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Case Law Database

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

Case No. ADJ20165742

Regular

Jul 18, 2025

DEBRA SILVEIRA vs. FEDEX GROUND PACKAGE SYSTEM, INCORPORATED

Applicant Debra Silveira sought reconsideration of an April 29, 2025 Findings of Fact and Order, which deemed a Qualified Medical Evaluator (QME) panel valid despite being requested by defendant FedEx Ground Package System, Incorporated, with an incorrect claim number. The Appeals Board granted the petition, rescinded the prior decision, and substituted new findings. The Board ruled that strict compliance with Administrative Director Rule 30 regarding complete and correct claim numbers for QME panel requests is required to ensure due process and prevent conflicting or overlapping panels. Consequently, the defendant's panel (7773036) was deemed invalid, and the applicant's panel (7775940) was declared valid.

QME panel validityincorrect claim numberAD Rule 30due processadministrative law judgePetition for Reconsiderationremoval standardDWC Medical Unitprocedural defectinadvertent error

References

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 The Workers' Compensation Appeals Board (WCAB) granted the applicant's petition for removal, rescinded the prior decision, and found that the applicant's chiropractic QME panel request was proper while the defendant's orthopedic surgery panel request was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

Case No. ADJ10473588, ADJ10473600

Regular

Jul 12, 2018

ANGEL MORAN vs. SELECT STAFFING, administered by CORVEL

The Workers' Compensation Appeals Board granted the applicant's petition for removal, rescinded the WCJ's order denying a replacement QME panel, and returned the matter to the trial level. The Board found that the WCJ's order was not based on admitted evidence, hindering meaningful review. Applicant alleged QME bias based on deposition testimony, which the Board noted could constitute a disqualifying conflict of interest under relevant regulations. The case requires further proceedings at the trial level to properly consider the applicant's request for a replacement QME based on an evidentiary record.

Petition for RemovalReplacement QME PanelDisqualifying Conflict of InterestWCJ OrderBiasDeposition TestimonyEvidentiary RecordLabor Code Section 5313Rule 31.5Rule 41.5

References

Case No. ADJ7532290

Regular

Aug 28, 2012

MAXINE BROWN VIRGIL vs. LUNCH STOP, INC., EMPLOYERS COMPENSATION INSURANCE

This case involves a dispute over obtaining a Qualified Medical Evaluator (QME) panel. The applicant requested a new panel because a QME on the initial panel could not provide an appointment within 60 days. However, the applicant failed to properly strike a physician from the original panel after the defendant did. As a result, the defendant was authorized to schedule an appointment with a remaining physician, and the applicant was not entitled to a new QME panel. The Appeals Board granted removal to amend the prior order to reflect a rescheduled appointment with the original QME.

Workers' Compensation Appeals BoardPetition for RemovalQualified Medical EvaluatorpanelstrikeLabor Code section 4062Administrative Director Rule 31.5section 4062.2(c)medical evaluatorappointment

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. ADJ8074524

Regular

Jan 17, 2013

Geoconda Acevedo vs. Reliable Caregivers, PEGASUS RISK MANAGEMENT

The Appeals Board dismissed the defendant's petition for reconsideration because the selection of a Qualified Medical Evaluator (QME) is not a final order. However, the Board granted removal to address issues with defective QME panels. The Board rescinded the prior award and ordered the WCJ to appoint a regular physician if the parties cannot agree on an Agreed Medical Examiner. This action aims to resolve the ongoing delays and procedural defects in selecting a QME for the applicant's evaluation.

QME panelremovalagreed medical examinerpanel qualified medical evaluatorWCJ authoritylabor code section 5701substantive right or liabilityprimary treating physicianindustrial injuryreconsideration

References

Case No. ADJ12347424

Regular

Nov 09, 2020

DANIELLE LOOMIS-LYONS vs. COUNTY OF MENDOCINO

This case concerns applicant Danielle Loomis-Lyons' injury to her right knee. The WCJ initially found injury AOE/COE, ordered a replacement QME panel in orthopedic surgery, and deemed the prior pain management QME report inadmissible. The Appeals Board granted reconsideration, affirming the injury finding and the need for a replacement panel, but corrected the panel specialty to pain medicine. The Board rescinded findings regarding the appropriate panel specialty due to lack of notice and opportunity to be heard.

QME panelpain managementorthopedic surgeryAOE/COEinadmissible reportPetition for ReconsiderationremovalLabor Code section 4062.1AD Rule 31.3AD Rule 31.5

References

Case No. ADJ1555913 (LAO 0880260)

Regular

Nov 09, 2016

Larry Joseph Madrid vs. P&O Cold Logistics, The Travelers Insurance Company

This case concerns the applicant's petition for reconsideration regarding the replacement of a Qualified Medical Evaluator (QME) in neurology. The Workers' Compensation Appeals Board (WCAB) dismissed the petition as a petition for reconsideration and treated it as a petition for removal, which was subsequently denied. The majority found that the order for a new QME panel was not a final decision and that the applicant failed to show substantial prejudice or irreparable harm warranting removal. The dissenting opinion argues that there was insufficient evidence of a disqualifying conflict of interest for the neurologist and that the defendant waived any objection by their delay and "doctor shopping" tactics.

