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

Case No. ADJ8363948
Regular
Oct 19, 2012

NICOLE NELSON vs. COUNTY OF SOLANO, INTERCARE HOLDINGS INSURANCE SERVICES

The defendant County of Solano sought removal to obtain a new panel of Qualified Medical Evaluators (QMEs) due to alleged ex parte communications between the applicant and the current QME. The Appeals Board denied this petition, finding that the communications were either insignificant and inconsequential or related to the QME examination itself. Specifically, emails concerning necessary forms and an insignificant mention of a claims adjuster's number did not violate the ex parte communication prohibition. Therefore, the WCJ's denial of the defendant's request for a new QME panel was upheld.

Petition for RemovalQualified Medical Evaluator (QME)ex parte communicationLabor Code section 4062.3termination of evaluationreplacement panelinsignificant communicationinconsequential communicationindustrial injurypsyche
References
Case No. ADJ6824732
Regular
Sep 06, 2012

SHEILA CORREIA, KENNETH BURNETT (Deceased) vs. VERIZON COMMUNICATIONS, AMERICAN HOME ASSURANCE COMPANY, CHARTIS, SEDGWICK CLAIMS MANAGEMENT SERVICES

This case concerns a deceased worker, Kenneth Burnett, diagnosed with mesothelioma due to asbestos exposure. The sole issue was determining the date of last injurious exposure to establish liability. The Workers' Compensation Appeals Board denied reconsideration of the judge's decision. The judge found the applicant's medical expert's opinion on a five to ten-year latency period to be more persuasive than the defendant's expert's twenty-year period. This led to a finding that the decedent's last injurious asbestos exposure occurred between 1996 and 2001, during his employment with Verizon.

MesotheliomaLatency PeriodAsbestos ExposureDate of Last Injurious ExposureLC §5500.5LC §5412Verizon CommunicationsSedgwick Claims Management ServicesDr. LurosDr. Raybin
References
Case No. ADJ2073136 (LAO 0859208)
Regular
Dec 27, 2017

J ACQUELINE STELLY vs. VERIZON COMMUNICATIONS, AMERICAN HOME ASSURANCE, administered by SEDGWICK CLAIMS SERVICES, INC.

The applicant, Jacqueline Stelly, filed a Petition for Removal and an objection to a trial setting. Subsequently, at the scheduled hearing, both parties jointly requested and were granted a continuance. As a result of this continuance, the applicant's Petition for Removal became moot. Therefore, the Workers' Compensation Appeals Board dismissed the Petition for Removal.

Petition for RemovalDismissedMootContinuanceObjection to Trial SettingWorkers' Compensation Appeals BoardADJ2073136LAO 0859208Pomona District OfficeVerizon Communications
References
Case No. ADJ3540065
En Banc
Jan 23, 2017

BRADLEY MAXHAM vs. CALIFORNIA DEPARTMENT OF CORRECTIONS AND REHABILITATION, STATE COMPENSATION INSURANCE FUND

The Appeals Board clarifies the distinction between "information" and "communication" under Labor Code § 4062.3, holding that a communication to a medical evaluator becomes "information" if it contains, references, or encloses medical or nonmedical records relevant to the medical issue, which requires prior agreement between the parties.

Workers' Compensation Appeals BoardPetition for RemovalAgreed Medical Evaluator (AME)Labor Code section 4062.3WCAB Rule 35informationcommunicationprejudiceirreparable harmex parte communication
References
Case No. ADJ916063
Regular
Dec 24, 2010

TERRY SCUDDER vs. VERIZON CALIFORNIA, INC., SEDGWICK CMS

This case involves a petition for reconsideration filed by defendant Verizon California, Inc. The Workers' Compensation Appeals Board (WCAB) granted the petition. This action was taken due to the need for further study of the factual and legal issues to ensure a just and reasoned decision. All future communications related to this matter should be directed to the WCAB's Office of the Commissioners.

WORKERS' COMPENSATION APPEALS BOARDPetition for ReconsiderationOPINION AND ORDERVERIZON CALIFORNIASEDGWICK CMSSTATUTORY TIME CONSTRAINTSFACTUAL AND LEGAL ISSUESJUST AND REASONED DECISIONFURTHER PROCEEDINGSDECISION AFTER RECONSIDERATION
References
Case No. ADJ4158530 (LBO 0325085) ADJ332706 (LBO 0325079)
Regular
Jul 23, 2013

VICTORIA ANTUNEZ vs. SEASIDE PRINTING CO., CALIFORNIA CASUALTY, GALLAGHER BASSETT SERVICES, PACIFIC NATIONAL INSURANCE, CIGA, INTERCARE INSURANCE SERVICES

The Board granted reconsideration regarding a defendant's petition challenging findings of industrial injury and the nature of a communication with an Agreed Medical Evaluator (AME). The Board affirmed findings of compensable injury for one period and no injury for another, but amended the awards to clarify that a letter from CIGA to the AME was improper, though not an ex parte communication. The Board found the letter constituted additional information improperly sent without affording the other party an objection opportunity, leading to exclusion of a supplemental report. Jurisdiction was reserved over costs and sanctions related to this improper communication.

