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

Case No. ADJ8363948
Regular
Oct 19, 2012

NICOLE NELSON vs. COUNTY OF SOLANO, INTERCARE HOLDINGS INSURANCE SERVICES

The defendant County of Solano sought removal to obtain a new panel of Qualified Medical Evaluators (QMEs) due to alleged ex parte communications between the applicant and the current QME. The Appeals Board denied this petition, finding that the communications were either insignificant and inconsequential or related to the QME examination itself. Specifically, emails concerning necessary forms and an insignificant mention of a claims adjuster's number did not violate the ex parte communication prohibition. Therefore, the WCJ's denial of the defendant's request for a new QME panel was upheld.

Petition for RemovalQualified Medical Evaluator (QME)ex parte communicationLabor Code section 4062.3termination of evaluationreplacement panelinsignificant communicationinconsequential communicationindustrial injurypsyche
References
Case No. ADJ6873149
Regular
May 29, 2012

MIRIAN AVILA vs. CANADIAN AMERICAN OIL COMPANY, PACIFIC COMPENSATION INSURANCE COMPANY

This case concerns whether a Qualified Medical Evaluator (QME) improperly interviewed non-party witnesses without the defendant's knowledge or consent, violating Labor Code section 4062.3 and AD Rule 35. The Appeals Board rescinded its order granting reconsideration, affirming the Workers' Compensation Judge's (WCJ) decision that these collateral interviews did not constitute prohibited ex parte communication. The majority held that the statute applies to communications between parties or their representatives and the QME, not to a QME's discussions with non-parties. Conversely, the dissenting commissioner argued that such interviews were impermissible under the spirit and letter of the law, constituting a denial of due process and advocating for the QME's report to be stricken.

PQMEnonparty witnessesex parte communicationLabor Code section 4062.3AD Rule 35oral interviewspetition to strikenew panelsubstantial evidencedue process
References
Case No. ADJ3540065
En Banc
Jan 23, 2017

BRADLEY MAXHAM vs. CALIFORNIA DEPARTMENT OF CORRECTIONS AND REHABILITATION, STATE COMPENSATION INSURANCE FUND

The Appeals Board clarifies the distinction between "information" and "communication" under Labor Code § 4062.3, holding that a communication to a medical evaluator becomes "information" if it contains, references, or encloses medical or nonmedical records relevant to the medical issue, which requires prior agreement between the parties.

Workers' Compensation Appeals BoardPetition for RemovalAgreed Medical Evaluator (AME)Labor Code section 4062.3WCAB Rule 35informationcommunicationprejudiceirreparable harmex parte communication
References
Case No. ADJ3133261 (VNO 0400017)
Regular
Aug 17, 2010

FELIPE TOLENTINO vs. CONCO CEMENT, CALIFORNIA INSURANCE GUARANTEE ASSOCIATION, XCHANGING INC., FREMONT COMPENSATION

The Workers' Compensation Appeals Board (WCAB) dismissed the lien claimant's petition for reconsideration as premature. The WCAB granted the defendant's petition for reconsideration regarding the temporary disability overpayment issue, deferring it for further proceedings. The Board affirmed the WCJ's findings on injury causation and permanent disability but amended the decision to clarify the overpayment issue. Finally, the WCAB issued a notice of intention to sanction defendant's counsel for attaching and citing unadmitted evidence.

Workers' Compensation Appeals BoardFELIPE TOLENTINOCONCO CEMENTCALIFORNIA INSURANCE GUARANTEE ASSOCIATIONXCHANGING INC.FREMONT COMPENSATIONliquidationADJ3133261VNO 0400017OPINION AND ORDERS DISMISSING PETITION FOR RECONSIDERATION AND GRANTING PETITION FOR RECONSIDERATION
References
Case No. ADJ4158530 (LBO 0325085) ADJ332706 (LBO 0325079)
Regular
Jul 23, 2013

VICTORIA ANTUNEZ vs. SEASIDE PRINTING CO., CALIFORNIA CASUALTY, GALLAGHER BASSETT SERVICES, PACIFIC NATIONAL INSURANCE, CIGA, INTERCARE INSURANCE SERVICES

The Board granted reconsideration regarding a defendant's petition challenging findings of industrial injury and the nature of a communication with an Agreed Medical Evaluator (AME). The Board affirmed findings of compensable injury for one period and no injury for another, but amended the awards to clarify that a letter from CIGA to the AME was improper, though not an ex parte communication. The Board found the letter constituted additional information improperly sent without affording the other party an objection opportunity, leading to exclusion of a supplemental report. Jurisdiction was reserved over costs and sanctions related to this improper communication.

