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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. ADJ8173186
Regular
Jun 07, 2013

NATHAN LITTLE vs. DIVERSIFIED UTILITY SERVICES, OLD REPUBLIC GENERAL INSURANCE CORPORATION

The Workers' Compensation Appeals Board denied Nathan Little's Petition for Removal concerning a Qualified Medical Examiner (QME) panel. The Board adopted the WCJ's report, which found the QME process was initiated correctly under Labor Code section 4062.2 while the applicant was represented. Although the applicant later became unrepresented, the Board stated the original procedure should be followed for this QME panel. The denial means the applicant must proceed with the designated QME process.

Petition for RemovalQME PanelLabor Code section 4062.1Labor Code section 4062.2unrepresented applicantrepresented applicantsubstantial prejudiceirreparable harmpanel QMEdermatology
References
Case No. ADJ14953769
Regular
Feb 28, 2023

MANUEL DE JESUS CHAVAC vs. 99 CENTS ONLY STORES, LLC, ATHENS ADMINISTRATORS

The applicant sought reconsideration of a WCJ's finding that QME Panel No. 7480460 was valid. The applicant argued the panel was invalid because the defendant failed to serve the denial letter on the applicant's attorney, thus violating due process and Labor Code section 4062.2. The Appeals Board granted reconsideration, finding the defendant's denial letter was improperly served, preventing the applicant's attorney from objecting. Consequently, QME Panel No. 7480460 was deemed invalid, and the parties were ordered to proceed with Panel No. 7483530.

Workers' Compensation Appeals BoardQualified Medical EvaluatorQME PanelLabor Code section 4060Administrative Director Rule 30(b)Petition for ReconsiderationFindings of Fact and OrderInjury AOE/COEDenial of LiabilityService of Process
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. ADJ12910087
Regular
Dec 28, 2020

ESTHER LEMUS SALDANA vs. TAO TAI HOMES CORPORATION, INSURANCE COMPANY OF THE WEST

This case concerns a dispute over the correct Qualified Medical Evaluator (QME) panel for applicant Esther Lemus Saldana. The defendant sought reconsideration of an order finding the applicant's chiropractic QME panel valid and the defendant's orthopedic panel invalid. The Workers' Compensation Appeals Board denied the petition, upholding the administrative law judge's decision. The Board found the applicant properly requested a new panel after retaining counsel, and despite a service error on the chiropractic panel, the defendant had opportunity to contest the specialty. Therefore, the applicant's chiropractic QME panel remains the correct one for the medical-legal evaluation.

QME PanelChiropractic QMEOrthopedic QMEPetition for ReconsiderationFindings of Fact and OrdersMedical-Legal EvaluationQualified Medical EvaluatorAdministrative Director RuleRomero v. Costco WholesaleLabor Code Section 4062.1
References
Case No. ADJ11350784
Regular
Jan 13, 2020

LUIS RODRIGUEZ vs. BRAD NYMAN DBA LIVE OAK DAIRY, ZENITH INSURANCE COMPANY

This case concerns a workers' compensation applicant challenging a finding that he waived his right to a replacement Qualified Medical Evaluator (QME) panel. The applicant requested a replacement panel after the initially appointed QME could not schedule an exam within 60 days, but the exam was ultimately scheduled within 90 days. The Workers' Compensation Appeals Board denied the applicant's petition, finding that by accepting an appointment within the 90-day window, he waived his right to a replacement panel. The Board also found the applicant's due process claims unpersuasive, as he had a full opportunity to litigate the issue.

QME panel disputewaiver of replacement panelAOE/COEdue processthreshold issueinterlocutory decisionremoval standardirreparable harmsignificant prejudiceAD Rule 31.3
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. 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
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. ADJ10334253
Regular
Jun 06, 2017

TERESA CAMBEROS vs. LYON, ET AL., DBA TACO BELL, CYPRESS INS. CO.

The applicant sought reconsideration of a WCJ's order requiring compliance with Labor Code section 4062.2 for selecting a new QME panel now that she is represented by counsel. The Appeals Board dismissed the reconsideration petition as the order was procedural, not final. The Board also denied the petition for removal, finding no irreparable harm or prejudice, and affirming that represented workers must use the section 4062.2 striking process for new QME panels.

Workers' Compensation Appeals BoardQualified Medical EvaluatorQMEPetition for ReconsiderationPetition for RemovalLabor Code Section 4062.2Labor Code Section 4062.1Final OrderInterlocutory OrderMedical-Legal Evaluation
References
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