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

Case No. ADJ12575364
Regular
Nov 25, 2020

MIGUEL SOLIS vs. KONICA MINOLTA BUSINESS SOLUTIONS, SOMPO AMERICA

The Workers' Compensation Appeals Board (WCAB) granted reconsideration of a WCJ's decision that overturned the Medical Unit's denial of a specialty change for a Qualified Medical Evaluator (QME) panel. The WCAB found that while they have jurisdiction to review Medical Unit decisions, the applicant did not meet the standard for vacating the chiropractic QME panel. The WCAB held that a chiropractor can evaluate disputed medical issues, even with referrals to other specialists, as long as they stay within their scope of practice and report any issues outside their expertise. Therefore, the WCAB rescinded the WCJ's order and directed the parties to utilize the original chiropractic QME panel.

QME panelMedical Unitspecialty disputeorthopedic surgerychiropracticAdjudication NumberPetition for ReconsiderationFindings and OrderLabor Codesubstantial evidence
References
4
Case No. G107 435
Regular Panel Decision
Jun 02, 2023

Matter of Marku v. ABM Industries

This case concerns the claim of Denise Perry under the Workers' Compensation Law. The Workers' Compensation Law Judge (WCLJ) previously found that the employer, Adventist Home Care, established a violation of Workers' Compensation Law § 114-a by the claimant for willfully making false statements to obtain benefits. Consequently, the WCLJ disallowed indemnity benefits and imposed both mandatory and discretionary penalties. A Board Panel decision filed on February 17, 2022, affirmed the WCLJ's findings. The claimant subsequently filed an application for reconsideration on March 18, 2022, which the Board Panel reviewed. After considering the claimant’s arguments, the Board Panel determined that the application did not raise new issues or present new material evidence, nor did it demonstrate an erroneous statement of material fact or law in the prior decision. Therefore, the Board Panel, by a majority vote, affirmed its prior decision.

Workers' Compensation FraudFalse RepresentationIndemnity Benefits DisallowanceWCL § 114-a PenaltyApplication for Reconsideration DeniedBoard Panel AffirmationWillful MisrepresentationWorkers' Compensation Law Judge DecisionEmployer Established Violation
References
0
Case No. ADJ9796670
Regular
Aug 05, 2016

Virginia Lopez vs. California Pizza Kitchen, Travelers Insurance

Applicant Virginia Lopez sought removal after an administrative law judge (WCJ) invalidated a chiropractic QME panel, ordering an orthopedic replacement. The Workers' Compensation Appeals Board (WCAB) granted removal, finding the original chiropractic panel was properly issued and defendants waived their right to object by failing to follow proper procedures. The WCAB amended the WCJ's decision to affirm the chiropractic panel, deeming removal necessary to prevent substantial prejudice. The WCAB affirmed the WCJ's order to issue a replacement panel in the "specialty previously issued," which was chiropractic.

Petition for RemovalQualified Medical Evaluator (QME)Specialty DesignationCompensability ExamLabor Code § 4060Rule 30(b)Rule 31.1(b)Written ObjectionMedical Director ReviewWaiver of Objection
References
6
Case No. ADJ11861160
Regular
Oct 25, 2019

ADRIANA MARTINEZ vs. AVITUS, AMERICAN ZURICH INSURANCE COMPANY, GALLAGHER BASSETT SERVICES

This case involves a dispute over the selection of Qualified Medical Evaluator (QME) panels for an applicant with claimed injuries to multiple body parts. The Workers' Compensation Appeals Board (WCAB) granted the applicant's petition for removal, rescinded the prior decision, and found that the applicant's chiropractic QME panel request was proper while the defendant's orthopedic surgery panel request was improper. The WCAB determined that chiropractic medicine is the appropriate specialty and struck the orthopedic surgery panel, ordering the parties to proceed with the chiropractic QME. The WCAB clarified that while chiropractors cannot perform surgery or prescribe medication, they are qualified to evaluate injuries within their scope of practice.

QME panel disputeremoval petitionchiropractic specialtyorthopedic surgery specialtyLabor Code 4062.2Medical Directoradministrative law judgeWorkers' Compensation Appeals Boardproper panel selectioninvalid panel request
References
9
Case No. ADJ12550205
Regular
Apr 06, 2020

OLGA PLASCENCIA vs. ADECCO USA, INC

This case involves a dispute over a Qualified Medical Evaluator (QME) panel request. The applicant sought a chiropractic QME panel, while the defendant later denied liability for certain injuries. The Workers' Compensation Appeals Board (WCAB) rescinded the prior ruling and returned the case to the trial judge. This decision was based on the need to further develop the record regarding the applicant's DWC-1 form filing and the effect of the defendant's partial acceptance of liability on the QME panel process. The WCAB emphasized that the validity of the QME panel needs resolution before further proceedings.

