CompFox Logo
AboutWorkflowFeaturesPricingCase LawInsights

Updated Daily

Case Law Database

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

Case No. ADJ7436407, ADJ1895040 (FRE 0238028)
Regular
Feb 04, 2015

Colleen Newby vs. Fresno Community Medical Center, St. Agnes Medical Center, State Compensation Insurance Fund

The Workers' Compensation Appeals Board denied Colleen Newby's Petition for Removal, upholding the denial of her petition to quash a Qualified Medical Evaluator (QME) request. The Board found that the prior employer, Fresno Community Medical Center, was authorized to file an application for adjudication of claim for Newby's subsequent employment with St. Agnes Medical Center. Crucially, the Board determined that a claim form is not a prerequisite for St. Agnes to request a QME panel in this specific scenario, where a second injury is claimed by a prior employer. Newby's due process claim was rejected as she had an opportunity to present her arguments on removal.

Petition for RemovalPetition to QuashQME RequestQualified Medical EvaluatorClaim FormDue ProcessAgreed Medical EvaluatorApplication for AdjudicationTemporary DisabilityPermanent Disability
References
1
Case No. MISSING
Regular Panel Decision

Main Evaluations, Inc. v. State

The claimant, Main Medical Evaluations, entered into contracts with the New York State Office of Temporary and Disability Assistance (OTDA) to perform consultative medical evaluations. OTDA terminated these contracts, alleging the claimant failed to disclose professional disciplinary proceedings against its chief medical officer, Arvinder Sachdev, and submitted false information during the bidding process. Following the dismissal of its claim in the Court of Claims, the claimant appealed. The appellate court affirmed the lower court's judgment, concluding that OTDA had legitimate grounds for termination due to the claimant's misrepresentations and failure to report substantial contract-related issues concerning Sachdev's integral role. Additionally, the court rejected the claimant's equal protection argument, finding no evidence of selective enforcement based on impermissible considerations.

Contract TerminationProfessional MisconductFalse RepresentationEqual ProtectionGovernment ContractsAppellate ReviewBreach of ContractMedical LicensingAdministrative ProceedingsDue Diligence
References
5
Case No. ADJ9 636706; ADJ9636707 ADJ9447837
Regular
Aug 09, 2016

RICK PARKER vs. DSC LOGISTICS, ZURICH NORTH AMERICA

This case concerns whether a Qualified Medical Evaluator (QME) must address all claimed industrial injuries filed prior to their initial evaluation. The Workers' Compensation Appeals Board (WCAB) rescinded a prior order that denied the defendant's petition to vacate new QME panels. The WCAB held that Labor Code section 4062.3(j) requires a QME to evaluate all contested medical issues arising from injuries reported on one or more claim forms prior to the employee's initial appointment. Therefore, the applicant must return to the original QME, Dr. Steinmann, to evaluate the disputed medical issues in all relevant case numbers.

Workers' Compensation Appeals BoardReconsiderationPetition to Vacate QME PanelsLabor Code section 4062.3Qualified Medical EvaluatorPanel QMEDuplicative Medical EvaluationsDoctor ShoppingNavarro v. City of MontebelloContested Medical Issues
References
1
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. 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
9
Case No. ADJ19432813; ADJ19432814
Regular
Mar 24, 2025

Yeni Saenz vs. Kellermeyer Bergensons Services, LLC; Zurich American Dallas

Applicant Yeni Saenz sought reconsideration of a Workers' Compensation Administrative Law Judge's (WCJ) finding that her strike from a Qualified Medical Evaluator (QME) panel was untimely, granting the defendant the right to select the QME. The Workers' Compensation Appeals Board granted the petition for reconsideration, concluding that although the applicant's strike was indeed untimely, the defendant had subsequently waived its right to exclusively select a QME by failing to act within a reasonable time. Consequently, the Board rescinded the WCJ's decision and ordered the parties to proceed with Dr. Patrick S. Hill as the designated Qualified Medical Evaluator. Commissioner José H. Razo issued a dissenting opinion, arguing that the applicant had obfuscated the untimeliness of her strike and scheduled an appointment during the period when the defendant held the exclusive right to selection.

