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

Case No. ADJ7673518, ADJ7647749
Regular
Jan 23, 2015

ANA DE AYALA vs. AO-THE UNIVERSITY CORPORATION / CALIFORNIA STATE UNIVERSITY NORTHRIDGE

The Workers' Compensation Appeals Board granted reconsideration and reversed a prior ruling, finding the applicant sustained industrial injury to her neck. While the applicant testified to injuring her neck in a workplace incident and this was partially corroborated, the Board found insufficient evidence for other claimed injuries. The Board specifically disagreed with the administrative law judge's credibility assessment concerning the neck injury itself, relying on medical reports and testimony supporting the neck injury claim. The Board affirmed the denial of claims for all other alleged injuries, finding insufficient medical evidence to link them to the incident.

Petition for ReconsiderationFindings and OrderIndustrial InjuryNeck InjuryBack InjurySpine InjuryUpper ExtremitiesPsycheGastroesophageal SystemInternal System
References
Case No. ADJ9348004
Regular
May 26, 2015

DOLORES NATIVIDAD vs. SHERBOURNE PROPERTIES, INC., EMPLOYERS COMPENSATION INSURANCE COMPANY

The defendant petitioned for removal, challenging the WCJ's decision to validate a chiropractic QME panel. The applicant failed to follow the rule requiring justification for requesting a specialty other than the treating physician's. However, the defendant's objection to the QME panel was deemed untimely as it was not raised with the Medical Unit promptly. The Appeals Board denied the petition for removal, finding the defendant failed to demonstrate prejudice or irreparable harm.

Petition for RemovalAmended Findings of Fact and OrderQualified Medical Evaluator (QME) panelAdministrative Director Rule 31.1(b)Labor Code section 4060occupational medicinechiropractic medicineorthopedic medicineMedical UnitDeclaration of Readiness to Proceed
References
Case No. ADJ7785251
Regular
Nov 14, 2014

Jon Brothers vs. STATE OF CALIFORNIA, DEPARTMENT OF FORESTRY AND FIRE PROTECTION, COASTAL/NORTH REGION; STATE COMPENSATION INSURANCE FUND/STATE CONTRACT SERVICES

The Workers' Compensation Appeals Board granted reconsideration to clarify that the applicant's cumulative trauma orthopedic injury claim is still under development. The Board agreed with the WCJ that the defense's medical expert, Dr. Baldwin, failed to provide substantial medical evidence due to a misunderstanding of cumulative trauma principles. Dr. Baldwin improperly required documented prior specific injuries to opine on cumulative trauma, thereby failing to adequately assess the applicant's extensive work history. Therefore, the case is affirmed except for the amendment of a finding of fact to reflect that the orthopedic injury claim is contested and requires further medical evaluation.

Cumulative traumaQualified Medical EvaluatorIndependent Medical Evaluatorsubstantial medical evidenceorthopedic injurybinaural hearing losscardiovascular systemBattalion Chiefretired annuitantorthopedic cumulative trauma
References
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
Case No. ADJ8677937
Regular
Nov 05, 2015

SHARON ADAMS vs. MERCED CITY SCHOOL DISTRICT, Permissibly Self-Insured, Adjusted by INTERCARE

The Appeals Board vacated its prior order granting reconsideration and dismissed the applicant's petition, finding it was not a final order. The Board treated the petition as a request for removal, which was denied. The Board determined that the defendant's request for a QME panel in "spine" specialty was proper, despite the applicant's treating physician being in "physical medicine and rehabilitation." The dissenting opinion argued that the defendant failed to provide sufficient medical support to deviate from the treating physician's specialty, especially given the claimed injuries to multiple body parts.

WCABReconsiderationRemovalQMESpecialtyPain MedicineSpineOrthopedicPhysical Medicine and RehabilitationTreating Physician
References
Case No. ADJ7232076
En Banc
Sep 26, 2011

Tsegay Messele vs. Pitco Foods, Inc.; California Insurance Company

The Appeals Board holds that the 10-day period for agreeing on an AME under Labor Code § 4062.2(b) is extended by five days when the initial proposal is served by mail, and clarifies the method for calculating this time period, finding both parties' panel requests premature.