Workers' Compensation Appeals BoardReconsiderationFindings and AwardIndustrial InjuryTemporary DisabilityPermanent DisabilityApportionmentAgreed Medical Evaluator (AME)Ex Parte CommunicationLabor Code Section 5412
References
Case No. ADJ3636557
Regular
May 08, 2009

MARIA ANA PAREDES (Deceased) CARLOS ALFREDO ALVAREZ (Widower) vs. ANDROMEDA ENTERTAINMENT dba GALAXY BALLROOM, STATE COMPENSATION INSURANCE FUND

This case concerns a petition for reconsideration and removal challenging a Workers' Compensation Judge's (WCJ) decision denying sanctions for alleged improper ex parte communication. The Board denied reconsideration and dismissed removal, affirming the WCJ's finding that the communication between defense counsel and the panel QME was administrative, not substantive, and therefore not a violation of Labor Code section 4062.3. The Board found no basis for sanctions under Labor Code section 5813 as no party initiated an improper ex parte communication. Consequently, the WCJ's denial of the motion to strike the QME report and request for penalties was upheld.

Workers' Compensation Appeals BoardPetition for ReconsiderationPetition for RemovalEx Parte CommunicationQualified Medical Evaluator (QME)Labor Code Section 4062.3SanctionsLabor Code Section 5813Panel QME ReportAdministrative Communication
References
Case No. ADJ2001631 (LAO 0876091)
Regular
Oct 01, 2010

SALVADOR AGUAYO, JR. vs. AMERICAN GOLF CORPORATION, ARCH INSURANCE COMPANY

The Workers' Compensation Appeals Board granted reconsideration to address an attorney's fee award of $4,500.00. This fee was awarded for services related to alleged prohibited ex parte communications with Qualified Medical Evaluators (QMEs), as per Labor Code section 4062.3. The Board rescinded the award, finding no explicit determination of prohibited communication occurred as the prior WCJ's orders were voided. The matter was returned to the trial level to first determine if prohibited ex parte communication occurred, and if so, to award fees based on incurred costs and attorney fees for related discovery.

Salvador Aguayo Jr.American Golf CorporationArch Insurance CompanyWorkers' Compensation Appeals BoardreconsiderationFindings and Awardattorney's feeprohibited communicationsQualified Medical EvaluatorsQME
References
Case No. ADJ10038732
Regular
Dec 02, 2016

Deborah Matthews vs. California Department of Corrections and Rehabilitation, State Compensation Insurance Fund

This case involves a defendant's petition for removal after an administrative law judge (WCJ) ordered a new Qualified Medical Examiner (QME) panel. The WCJ found the defendant violated Labor Code section 4062.3 by engaging in ex parte communication with the prior QME. The defendant admitted a violation of Labor Code section 4062.3 but argued a new panel was unwarranted due to applicant forfeiture or the communication's insignificance. The Workers' Compensation Appeals Board (WCAB) denied the petition, finding no waiver by the applicant and that the communication was not insignificant. The WCAB emphasized that prejudice is not required to obtain a new panel for such violations.

Labor Code 4062.3Ex parte communicationPQME panelPetition for RemovalAggrieved partyWaiverDoctor shoppingFindings of Fact and OpinionWCJAppeals Board
References
Case No. ADJ795505 (LAO 0794863)
Regular
Feb 13, 2014

VICTORIA SHANLEY vs. HENRY MAYO NEWHALL MEMORIAL HOSPITAL, TRAVELERS INSURANCE CO.

The Appeals Board reconsidered a WCJ's decision upholding utilization review (UR) denials for an MRI and EMG. While other contentions regarding the UR physician's qualifications and licensing were dismissed based on precedent, the Board found the UR decisions invalid due to untimely communication. Specifically, the defendant failed to prove by substantial evidence that the UR decisions were communicated by phone, fax, or email within 24 hours of being made. The matter is returned to the trial level to determine medical necessity, as the UR denials are void.

Utilization ReviewLabor Code Section 4610Administrative Director Rule 9792.9Physician QualificationLicensing RequirementsCommunication TimeframesTimely CommunicationMedical NecessityIndependent Medical ReviewInvalid UR Decision
References
Case No. ADJ7652327; ADJ7686431
Regular
Mar 21, 2012

DEBORAH HELMS vs. CAPISTRANO UNIFIED SCHOOL DISTRICT, CORVEL CORPORATION

In this case, the defendant school district sought removal of an order allowing the applicant to obtain a new Qualified Medical Evaluator (QME) due to a new alleged cumulative trauma injury. The Appeals Board denied the petition, adopting the WCJ's reasoning that a new panel was appropriate. The Board also clarified that the defendant's communication to a QME was a subsequent, not ex parte, communication.

Petition for RemovalOrder Off CalendarPanel PhysicianQualified Medical Evaluators (QMEs)Cumulative Trauma InjuryMedical EvaluationSubsequent CommunicationEx Parte CommunicationLabor Code section 4062.3(e)Labor Code section 4062.3(f)
References
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