Workers' Compensation Appeals BoardReconsiderationFindings and AwardIndustrial InjuryTemporary DisabilityPermanent DisabilityApportionmentAgreed Medical Evaluator (AME)Ex Parte CommunicationLabor Code Section 5412
References
Case No. ADJ3636557
Regular
May 08, 2009

MARIA ANA PAREDES (Deceased) CARLOS ALFREDO ALVAREZ (Widower) vs. ANDROMEDA ENTERTAINMENT dba GALAXY BALLROOM, STATE COMPENSATION INSURANCE FUND

This case concerns a petition for reconsideration and removal challenging a Workers' Compensation Judge's (WCJ) decision denying sanctions for alleged improper ex parte communication. The Board denied reconsideration and dismissed removal, affirming the WCJ's finding that the communication between defense counsel and the panel QME was administrative, not substantive, and therefore not a violation of Labor Code section 4062.3. The Board found no basis for sanctions under Labor Code section 5813 as no party initiated an improper ex parte communication. Consequently, the WCJ's denial of the motion to strike the QME report and request for penalties was upheld.

Workers' Compensation Appeals BoardPetition for ReconsiderationPetition for RemovalEx Parte CommunicationQualified Medical Evaluator (QME)Labor Code Section 4062.3SanctionsLabor Code Section 5813Panel QME ReportAdministrative Communication
References
Case No. ADJ2001631 (LAO 0876091)
Regular
Oct 01, 2010

SALVADOR AGUAYO, JR. vs. AMERICAN GOLF CORPORATION, ARCH INSURANCE COMPANY

The Workers' Compensation Appeals Board granted reconsideration to address an attorney's fee award of $4,500.00. This fee was awarded for services related to alleged prohibited ex parte communications with Qualified Medical Evaluators (QMEs), as per Labor Code section 4062.3. The Board rescinded the award, finding no explicit determination of prohibited communication occurred as the prior WCJ's orders were voided. The matter was returned to the trial level to first determine if prohibited ex parte communication occurred, and if so, to award fees based on incurred costs and attorney fees for related discovery.

Salvador Aguayo Jr.American Golf CorporationArch Insurance CompanyWorkers' Compensation Appeals BoardreconsiderationFindings and Awardattorney's feeprohibited communicationsQualified Medical EvaluatorsQME
References
Case No. ADJ10038732
Regular
Dec 02, 2016

Deborah Matthews vs. California Department of Corrections and Rehabilitation, State Compensation Insurance Fund

This case involves a defendant's petition for removal after an administrative law judge (WCJ) ordered a new Qualified Medical Examiner (QME) panel. The WCJ found the defendant violated Labor Code section 4062.3 by engaging in ex parte communication with the prior QME. The defendant admitted a violation of Labor Code section 4062.3 but argued a new panel was unwarranted due to applicant forfeiture or the communication's insignificance. The Workers' Compensation Appeals Board (WCAB) denied the petition, finding no waiver by the applicant and that the communication was not insignificant. The WCAB emphasized that prejudice is not required to obtain a new panel for such violations.

Labor Code 4062.3Ex parte communicationPQME panelPetition for RemovalAggrieved partyWaiverDoctor shoppingFindings of Fact and OpinionWCJAppeals Board
References
Case No. ADJ795505 (LAO 0794863)
Regular
Feb 13, 2014

VICTORIA SHANLEY vs. HENRY MAYO NEWHALL MEMORIAL HOSPITAL, TRAVELERS INSURANCE CO.

The Appeals Board reconsidered a WCJ's decision upholding utilization review (UR) denials for an MRI and EMG. While other contentions regarding the UR physician's qualifications and licensing were dismissed based on precedent, the Board found the UR decisions invalid due to untimely communication. Specifically, the defendant failed to prove by substantial evidence that the UR decisions were communicated by phone, fax, or email within 24 hours of being made. The matter is returned to the trial level to determine medical necessity, as the UR denials are void.

Utilization ReviewLabor Code Section 4610Administrative Director Rule 9792.9Physician QualificationLicensing RequirementsCommunication TimeframesTimely CommunicationMedical NecessityIndependent Medical ReviewInvalid UR Decision
References
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