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

Case No. ADJ6915098
Regular
Oct 22, 2013

KIMBERLY HOOVER vs. RUSNAK WESTLAKE (PRM CORP.), ZENITH INSURANCE

The Workers' Compensation Appeals Board denied Defendant's Petition for Removal, finding they failed to demonstrate substantial prejudice or irreparable harm. The Board noted the defendant's delay in requesting a replacement Qualified Medical Examiner (QME) after objecting to a QME's report, suggesting potential doctor-shopping. Removal is an extraordinary remedy not granted absent a clear showing of severe harm that cannot be remedied by reconsideration.

Petition for RemovalWorkers' Compensation Appeals BoardWCJ reportdoctor-shoppingQME Levinereplacement panelsubstantial prejudiceirreparable harmreconsiderationsanctions
References
Case No. ADJ8931511
Regular
Sep 04, 2014

DOUGLAS FEUTZ vs. COUNTY OF SACRAMENTO

The Workers' Compensation Appeals Board denied the applicant's petition for removal, affirming the WCJ's decision. The applicant's attorney objected to a supplemental QME report being untimely, but did not request a new QME panel until after reviewing the report. The Board found this action constituted a waiver of the objection because the request was not made contemporaneously with the objection to the violation. Allowing such a delay would undermine efficient dispute resolution and permit doctor shopping.

Petition for RemovalSupplemental ReportPanel Qualified Medical EvaluatorPQMEMedical UnitReplacement QME PanelTimely Supplemental ReportProcedural ViolationWaiverDoctor-Shopping
References
Case No. ADJ815944
Regular
Jan 14, 2010

LINDALAIVAREZ vs. BLUE DIAMOND GROWERS, TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICA

The Workers' Compensation Appeals Board denied a Petition for Removal, upholding the WCJ's decision to deny a new QME panel. The applicant's attempt to obtain a new panel was deemed impermissible "doctor-shopping" by delaying objection to a late supplemental QME report until after receiving and reviewing it, and finding it favorable. The Board applied the principle that parties cannot exploit delays in medical reports for strategic advantage. Therefore, removal was denied as the conduct did not justify a new panel appointment.

Petition for RemovalQME panelmedical-legal reportdoctor-shoppinguntimely reportsupplemental reportobjectionwrit deniedAppeals Board panel decisionadministrative law judge
References
Case No. ADJ5738297
Regular
Apr 13, 2011

Douglas Riedo vs. REGENTS OF UNIVERSITY OF CALIFORNIA, UCSB & SEDGWICK CMS

The Workers' Compensation Appeals Board (WCAB) granted the applicant's petition for removal and rescinded an order compelling attendance at a medical evaluation. The WCAB found that the employer failed to comply with Administrative Director Rule 32(d) regarding the selection of a consulting physician and rejected the employer's reliance on Labor Code section 4064(d). The Board clarified that parties cannot obtain multiple evaluations on the same issue until they receive a favorable opinion, a practice known as "doctor shopping."

Petition for RemovalRescind OrderLabor Code section 4050Labor Code section 4060Labor Code section 4062Labor Code section 4062.2compensable consequence injuriesorthopedic qualified medical evaluator (QME)Administrative Director Rule 32(d)Labor Code section 4064(d)
References
Case No. ADJ3501807 (SRO 0141934)
Regular
Sep 08, 2011

JESSICA REYNOLDS vs. AMERICAN MEDICAL RESPONSE, ACE AMERICAN INSURANCE

The Appeals Board denied the defendant's Petition for Removal seeking to replace a Qualified Medical Evaluator (QME). The defendant argued the QME violated Administrative Director Rule 34(b) by scheduling an exam at an unlisted address. However, the Board found the defendant failed to demonstrate substantial prejudice or irreparable harm necessary for removal. The Board agreed with the WCJ's finding that the objection appeared to be an attempt at "doctor shopping" and gamesmanship, contrary to the policy of substantial justice.