Workers' Compensation Appeals BoardTsegay MesselePitco FoodsInc.California Insurance CompanyADJ7232076Opinion and Decision After ReconsiderationOrder Granting RemovalDecision After RemovalEn Banc
References
Case No. ADJ3486059 (OXN 0125841) ADJ1942145 (OXN 0125840)
Regular
Nov 19, 2018

SEATRIZ GONZALEZ vs. EOS CORPORATION, STATE COMPENSATION INSURANCE FUND, CYPRESS INSURANCE COMPANY

The Appeals Board rescinded the WCJ's prior decision and returned the case for further proceedings due to an incomplete medical record concerning apportionment of permanent disability. Specifically, the Board requires supplemental reports from the Agreed Medical Evaluator (AME) in orthopedics and the Qualified Medical Evaluator (QME) in internal medicine. The Board also noted that the issue of claims administration was not properly addressed and needs further consideration by the WCJ. Lastly, the WCJ must revisit the finding regarding the specific injury of November 1, 2001, ensuring parties have notice and an opportunity to be heard.

Workers' Compensation Appeals BoardDecision After ReconsiderationApportionmentLabor Code section 4663Benson v. Workers' Comp. Appeals Bd.Agreed Medical Evaluator (AME)Cumulative Trauma (CT)Specific InjuryPermanent DisabilityHypertension
References
Case No. ADJ10800397
Regular
May 20, 2019

MARILYN RAMIREZ GALVEZ vs. NIAGARA BOTTLING LLC, SAFETY NATIONAL INSURANCE CO.

The applicant sought a QME panel in psychology for a claimed psychiatric injury after orthopedic and internal medicine evaluations. The WCJ denied the request, finding no substantial medical evidence for a psychological QME. The Appeals Board granted removal, rescinded the WCJ's order, and found good cause for a psychological QME panel. This decision allows the applicant to pursue necessary medical-legal discovery regarding her disputed psychological injury claim.

Petition for RemovalFindings and OrderQualified Medical EvaluatorQME panelpsychologypsychiatric injurydiscoveryinternal medicineorthopedic QMEhypertension
References
Case No. ADJ11134833, ADJ11134852
Regular
Apr 15, 2019

PETER LUCKHARDT vs. CITY OF TRACY

The Workers' Compensation Appeals Board denied the defendant's Petition for Reconsideration regarding an order for applicant to proceed with a pain management QME panel. The Board found that the applicant, having become represented by counsel after an initial orthopedic panel issued, was entitled to request a new panel specialty. Defendant's arguments concerning unilateral panel changes and due process were rejected, as the issues addressed were framed for adjudication and the applicant's request for a new panel was permissible under current law. The Board also denied the petition concerning an internal medicine panel, adopting the reasoning of the WCJ.

QME panelremovalreconsiderationinterlocutory orderdue processsubstantial complianceirreparable harmlabor codemedical evaluationmedical unit
References
Case No. ADJ8676814
Regular
Nov 18, 2013

JAMES JOSEPH vs. PEOPLEASE CORPORATION, ARCH INSURANCE COMPANY

The Workers' Compensation Appeals Board dismissed the defendant's petition for reconsideration. The defendant sought to challenge an order directing the Medical Director to issue a Qualified Medical Evaluator (QME) panel in Physical Medicine and Rehabilitation, arguing it should be in orthopedic surgery. The Board found the order was not a final order, and therefore, not subject to reconsideration. Furthermore, even if considered a petition for removal, it would be denied due to a lack of demonstrated significant prejudice or irreparable harm. The defendant's counsel also violated Appeals Board rules by filing a supplemental pleading without permission.

QME panelPhysical Medicine and Rehabilitationorthopedic surgeryPetition for Reconsiderationfinal orderinterlocutory ordersubstantive rightsdiscoverymandatory settlement conferenceremoval
References
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