QME PanelUntimely StrikeLabor Code Section 4062.2WaiverTimely SelectionReconsiderationJoint Findings and OrderWCJAppeals BoardPetition for Reconsideration
References
2
Case No. ADJ10917207
Regular
Aug 13, 2019

CARMEN ROJO vs. K & M MEAT COMPANY, STARR INDEMNITY & LIABILITY COMPANY

This case involves a dispute over the necessity of an additional Qualified Medical Evaluator (QME) panel in orthopedic surgery. The Applicant sought reconsideration of an administrative law judge's (ALJ) order for a new orthopedic QME panel, arguing it was an abuse of discretion and prejudicial. The Appeals Board granted reconsideration, finding the original QME's referral for an orthopedic evaluation was for treatment, not a recommendation for a new medical-legal evaluation. Consequently, the Board amended the ALJ's findings, holding there was no good cause for an additional orthopedic QME panel and denying the defendant's request.

QME panelorthopedic surgeryreconsiderationremovalFindings & Orderchiropractic QMEmedical-legal evaluationgood causesupplemental pleadingmedical dispute
References
9
Case No. ADJ12575364
Regular
Nov 25, 2020

MIGUEL SOLIS vs. KONICA MINOLTA BUSINESS SOLUTIONS, SOMPO AMERICA

The Workers' Compensation Appeals Board (WCAB) granted reconsideration of a WCJ's decision that overturned the Medical Unit's denial of a specialty change for a Qualified Medical Evaluator (QME) panel. The WCAB found that while they have jurisdiction to review Medical Unit decisions, the applicant did not meet the standard for vacating the chiropractic QME panel. The WCAB held that a chiropractor can evaluate disputed medical issues, even with referrals to other specialists, as long as they stay within their scope of practice and report any issues outside their expertise. Therefore, the WCAB rescinded the WCJ's order and directed the parties to utilize the original chiropractic QME panel.

QME panelMedical Unitspecialty disputeorthopedic surgerychiropracticAdjudication NumberPetition for ReconsiderationFindings and OrderLabor Codesubstantial evidence
References
4
Case No. ADJ1346416 (ANA 0390656)
Regular
Jan 19, 2010

ADAM TRAN vs. LAIDLAW TRANSIT SERVICE, BROADSPIRE CLAIMS SERVICES, INSURANCE CO. OF THE STATE OF PENNSYLVANIA

The Workers' Compensation Appeals Board denied the applicant's petition for removal, which sought to rescind an order compelling a medical examination. The applicant argued he could withdraw from an Agreed Medical Evaluator (AME) agreement due to prior difficulties obtaining a Qualified Medical Evaluator (QME). The Board found the petition timely filed but denied it, as the applicant failed to demonstrate significant prejudice or irreparable harm from the AME evaluation, despite a prolonged, unsuccessful attempt to secure a QME.

Petition for RemovalAgreed Medical EvaluatorQualified Medical EvaluatorQME PanelLabor Code section 4062.2TimelinessWCJSignificant PrejudiceIrreparable HarmWCAB Rule 10843(a)
References
0
Case No. ADJ8579043
Regular
Apr 14, 2015

MARY JONES vs. ST. HELENA HOSPITAL

The Workers' Compensation Appeals Board granted reconsideration and rescinded the prior "take nothing" order, remanding the case for further development of the medical record. Applicant alleged a cumulative trauma knee injury, but the Qualified Medical Evaluator's (QME) opinion, relied upon by the judge, was deemed not substantial medical evidence. The Board found the QME failed to adequately inquire into the applicant's job duties or demonstrate a clear understanding of cumulative trauma. The case will be returned for selection of a new QME to re-evaluate the claim.

WCABPetition for ReconsiderationFindings and OrderCumulative Trauma InjuryBilateral KneesVocational Nurse LVNQualified Medical Evaluator QMEDr. OsborneSubstantial Medical EvidenceIndustrial Causation
References
4
Showing 1-10 of 9,912 results

Ready to streamline your practice?

Apply these legal strategies instantly. CompFox helps you find decisions, analyze reports, and draft pleadings in minutes.

CompFox Logo

The AI standard for workers' compensation professionals. Faster research, deeper analysis, better outcomes.

Product

  • Platform
  • Workflow
  • Features
  • Pricing

Solutions

  • Defense Firms
  • Applicants' Attorneys
  • Insurance carriers
  • Medical Providers

Company

  • About
  • Insights
  • Case Law

Legal

  • Privacy
  • Terms
  • Trust
  • Cookies
  • Subscription

© 2026 CompFox Inc. All rights reserved.

Systems Operational