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

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 The Workers' Compensation Appeals Board (WCAB) granted the applicant's petition for removal, rescinded the prior decision, and found that the applicant's chiropractic QME panel request was proper while the defendant's orthopedic surgery panel request was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. 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. 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. 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. 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
Case No. ADJ7199986 ADJ7399845
Regular
Oct 03, 2011

ELMIRA SMITH vs. PACIFIC AUTISM CENTER FOR EDUCATION, TRI- STAR RISK MANAGEMENT

The applicant sought removal to challenge a finding that defendant's requested Qualified Medical Evaluator (QME) panel was properly assigned. The Appeals Board granted removal, rescinded the finding, and determined that *neither* panel was properly assigned. Both panel requests were found to be premature as they were made before the statutory 10-day period for agreeing on an Agreed Medical Evaluator had expired, plus an additional five days for mail service. This decision clarifies the timing requirements for QME panel requests following an unsuccessful attempt to select an AME.

Petition for RemovalQualified Medical Evaluator (QME)Agreed Medical Evaluator (AME)Labor Code section 4062.2(b)WCAB Rule 10507Messele v. Pitco FoodsInc.Premature RequestPanel AssignmentMedical Unit
References
Case No. ADJ7712746
Regular
Dec 08, 2015

Glen Rizuto vs. United Parcel Service, Gallagher Bassett

The Appeals Board granted UPS's Petition for Removal, rescinding the WCJ's order to negotiate a QME selection. The Board found the WCJ erred by not addressing UPS's contentions regarding the validity of the second QME panel issued over 24 months after the first. UPS successfully argued they would be prejudiced if forced to negotiate when the second panel was allegedly the only valid one. The Board ordered parties to select a QME from the July 2, 2014 panel, allowing each to strike one name.

Petition for RemovalQualified Medical Evaluator (QME)Panel SelectionCumulative Trauma InjuryLabor Code Section 4062.1Labor Code Section 4062.2Romero v. Costco WholesaleIrreparable HarmPrejudiceMedical Unit
References
Case No. ADJ9834159 (MF) ADJ9834161
Regular
Jul 30, 2018

ESAU HERNANDEZ vs. D.L. BONE AND SONS PAINTING, ICW GROUP/EXPLORER INSURANCE COMPANY, STATE COMPENSATION INSURANCE FUND

This case concerns a defendant's attempt to obtain a replacement Qualified Medical Evaluator (QME) panel after the applicant initially objected to the timeliness of the original QME's report. The Appeals Board treated the defendant's petition as one for removal and denied it. The Board found that the defendant, having failed to timely object to the QME's report itself, could not rely on the applicant's subsequent objection to request a new panel. The Board concluded that the defendant's failure to act promptly meant they were not entitled to a replacement QME panel, and no substantial prejudice or irreparable harm warranting removal was demonstrated.

Workers' Compensation Appeals BoardReconsiderationRemovalQualified Medical EvaluatorQME panelAdministrative Director RuleTimeliness objectionReplacement QME panelLabor CodeFindings of Fact
References
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