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

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 The Appeals Board granted removal, rescinded the finding, and determined that *neither* panel was properly assigned.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
2
Case No. ADJ6816825
Regular
Jun 14, 2010

KAI CHRISTOPHER vs. TIME WARNER CABLE, ESIS

The Appeals Board granted defendant's petition for removal, finding the WCJ erred in denying a QME panel request. This denial was based on Administrative Director Rule 30(d)(3), which previously stated only the employee could request a QME panel after a total denial of injury. However, the Board's recent en banc decision in *Mendoza v. Huntington Hospital* invalidated this rule as conflicting with Labor Code sections 4060(c) and 4062.2, which allow either party to request a QME panel. Therefore, the prior order was rescinded, and the matter returned to the trial level with instructions to issue a QME panel.

Petition for RemovalQualified Medical Evaluator (QME)Administrative Director RuleInvalid RuleMendoza v. Huntington HospitalLabor Code sections 4060(c)Labor Code sections 4062.2Denial of InjuryEither Party RequestMedical Director
References
1
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
15
Case No. ADJ11446545
Regular
Dec 03, 2019

ROSA LOPEZ RODRIGUEZ vs. UNIVERSAL BUILDING SERVICES SUPPLY COMPANY, INSURANCE COMPANY OF THE WEST

This case concerns a dispute over the appropriate medical specialty for a Qualified Medical Evaluator (QME) panel. The applicant, Rosa Lopez Rodriguez, initially requested a chiropractic QME panel, which was issued first. The defendant objected, arguing that chiropractic was inappropriate due to the applicant's prior surgery and lack of full recovery. The Medical Unit then invalidated the chiropractic panel and issued an orthopedic surgery panel. The Workers' Compensation Appeals Board granted reconsideration, overturning the WCJ's decision. The Board held that the party who first requests a QME panel has the right to designate the specialty and that the defendant failed to provide sufficient grounds to invalidate the chiropractic panel. Therefore, the Board amended the findings to sustain the applicant's objection and affirm chiropractic as the appropriate panel specialty.

AD Rule 31.5(a)(10)AD Rule 31.5(a)(9)AD Rule 31.1(b)Labor Code section 4062Labor Code section 4062.2Qualified Medical Evaluator (QME)QME panel specialtyPetition for RemovalPetition for ReconsiderationMedical Unit determination
References
1
Case No. MISSING
Regular Panel Decision

Claim of Broomfield v. Roosevelt Hotel Corp.

The case involves an appeal from a Workers’ Compensation Board decision denying the employer’s request for full Board review. The employer had repeatedly failed to appear at hearings regarding a discrimination complaint filed by the claimant, leading the Workers’ Compensation Law Judge (WCLJ) to find discrimination. The employer’s subsequent untimely appeal to a Board panel was denied for lack of good cause. The employer then sought full Board review, which was also denied. The court affirmed the denial of full Board review, finding no abuse of discretion by the Board panel, as their decision was unanimous and based on a full consideration of the matter.

DiscriminationWorkers' Compensation BoardUntimely AppealFull Board ReviewAbuse of DiscretionAdjournmentsFailure to AppearJudicial ReviewAppellate DivisionWCLJ Decision
References
6
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. ADJ9539560
Regular
May 14, 2015

OSCAR MELENDEZ vs. B&D UPHOLSTERY, PROCENTURY INSURANCE COMPANY, MIDWEST INSURANCE COMPANY

In this workers' compensation case, the defendant sought to invalidate the applicant's requested QME panel. The defendant argued that the applicant's request was invalid because it was not served on their attorney. The Appeals Board denied the petition for removal, finding that while service on the attorney was required, the defendant's own QME request contained material defects, including misidentifying the treating physician's specialty and the reason for the request. Therefore, the WCJ's finding of the applicant's panel's validity did not cause irreparable harm.

Petition for RemovalQualified Medical EvaluatorQME PanelLabor Code section 4060Compensability examWCAB Rule 10510(b)Service on attorneyRule 31.1(b)Specialty disputeMaterial defects
References
0
Case No. ADJ20508246
Regular
Sep 02, 2025

ANA BERTHA ORTIZ vs. ATLANTIC SOLUTIONS GROUP, INC., SUNZ INSURANCE COMPANY

Applicant Ana Bertha Ortiz challenged a Workers' Compensation Judge's (WCJ) order affirming panel 7799274 for a Qualified Medical Evaluator (QME). The Appeals Board granted the petition for reconsideration, finding the defendant's request for the QME panel was premature. Specifically, defendant requested the panel before the legally mandated 15-day waiting period after serving their objection letter via email. Consequently, the Appeals Board invalidated panel 7799274 and returned the matter for further proceedings.

Petition for RemovalPetition for ReconsiderationPanel InvalidPremature RequestLabor Code 4062.2Qualified Medical EvaluatorAgreed Medical EvaluatorMedical UnitElectronic Adjudication Management SystemThreshold Issue
References
9
Case No. ADJ8529720
Regular
Feb 06, 2017

ALEJANDRA GONZALEZ vs. 3M COMPANY, OLD REPUBLIC INSURANCE

This case concerns whether an untimely supplemental Qualified Medical Evaluator (QME) report warrants a replacement panel. The applicant requested a new panel because the original QME's supplemental report was late. The WCJ denied the defendant's request to keep the original QME, finding the defendant waived objection by striking a name from the new panel. The Appeals Board granted removal, rescinded the WCJ's order, and remanded the case. The Board clarified that striking a name from a new panel does not automatically waive the right to object to its validity.

PQMESupplemental ReportReplacement PanelLabor Code 4062.5DWC Medical UnitDeclaration of ReadinessMSCWaiverAdministrative Director Rule 38Rule 31.5
References
0
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
4
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