the subsequent QME to review it.

Workers Compensation Appeals BoardPsychiatric InjuryCompensable ConsequenceQualified Medical EvaluatorQME ReportAdmissibility of EvidenceMedical EvaluationFurther ProceedingsFindings and AwardReconsideration
References
9
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