QME paneldisqualifying conflict of interestsecondary treating physicianPetition for RemovalPetition for ReconsiderationAdministrative Director Rule 41.5(d)(4)discovery ordersubstantial prejudiceirreparable harmwaiver

References

Case No. ADJ10542261, ADJ10738226

Regular

Nov 01, 2017

MARTIN DUENAS REYES vs. HIS LIFE WOODWORKS, AMTRUST

The Workers' Compensation Appeals Board denied the applicant's Petition for Removal concerning a Joint Findings and Order that struck a Qualified Medical Evaluator (QME) panel. The Board affirmed the WCJ's finding that the panel was improperly obtained because the applicant requested it less than 10 days after the claim denial, violating Labor Code section 4062.2(b). Applicant failed to demonstrate substantial prejudice or irreparable harm from the panel being stricken, and can obtain a new panel following proper procedures.

Petition for RemovalJoint Findings and OrderQualified Medical Evaluator (QME)Labor Code section 4062.2(b)stricken panelcompensability disputedenial letter10-day waiting periodBahena v. Charles Virzi Constructionpremature panel request

References

Case No. ADJ9623223

Regular

Aug 04, 2015

KORI HARDING vs. ABM INDUSTRIES

The Workers' Compensation Appeals Board affirmed a finding that an applicant was entitled to a chiropractic QME panel. The Board found the defendant's objection and request for an orthopedic QME panel did not comply with Rule 31.5(10) as the Medical Unit did not determine the initial specialty was "medically or otherwise inappropriate for the disputed medical issue(s)." Newly discovered evidence of disc herniation was deemed insufficient to change this outcome, as the initial determination was flawed. The WCAB affirmed the original award directing use of the chiropractic QME panel.

Workers' Compensation Appeals BoardQualified Medical EvaluatorQME PanelMedical UnitPrimary Treating PhysicianChiropractic CareOrthopedicsRule 31.5(10)Industrial InjuryReplacement Panel

References

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Updated Daily

Case Law Database

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

Case No. ADJ20165742

Regular

Jul 18, 2025

DEBRA SILVEIRA vs. FEDEX GROUND PACKAGE SYSTEM, INCORPORATED

QME panel validityincorrect claim numberAD Rule 30due processadministrative law judgePetition for Reconsiderationremoval standardDWC Medical Unitprocedural defectinadvertent error

References

Case No. ADJ11861160

Regular

Oct 25, 2019

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

References

Case No. ADJ10473588, ADJ10473600

Regular

Jul 12, 2018

ANGEL MORAN vs. SELECT STAFFING, administered by CORVEL

Petition for RemovalReplacement QME PanelDisqualifying Conflict of InterestWCJ OrderBiasDeposition TestimonyEvidentiary RecordLabor Code Section 5313Rule 31.5Rule 41.5

References

Case No. ADJ7532290

Regular

Aug 28, 2012

MAXINE BROWN VIRGIL vs. LUNCH STOP, INC., EMPLOYERS COMPENSATION INSURANCE

Workers' Compensation Appeals BoardPetition for RemovalQualified Medical EvaluatorpanelstrikeLabor Code section 4062Administrative Director Rule 31.5section 4062.2(c)medical evaluatorappointment

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

Workers' Compensation Appeals BoardPetition for ReconsiderationPetition for RemovalWCJ Orderconflict of interestQME panelpsychiatric QMEreplacement QMEstipulationsinterim order

References

Case No. ADJ8074524

Regular

Jan 17, 2013

Geoconda Acevedo vs. Reliable Caregivers, PEGASUS RISK MANAGEMENT

QME panelremovalagreed medical examinerpanel qualified medical evaluatorWCJ authoritylabor code section 5701substantive right or liabilityprimary treating physicianindustrial injuryreconsideration

References

Case No. ADJ12347424

Regular

Nov 09, 2020

DANIELLE LOOMIS-LYONS vs. COUNTY OF MENDOCINO

QME panelpain managementorthopedic surgeryAOE/COEinadmissible reportPetition for ReconsiderationremovalLabor Code section 4062.1AD Rule 31.3AD Rule 31.5

References

Case No. ADJ1555913 (LAO 0880260)

Regular

Nov 09, 2016

Larry Joseph Madrid vs. P&O Cold Logistics, The Travelers Insurance Company

References

Case No. ADJ10542261, ADJ10738226

Regular

Nov 01, 2017

MARTIN DUENAS REYES vs. HIS LIFE WOODWORKS, AMTRUST

References

Case No. ADJ9623223

Regular

Aug 04, 2015

KORI HARDING vs. ABM INDUSTRIES

Workers' Compensation Appeals BoardQualified Medical EvaluatorQME PanelMedical UnitPrimary Treating PhysicianChiropractic CareOrthopedicsRule 31.5(10)Industrial InjuryReplacement Panel

References

Showing 1-10 of 1,378 results

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