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

Case No. ADJ1478308 (MON 0350963) ADJ2388916 (MON 0350964)
Regular
Nov 19, 2015

GALO ALARCON vs. CFHS HOLDINGS, INC dba KERLAN-JOBE ORTHOPEDIC CLINIC, AMERICAN HOME ASSURANCE CO., administered by AIG CLAIM SERVICES, INC.

This case involves a defendant seeking removal of a Workers' Compensation Appeals Board (WCAB) order for a second Qualified Medical Evaluator (QME) panel in urology. The defendant argued the WCJ improperly issued the order before their objection was considered, violating due process. The WCAB granted removal, rescinded the order, and remanded the case for the WCJ to consider the defendant's objection and issue a new decision. This decision was based on the defendant demonstrating potential for significant prejudice and irreparable harm due to the denial of their right to be heard.

Petition for RemovalQualified Medical EvaluatorQME PanelDue ProcessWCJ DecisionAdditional QMEUrologyMedical Legal EvaluationWCAB Rule 31.7Significant Prejudice
References
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 The original findings of fact were rescinded, and the issue of further QME panels in urology and neurology was deferred.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
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. 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
Case No. ADJ12910087
Regular
Dec 28, 2020

ESTHER LEMUS SALDANA vs. TAO TAI HOMES CORPORATION, INSURANCE COMPANY OF THE WEST

This case concerns a dispute over the correct Qualified Medical Evaluator (QME) panel for applicant Esther Lemus Saldana. The defendant sought reconsideration of an order finding the applicant's chiropractic QME panel valid and the defendant's orthopedic panel invalid. The Workers' Compensation Appeals Board denied the petition, upholding the administrative law judge's decision. The Board found the applicant properly requested a new panel after retaining counsel, and despite a service error on the chiropractic panel, the defendant had opportunity to contest the specialty. Therefore, the applicant's chiropractic QME panel remains the correct one for the medical-legal evaluation.

QME PanelChiropractic QMEOrthopedic QMEPetition for ReconsiderationFindings of Fact and OrdersMedical-Legal EvaluationQualified Medical EvaluatorAdministrative Director RuleRomero v. Costco WholesaleLabor Code Section 4062.1
References
Case No. ADJ7578707; ADJ7578722
Regular
Jul 06, 2011

Melissa Voisenat vs. COUNTY OF FRESNO

This case involves a dispute over the specialty of a Qualified Medical Evaluator (QME) for applicant Melissa Voisenat, who claims industrial injuries as a police officer. Defendant County of Fresno seeks to remove an administrative order denying their request for an orthopedic QME panel. The Appeals Board granted removal due to an insufficient record, lacking crucial documents needed to assess compliance with QME panel selection rules. The case is returned to the trial level for further proceedings to allow parties to submit relevant evidence on the QME specialty issue.

Petition for RemovalQualified Medical Evaluator (QME) panelspecialty disputeorthopedic QMEchiropractic QMEAdministrative Director's Medical Unit (MU)EAMSrescinded ordertrial levelindustrial injuries
References
Case No. ADJ9975590; ADJ9976116
Regular
Feb 25, 2016

Ana Nieto vs. Avitus, Inc., American Zurich Insurance Company

The Workers' Compensation Appeals Board (WCAB) dismissed the defendant's petition for reconsideration, finding the appealed order was interlocutory and not subject to reconsideration. The WCAB treated the petition as one for removal and denied it, as the defendant failed to demonstrate substantial prejudice or irreparable harm. The defendant's contention that their trial exhibits and an orthopedic QME panel were erroneously stricken was rejected, as was their claim that the orthopedic QME panel was improperly denied. The defendant failed to provide sufficient evidence to support their request for an orthopedic QME panel over a chiropractic one.

Workers' Compensation Appeals BoardPetition for ReconsiderationPetition for RemovalJoint Findings of Fact & OrdersQualified Medical Evaluator (QME)Orthopedic Surgery QMEChiropractic QMETrial ExhibitsAdministrative Law Judge (WCJ)Labor Code § 4062.2
References
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
Case No. ADJ9099536
Regular
Sep 09, 2014

MARIA SOTO vs. CCC HOSPITALITY PISMO, LLC dba SEACREST OCEANFRONT HOTEL, STAR INSURANCE COMPANY

In this case, the defendant hospital sought removal after the WCJ ordered a chiropractic QME panel, arguing chiropractors were unqualified for the applicant's knee injury. The defendant had initially requested an orthopedic surgeon QME, but their request was rejected by the Medical Unit as incomplete. The Appeals Board found the defendant's initial request substantially complied with regulations and was improperly rejected. Therefore, the Board granted removal, rescinded the WCJ's order, and directed the Medical Unit to issue a panel of orthopedic surgery QMEs.

Petition for RemovalPQMEMedical UnitChiropractic QMEOrthopedic Surgery QMERequest for QME PanelAdministrative Director Rule 30(b)Labor Code section 4062.2Messele v. Pitco FoodsInc.
References
Case No. ADJ7873790
Regular
Jun 27, 2013

LAURA BERNAL vs. RINCON TAURINO RESTAURANT, INC., CALIFORNIA RESTAURANT MUTUAL BENEFIT CORPORATION

The Workers' Compensation Appeals Board (WCAB) granted the defendant's petition for removal, overturning a prior ruling that allowed the applicant to refuse a Qualified Medical Evaluator (QME) examination based on the QME's refusal to allow audio recording. The WCAB found the applicant's attorney had made "unusual efforts to obstruct the QME process." Applicant is now ordered to attend the QME examination with a court reporter present at the defendant's expense. Failure to comply will result in suspension or barring of disability payments.

QMEAMEremovalreconsiderationtape recordingcourt reporterobstructionsanctionsLabor Code section 4062.2Labor Code section 5813
References
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