Workers' Compensation Appeals BoardReconsiderationFindings and OrderDelay LetterMedical EvaluationQME PanelChiropracticOrthopedicLabor Code Section 4060Causation Dispute
References
5
Case No. MISSING
Regular Panel Decision

Claim of Mulligan v. Workers' Compensation Board

The claimant, a former workers' compensation law judge, appealed the denial of reduced earning benefits, which stemmed from his claim that stress from his job caused him to voluntarily withdraw from the labor market. He had previously received benefits for a 1995 angina attack. An arbitrator and subsequent arbitration panel concluded that he voluntarily withdrew from the labor market, a determination the claimant contested, asserting his retirement was due to work-related stress. The court, led by Judge Carpinello, found substantial evidence supported the panel's decision, noting the claimant never complained of stress to supervisors, sought accommodations, or applied for disability retirement. The court affirmed the arbitration panel's decision, denying the claimant's appeal.

Voluntary Withdrawal from Labor MarketReduced Earning BenefitsWorkers Compensation BenefitsArbitration Panel DecisionSubstantial EvidenceDisability RetirementJob-Related StressAppellate ReviewLabor Market WithdrawalClaim Denial
References
8
Case No. WCB No. G076 2707
Regular Panel Decision
Dec 09, 2021

Matter of Duncan v. John Wiley & Sons, Inc.

This Board Panel Decision concerns an appeal by the applicant, Joseph Lafayette, regarding a Workers' Compensation Law Judge's (WCLJ) finding on the causal relationship of his back injury. The applicant sustained injuries to his back, neck, and shoulder during his employment. The WCLJ had previously established a causal relationship for the neck and shoulder injuries but disallowed the claim for the back injury. Upon review, the Board Panel determined that the medical evidence in the record supports a causal relationship between the claimant's employment and his lower back injury. As a result, the Panel modified the WCLJ's decision to establish a causal relationship for the back injury, while affirming the other aspects of the original decision.

Workers' CompensationBack InjuryNeck InjuryShoulder InjuryCausal RelationshipMedical EvidencePanel ReviewWCLJ DecisionModificationAppeal
References
2
Case No. G0699450
Regular Panel Decision
Aug 10, 2023

Matter of Von Maack v. Wyckoff Heights Medical Center

The claimant, Yvette Robles, sustained a work-related injury to her left knee. The Workers' Compensation Law Judge (WCLJ) initially established accident, notice, and causal relationship. However, the employer and carrier appealed, contending the claim was untimely filed. A Board Panel modified the WCLJ's decision, determining that the claim was barred by Workers' Compensation Law § 28 due to untimely filing. The Full Board subsequently affirmed the Board Panel's decision, upholding the bar to the claim.

Timeliness of ClaimWCL § 28Board Panel ReviewAccident, Notice, and Causal RelationshipLeft Knee InjuryEmployer AppealFull Board ReviewClaim BarredStatute of LimitationsWork-Related Injury
References
0
Case No. ADJ12402022
Regular
Dec 02, 2019

ORIS CHAVARRIA vs. CREWS OF CALIFORNIA, INC., REDWOOD FIRE AND CASUALTY INSURANCE COMPANY c/o BERKSHIRE HATHAWAY HOMESTATE COMPANIES

The Workers' Compensation Appeals Board (WCAB) granted removal and rescinded an administrative law judge's (ALJ) order that invalidated a Qualified Medical Evaluator (QME) panel. The WCAB found that the applicant, though represented, had a legal basis to request a QME panel when the employer delayed accepting the claim, as this created a dispute regarding compensability. Removal was granted because the ALJ's decision would cause substantial prejudice by depriving the applicant of essential medical evidence regarding causation. The WCAB clarified that a claim dispute, even before formal denial, allows a represented applicant to request a QME panel under Labor Code section 4062.2.

QME panelremovalreconsiderationLabor Code section 4060Labor Code section 4062.2medical-legal evaluationcompensability disputerepresented applicantadministrative law judgeWorkers' Compensation Appeals Board
References
8
Case No. ADJ11913752
Regular
Nov 19, 2019

LAURA DOW vs. UCSF, administered by SEDGWICK CLAIMS MANAGEMENT SERVICES

This case concerns a dispute over the proper procedure for requesting a Qualified Medical Evaluator (QME) panel after a workers' compensation claim was denied. The Workers' Compensation Appeals Board (WCAB) granted removal, reversing a WCJ's decision. The WCAB found that the defendant's request for an orthopedic surgery QME panel was valid, initiated after the denial notice and statutory waiting period. They also determined that orthopedic surgery was an appropriate specialty, overriding the WCJ's order for a pain medicine panel. The parties are now directed to proceed with the orthopedic surgery QME panel.

QME panelPetition for RemovalOpinion and OrderFindings and OrdersMedical UnitPain MedicineOrthopedic SurgeryDenial NoticeQualified Medical EvaluatorLabor Code Section 4060
References
4
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