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

Case No. ADJ11629744
Regular
Apr 24, 2023

ROCHELLE BOYD vs. VISSER, NATIONAL INTERSTATE RICHFIELD

The applicant sought reconsideration after the WCJ denied injury claims to the brain, internal system, psyche, and sexual dysfunction, as well as the issuance of additional QME panels. The Appeals Board granted reconsideration, finding good cause existed for additional QME panels in internal medicine and psychiatry. The original findings of fact were rescinded, and the issue of further QME panels in urology and neurology was deferred. The Board concluded that additional QME evaluations were necessary for a full adjudication of the claimed injuries outside of the admitted orthopedic injuries.

Workers' Compensation Appeals BoardPetition for ReconsiderationQualified Medical EvaluatorQME panelsinternal medicinepsychiatryneurologyurologysexual dysfunctionpsyche
References
3
Case No. ADJ10389861
Regular
Feb 05, 2020

TERESA GARCIA vs. WAL-MART ASSOCIATES, INC., ACE AMERICAN INSURANCE

The Workers' Compensation Appeals Board granted reconsideration to amend an order regarding a Qualified Medical Evaluator (QME) panel in urology. While the WCJ's decision addressed a threshold issue (injury arising out of and in the course of employment), making it a final order subject to reconsideration, the defendant's challenge focused on an interlocutory issue. The Board affirmed the WCJ's decision, but clarified that if parties cannot agree on an Agreed Medical Evaluator (AME) urologist, the Medical Unit must issue a QME panel for the applicant's zip code. The Board found no basis for removal, as no significant prejudice or irreparable harm was demonstrated.

Workers' Compensation Appeals BoardPetition for ReconsiderationThreshold IssueInjury AOE/COELumbar SpineInterlocutory DecisionRemoval StandardIrreparable HarmQualified Medical Evaluator (QME)Urology
References
3
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
Case No. ADJ6470549
Regular
Feb 27, 2012

KATHRYN BENSON vs. CITY OF SAN DIEGO

The Workers' Compensation Appeals Board granted reconsideration and reversed a prior decision, allowing a Qualified Medical Examiner's (QME) report into evidence. The original decision excluded the QME report, finding no ratable permanent disability based on the treating physician's opinion. The Appeals Board found the QME report should have been admitted, as there are no explicit time limits for objecting to a treating physician's report or obtaining a QME evaluation for permanent disability. The case is remanded for further proceedings on permanent disability and attorney's fees with the QME report now part of the record.

Workers Compensation Appeals BoardFindings and AwardPetition for ReconsiderationQualified Medical Examiner (QME)Permanent DisabilityFuture Medical TreatmentTreating PhysicianAgreed Medical Examiner (AME)Labor Code Section 4061Strawn v. Golden Eagle Insurance Co.
References
1
Case No. ADJ7294109
Regular
Jun 07, 2013

MANSOUREH AZIMZADEH vs. BURG & BROCK, EMPLOYERS COMPENSATION CO.

This case involves an applicant challenging a Workers' Compensation Judge's decision to disregard the Qualified Medical Examiner's (QME) reports due to flawed apportionment analysis and ordering a new QME panel. The Appeals Board granted removal, rescinded the order for a new QME panel, and returned the matter for further development of the record. The Board agreed that the QME's reports lacked substantial medical evidence due to a misunderstanding of apportionment law and that further development with the same QME would be unhelpful. The Board emphasized that new medical-legal reporting would be necessary to properly weigh evidence.

RemovalReconsiderationPetitionPanel Qualified Medical ExaminerPQMESubstantial Medical EvidenceApportionmentFindings and OrderMedical UnitDiscovery
References
9
Case No. ADJ1934243 (FRE 0221043)
Regular
Apr 25, 2011

MARIA RAYOS vs. WALGREENS, ZURICH INSURANCE COMPANY

This case concerns a dispute over a second Qualified Medical Examiner (QME) for an applicant with a work-related knee, back, and hip injury. The defendant sought removal, arguing that allowing a second QME without striking the first QME's reports violated due process and would taint the new evaluation. The Appeals Board granted removal, amended the prior order, and clarified that a new QME is allowed. However, the admissibility of the first QME's reports is deferred to the trial judge, and those reports, unlike diagnostic study results, are not to be provided to the new evaluator.

Petition for RemovalQualified Medical Evaluator (QME)Admissibility of ReportsDue ProcessWorkers' Compensation Appeals Board (WCAB)Administrative Law Judge (WCJ)Industrial InjuryMedical EvaluationsDiscoveryMandatory Settlement Conference (MSC)
References
0
Case No. ADJ7555685
Regular
Apr 02, 2012

RAHUL ROY vs. GALLO SALES COMPANY INC.

This case concerns the admissibility of a Qualified Medical Evaluator's (QME) reports due to alleged violations of Labor Code section 4062.3 and AD Rule 35. The defendant, Gallo Sales Company, Inc., sent medical information and sub rosa films to the QME without timely providing copies or notice of objection rights to the applicant, Rahul Roy. The Workers' Compensation Appeals Board affirmed the finding that the QME's reports were inadmissible due to these ex parte communications, disqualifying the QME. The applicant is entitled to a new QME panel.

PQMEAD Rule 35Ex parte communicationLabor Code section 4062.3Medical informationNon-medical recordsSupplemental reportSub rosa filmsQME panelAdmissibility
References
12
Case No. ADJ8418853
Regular
Oct 22, 2013

ANA ORELLANA vs. AMERIPRIDE SERVICES, INC., C.N.A.; administered by TRISTAR RISK MANAGEMENT

The Workers' Compensation Appeals Board dismissed the Defendant's Petition for Reconsideration because it was filed from a non-final interlocutory order regarding a Qualified Medical Examiner (QME) selection. The Board also denied the Defendant's request for removal, finding no showing of substantial prejudice or irreparable harm. The Defendant argued the Applicant should be re-evaluated by the same QME from a prior, unrepresented claim, but the Board adopted the Judge's reasoning that the Applicant, now represented, is entitled to a new QME panel for the distinct, current claim. The Board determined the distinction between represented and unrepresented employee QME procedures supported the entitlement to a new panel, overriding the Defendant's argument for re-evaluation by the prior QME.

Workers' Compensation Appeals BoardPetition for ReconsiderationDenial of RemovalFinal OrderInterlocutory OrderSubstantive RightIrreparable HarmCumulative TraumaPanel QMEUnrepresented Employee
References
12
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
16
Case No. ADJ1644999 (LAO0880435)
Regular
Dec 11, 2012

, MANUEL FERNIZA, vs. , RENT A CENTER, INC.; FIREMAN'S FUND INSURANCE COMPANY/ASSOCIATED INDEMNITY,

The Workers' Compensation Appeals Board (WCAB) vacated its prior order granting reconsideration and dismissed the applicant's petition. The WCAB determined that the applicant's petition sought reconsideration of an interim procedural order, not a final decision, which is not appealable. Even if the merits were considered, the WCAB would have affirmed the judge's decision, finding the QME report timely and deferring a decision on treatment authorization until a PQME urological report was issued.

Workers' Compensation Appeals BoardReconsiderationFinal OrderInterim OrdersPanel Qualified Medical ExaminerMedical Provider NetworkUrological ConditionIndustrial InjuryAdministrative DirectorWCJ Report
References
1
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