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

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
0
Case No. ADJ12550205
Regular
Apr 06, 2020

OLGA PLASCENCIA vs. ADECCO USA, INC

This case involves a dispute over a Qualified Medical Evaluator (QME) panel request. The applicant sought a chiropractic QME panel, while the defendant later denied liability for certain injuries. The Workers' Compensation Appeals Board (WCAB) rescinded the prior ruling and returned the case to the trial judge. This decision was based on the need to further develop the record regarding the applicant's DWC-1 form filing and the effect of the defendant's partial acceptance of liability on the QME panel process. The WCAB emphasized that the validity of the QME panel needs resolution before further proceedings.

Workers' Compensation Appeals BoardReconsiderationFindings and OrderDelay LetterMedical EvaluationQME PanelChiropracticOrthopedicLabor Code Section 4060Causation Dispute
References
5
Case No. ADJ6870507
Regular
Jun 24, 2010

ULISES FUENTES vs. DICKIE DOBINS CLEANERS, ILLINOIS WEST INSURANCE AGENCY, TOWER SELECT INSURANCE AGENCY

This case involves a dispute over the issuance of a Qualified Medical Evaluator (QME) panel in a workers' compensation claim. The applicant sought reconsideration of an order for a QME panel, alleging a deviation from an agreed medical evaluator process and lack of notice. The defendant presented a conflicting account of events, claiming the applicant's attorney conditioned the agreed medical evaluation on the defendant providing temporary disability benefits. The Appeals Board found the divergent factual accounts warranted removal and rescinded the QME panel order. The case is returned to the trial level for factual resolution and to determine if sanctions are appropriate.

WORKERS' COMPENSATION APPEALS BOARDRemovalQME PanelLabor Code § 4062.2Agreed Medical EvaluatorPetition to CompelEx parteNoticeSanctionsLabor Code § 5813
References
1
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
11
Case No. MISSING
Regular Panel Decision

Matter of Burns v. New York State Workers' Compensation Board

Claimant sought workers' compensation benefits due to injuries from an automobile accident. As an employee of the Workers’ Compensation Board, his claim was processed through a neutral outside arbitration process. An arbitrator established his claim and average weekly wage. Claimant appealed, arguing his average weekly wage should have been calculated differently due to a recent promotion, as per Workers’ Compensation Law § 14 (2). An arbitration panel declined to address this argument because it was not raised before the arbitrator. The appellate court affirmed the panel's decision, citing that the panel could decline review of issues not previously raised, consistent with 12 NYCRR 300.13 [e] [1] [iii].

ArbitrationAverage Weekly WageWorkers' CompensationAppellate ReviewIssue PreservationAdministrative LawProcedural Due ProcessStatutory InterpretationWorkers’ Compensation Board
References
2
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
8
Case No. ADJ1457992 (AHM 0084718)
Regular
Dec 26, 2014

DARLENE HELLER vs. COWELL BAKER'S STRIPPING SERVICES, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION, SEDGWICK CMS, FREMONT INSURANCE COMPANY

This case concerns a dispute over the correct procedure for obtaining medical reevaluations for a worker's injury with a date prior to January 1, 2005. The Appeals Board denied the applicant's petition for reconsideration, reversing an earlier decision that had directed the parties to use the panel QME process. The Board clarified that for pre-2005 injuries, the pre-Senate Bill 899 AME/QME procedures apply, not the current section 4062.2 QME process. One Commissioner dissented, arguing the prior award should be reinstated.

Workers' Compensation Appeals BoardPetition for ReconsiderationOpinion and Order DenyingFindings and AwardLabor Code section 4062.2panel qualified medical examinationQMEdisputed body partsadmitted liabilitydate of injury
References
3
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
5
Case No. ADJ10019950
Regular
Mar 14, 2018

ILBRA BEITPOLOUS vs. CALIFORNIA CORRECTIONAL HEALTHCARE SERVICES, STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board vacated its prior order granting reconsideration and denied the applicant's petition for removal. The Board found that the original order was not a final order subject to reconsideration because it concerned evidentiary matters, specifically the issuance of a new Qualified Medical Evaluator (QME) panel. While the Board acknowledged the novel issue of telemedicine in QME evaluations, it found no substantial prejudice or irreparable harm to the applicant to warrant removal. Ultimately, the Board agreed with the judge's order for a new QME panel due to concerns about proper disclosure and due process regarding the assistance of another physician in the examination.

QMEtelemedicinesubstantial medical evidencewaiverestoppelremovalreconsiderationlabor code 4628anti-ghostwriting statutequalified medical evaluator
References
9
Case No. ADJ19167634
Regular
Nov 07, 2025

JOSIE VERGARA vs. COMPASS GROUP, AIU INSURANCE COMPANY

The Workers' Compensation Appeals Board denied the Petition for Removal filed by the applicant, Josie Vergara. The petition challenged a Workers' Compensation Judge's (WCJ) determination that a Qualified Medical Evaluator (QME) panel was invalid due to inaccuracies in the panel request, specifically an incorrect claim number and primary treating physician. The Board affirmed that strict compliance with AD Rule 30, which requires accurate information in QME panel requests, is essential for due process and proper claim identification, citing prior decisions. The Board found that the petitioner failed to demonstrate substantial prejudice or irreparable harm warranting removal.

Petition for RemovalFinal OrderInterlocutory OrderThreshold IssueStipulationFindings of FactQualified Medical EvaluatorQME Panel RequestAdministrative Rule 30Due Process
References
18
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