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

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 The Board rescinded findings regarding the appropriate panel specialty due to lack of notice and opportunity to be heard.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. ADJ8233060, ADJ8237202
Regular
Aug 23, 2013

SYLVIA TORRES vs. TODD MACKEY dba CAREFREE PLANTS & DESIGN, PREFERRED EMPLOYER'S INSURANCE CO.

The Workers' Compensation Appeals Board dismissed the applicant's petition for reconsideration because the WCJ's order regarding a replacement panel was not a final decision. The Board denied the petition for removal, finding no substantial prejudice or irreparable harm, despite the PQME's late supplemental report. Applicant failed to formally request a replacement panel from the Medical Director as required by regulation. Therefore, the Board affirmed the WCJ's decision not to order a replacement panel and to schedule a supplemental evaluation with the original PQME.

WCABPetition for ReconsiderationPetition for RemovalPanel Qualified Medical EvaluatorPQMESupplemental ReportFindings of Fact and OrderWCJDeclaration of ReadinessReplacement Panel
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. ADJ8022096
Regular
Apr 09, 2013

CLISE MARTINEZ vs. GOLDEN VALLEY HEALTH CENTER, AMTRUST NORTH AMERICA

The Appeals Board dismissed the Applicant's Petition for Reconsideration because it was not taken from a "final" order, but rather an interlocutory procedural decision. The Applicant sought to strike a Qualified Medical Examiner's report and obtain a replacement panel, alleging violations of administrative regulations regarding notice periods and office standards. The Board found that the Applicant's motion was untimely, having been filed after the QME report was issued, and that the alleged violations did not warrant a replacement panel, especially as they appeared to be attempts at "doctor shopping." Therefore, both the Petition for Reconsideration and the Petition for Removal were denied.

Petition for ReconsiderationPetition for RemovalFinal OrderInterlocutory OrderSubstantive RightLiabilityMedical-Legal EvaluationQualified Medical Examiner (QME)Panel QMEReplacement Panel
References
Case No. ADJ19417386
Regular
Mar 17, 2025

LOURDES AVILA vs. PRIORITY WORKFORCE, MVP PAYROLL FINANCING, LLC, SUNZ INSURANCE COMPANY

The Workers' Compensation Appeals Board denied the defendant's Petition for Removal regarding a WCJ's order to replace a Qualified Medical Evaluator (QME) panel. The defendant argued that their due process rights were violated and that they were entitled to an additional strike due to an initial double strike of a QME. The Board found that removal is an extraordinary remedy, and the petitioner failed to demonstrate substantial prejudice or irreparable harm. They upheld the WCJ's decision, emphasizing that the subsequent strikes by both parties were untimely and the order to obtain a replacement panel did not determine substantive rights.

Removal PetitionPanel StrikesQualified Medical EvaluatorIrreparable AmbiguityDue ProcessMailbox RuleTimelinessLabor Code Section 4062.2(c)Agreed Medical EvaluatorAlvarado v. WCAB
References
Case No. ADJ8507046
Regular
Oct 21, 2016

SANTIAGO RODRIGUEZ vs. VPM MANAGEMENT INC., ZURICH AMERICAN INSURANCE CO., AMERICAN CLAIMS MANAGEMENT, INC.

The Workers' Compensation Appeals Board granted applicant's petition for removal, finding that the WCJ denied applicant due process. The WCJ issued orders replacing three Qualified Medical Examiner (PQME) panels based on a petition filed shortly before a hearing, without allowing applicant a written response or a full hearing on the new contentions. The Board rescinded the replacement orders and returned the case for further proceedings, noting that reconsideration would be inadequate given the potential impossibility of restoring prior panels. This ensures applicant receives a fair hearing and the opportunity to present evidence.

Petition for RemovalPQME panelsdue processfair hearingadministrative law judgeDeclaration of Readinessreplacement paneldepositionprejudiceconstitutional guaranty
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. ADJ9705507
Regular
Jun 12, 2017

MICHAEL SANTINI vs. SCHNEIDER ELECTRIC, ACE AMERICAN INSURANCE COMPANY, ESIS, INC.

The Appeals Board dismissed the applicant's Petition for Reconsideration as the order for a replacement QME panel was not a final decision. However, the Board granted removal, rescinded the WCJ's Minute Order, and returned the matter to the trial level. This action was taken because the WCJ's order lacked an accompanying opinion and did not refer to supporting evidence, hindering meaningful review. Furthermore, the parties had not stipulated to submit the replacement panel issue at the conference where the order was issued.

Petition for ReconsiderationPetition for RemovalPanel Qualified Medical EvaluatorPQMEReplacement PanelMinute OrderOpinion on DecisionDevelop the RecordAdjudication FileEAMS
References
Case No. ADJ6754074
Regular
Dec 14, 2010

BARBARA JACOME vs. DURHAM SCHOOL SERVICES, OLD REPUBLIC, SEDGWICK CMS

This case involves an applicant's petition for removal challenging a WCJ's order granting the defendant's request for a replacement Qualified Medical Evaluator (QME). The applicant argued the defendant's objection to the QME's report timeliness was conditional and not properly served, thereby waiving their right to a replacement. The Appeals Board granted removal, finding the defendant's objection, made after receiving the report, was insufficient and void. Therefore, the defendant was not entitled to a replacement panel, and the QME's report was deemed admissible.

Petition for RemovalQualified Medical EvaluatorReplacement PanelTimeliness ObjectionConditional ObjectionLabor Code SectionsCalifornia Code of RegulationsMedical DirectorAdministrative DirectorComprehensive Medical-Legal Evaluation
References
Case No. ADJ1211801
Regular
Apr 13, 2012

GUISELA REYNOSO vs. UNIVERSAL PROTECTION SERVICES, AMERICAN CASUALTY COMPANY OF READING, PENNSYLVANIA, CNA CLAIMPLUS

The Workers' Compensation Appeals Board dismissed the defendant's Petition for Reconsideration because the WCJ's decision denying a replacement QME was an intermediate procedural order, not a final determination of substantive rights. The defendant sought a new panel after the QME allegedly violated a regulation by evaluating the applicant at an unlisted address and missed a deposition. The Board found the defendant's objection to the evaluation was untimely and that the request for a new panel appeared to be an attempt to "doctor shop" after receiving unfavorable reports. Even if considered for removal, the petition would be denied due to the unreasonable delay in raising objections.

Workers' Compensation Appeals BoardQualified Medical EvaluatorQME panelindustrial injuryspider bitesecurity guardreplacement paneldepositiondiscovery ordersfinal order
References
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