Petition for RemovalQualified Medical EvaluatorReplacement Panel QMELabor Code section 4062.2Administrative Director Rule 34(b)substantial prejudiceirreparable harmdoctor shoppinggamesmanshipsocial public policy
References
Case No. ADJ7395101
Regular
Jan 13, 2016

Phillips Wylly Jr. vs. Omni Hotel, Arch Insurance Company

The Workers' Compensation Appeals Board rescinded the original findings regarding the applicant's right thumb injury, as it was based on an unclear stipulation and the employer's insurer's identity was irrelevant. However, the Board affirmed the denial of the applicant's request to strike the medical report of Dr. Ronald Carlish. This denial was due to the applicant's waiver of objection by not unqualifiedly objecting to the untimely report before reviewing its contents. The Board found that allowing such an objection after seeing an unfavorable opinion would promote doctor shopping and hinder expeditious litigation.

Petition for ReconsiderationStipulation of CounselIndustrial InjuryPanel Qualified Medical EvaluatorMedical ReportReplacement PanelWaiverInvited ErrorUntimely ServiceDoctor Shopping
References
Case No. ADJ8022096
Regular
Apr 09, 2013

CLISE MARTINEZ vs. GOLDEN VALLEY HEALTH CENTER, AMTRUST NORTH AMERICA

The Appeals Board dismissed the Applicant's Petition for Reconsideration because it was not taken from a "final" order, but rather an interlocutory procedural decision. The Applicant sought to strike a Qualified Medical Examiner's report and obtain a replacement panel, alleging violations of administrative regulations regarding notice periods and office standards. The Board found that the Applicant's motion was untimely, having been filed after the QME report was issued, and that the alleged violations did not warrant a replacement panel, especially as they appeared to be attempts at "doctor shopping." Therefore, both the Petition for Reconsideration and the Petition for Removal were denied.

Petition for ReconsiderationPetition for RemovalFinal OrderInterlocutory OrderSubstantive RightLiabilityMedical-Legal EvaluationQualified Medical Examiner (QME)Panel QMEReplacement Panel
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. ADJ1211801
Regular
Apr 13, 2012

GUISELA REYNOSO vs. UNIVERSAL PROTECTION SERVICES, AMERICAN CASUALTY COMPANY OF READING, PENNSYLVANIA, CNA CLAIMPLUS

The Workers' Compensation Appeals Board dismissed the defendant's Petition for Reconsideration because the WCJ's decision denying a replacement QME was an intermediate procedural order, not a final determination of substantive rights. The defendant sought a new panel after the QME allegedly violated a regulation by evaluating the applicant at an unlisted address and missed a deposition. The Board found the defendant's objection to the evaluation was untimely and that the request for a new panel appeared to be an attempt to "doctor shop" after receiving unfavorable reports. Even if considered for removal, the petition would be denied due to the unreasonable delay in raising objections.

Workers' Compensation Appeals BoardQualified Medical EvaluatorQME panelindustrial injuryspider bitesecurity guardreplacement paneldepositiondiscovery ordersfinal order
References
Case No. ADJ7699696
Regular
Apr 06, 2020

George Ramirez, Jr vs. Preston Pipelines, Subsequent Injuries Benefits Trust Fund

This case concerns the applicant's claim for Subsequent Injuries Benefits Trust Fund (SIBTF) benefits, which was initially denied by the WCJ who excluded Dr. Chen's medical reports as inadmissible "doctor shopping." The applicant appealed, arguing Dr. Chen's reports were admissible and not duplicative of Dr. Lockwood's initial, incomplete report. The Appeals Board rescinded the prior order, finding the applicant should not be denied benefits solely due to the exclusion of Dr. Chen's reports, and returned the matter to the trial level to allow the applicant to obtain supplemental reporting from Dr. Lockwood to address his SIBTF eligibility.

Subsequent Injuries Benefits Trust FundSIBTFLabor Code section 4751inadmissible evidencedoctor shoppingQME evaluationsLabor Code section 5703examining physiciancumulative traumaCompromise and Release
References
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