What the panel ordered
The WCAB granted the Petition for Reconsideration, rescinded the April 9, 2024 Findings and Order, substituted new findings that applicant is entitled to a QME panel in internal medicine for case ADJ14300773, and returned the matter to the district office for further proceedings.
Applicant sought reconsideration of the WCJ's April 9, 2024 Findings and Order denying his request for a supplemental panel Qualified Medical Evaluator (QME) in internal medicine for cases ADJ14300773 and ADJ16390001.
What was disputed, and how it came out
Each issue the panel decided, with the reasoning it gave. An outcome is what this panel did on this record — not a rule, and not a prediction.
The WCAB found good cause for issuance of an additional QME panel in internal medicine because applicant claimed injury to internal systems during the continuous trauma period and existing medical evidence supported the need for causation opinion in that specialty. The WCJ's denial based on timeliness and procedural grounds was found erroneous and rescinded.
From the decision · page 8*** (c) Form 31.7 shall be used to request an additional QME panel in a different specialty. The Appeals Board has the discretionary authority to develop the record when the medical record is not substantial evidence or when appropriate to provide due process or fully adjudicate the issues. We note that here, applicant has testified that he claims injury to body parts outside the field of orthopedic medicine, and existing medical records indicate that applicant has sought treatment for these conditions during the period of industrial exposure. Thus good cause exists for the issuance of an additional panel as requested. This issue has now occupied two trials in six months, and further delay on this issue by the parties would not ensure an expeditious resolution of this matter. Consequently, an additional QME panel will be required to fully address the claimed continuous trauma injury in the field of internal medicine. Accordingly, we grant applicant's Petition for Reconsideration, rescind the April 9, 2024 Findings and Order, and substitute new findings that applicant is entitled to a QME in internal medicine and all other issues are deferred.
The facts that decided it
What the panel treated as outcome-determinative, and which side it favoured.
WCJ's denial was based on mistaken assumption of untimeliness and procedural grounds which were not supported by the record.
Favours Applicant prevailed
Led to rescission of the denial and granting of the additional QME panel.
From the decision · page 7To the extent that the WCJ seems to have based his findings upon a mistaken assumption as to the timeliness of applicant's objection, we further find the record does not support the existing decision.
Applicant claimed injury to internal systems including diabetes and cardiovascular conditions during continuous trauma period from 2003 to 2020.
Favours Applicant prevailed
Supported the need for an additional QME panel in internal medicine to address causation of these internal injuries.
From the decision · page 2Applicant, while employed by defendant during the period January 1, 2003 to August 6, 2020, sustained injury arising out of and in the course of employment (AOE/COE) to his left shoulder, and claims to have sustained injury to his right shoulder, neck, back, hips, knees, legs, wrists, arms, hernia, diabetes, and cardiovascular system. That case was assigned case number ADJ14300773.
Existing medical evidence and testimony showed applicant received treatment for diabetes and cardiovascular issues during the industrial exposure period.
Favours Applicant prevailed
Indicated good cause for issuance of additional QME panel in internal medicine.
From the decision · page 3Applicant claims industrial injury as a result of a continuous trauma during the period January 1, 2003 through August 6, 2020, including injury in the form of diabetes and cardiovascular injury in ADJ14300773. Applicant testified in his deposition that he had been diagnosed and started receiving treatment for same "approximately five years ago". (Ex. M, Volume I of the deposition
What the panel did with the medical opinions
The role the physician served, and the weight the opinion carried. Physicians are named here as the decision names them; we do not score them.
Reviewed medical records and reporting by Dr. Manoj Khatore regarding applicant's cardiovascular symptoms related to work.
Supports the need for additional QME panel in internal medicine due to cardiovascular complaints during industrial exposure period.
From the decision · page 4Further, the orthopedic QME, Andrew Bulczynski, M.D., in his report dated November 21, 2023, reviewed medical records and reporting by Manoj Khatore, M.D., who evaluated applicant on February 10, 2020 for a second opinion on his cardiovascular issues. In his report, Dr. Khatore documented applicant's symptoms relating to his work and lightheadedness when bending forward and standing up. (Ex. O, Report of PQME Bulczynski, November 21, 2023, p. 6).
The rules the panel named
Authorities as the decision cited them, with how this panel applied each one.
California Labor Code
Labor Code section 4062(a) and 4062.2 regarding additional QME panels
Governs the process and requirements for obtaining additional QME panels in represented cases.
From the decision · page 1Applicant contends that the Order denying this request was in error as it was based upon an incorrect assumption that applicant's objection letter invoking the panel process per Labor Code1 section 4062(a) was untimely.
Cal. Code Regs., tit. 8, 10517
California Code of Regulations, title 8, section 10517 regarding amendment of pleadings
Allows pleadings to be amended to conform to proof and stipulations to facilitate adjudication on merits.
From the decision · page 6Similarly, Rule 10517 specifies that pleadings are deemed amended to conform to the stipulations agreed to by the parties on the record or may be amended by the Appeals Board to conform to proof. (Cal. Code Regs., tit. 8, § 10517.) These rules represent the application of California's public policy in favor of adjudication of claims on their merits, rather than on the technical sufficiency of the pleadings. Additionally, we observe, "the Board's procedural rules serve the convenience of the tribunal and the [litigants] and facilitate the proceedings. They do not deprive the tribunal of the power to dispense with compliance when the purposes of justice require it, particularly when the violation is formal and does not substantially prejudice the other party." (Beaida v. Workmen's Comp. App. Bd., supra, 263 Cal.App.2d at p. 210; Blanchard, supra, 53 Cal.App.3d at p. 595.)
Administrative Director Rule 31.7(b) and (c) regarding issuance of additional QME panels
Provides criteria and procedure for issuance of additional QME panels in different specialties upon showing of good cause.
From the decision · page 7Administrative Director (AD) Rule 31.7(b) and (c) provide for an additional QME panel in another specialty as follows in relevant part:
What proof carried it
The evidence the panel weighed, by kind.
Applicant's testimony and medical records indicating treatment for diabetes and cardiovascular conditions during the continuous trauma period
From the decision · page 3Applicant claims industrial injury as a result of a continuous trauma during the period January 1, 2003 through August 6, 2020, including injury in the form of diabetes and cardiovascular injury in ADJ14300773. Applicant testified in his deposition that he had been diagnosed and started receiving treatment for same "approximately five years ago". (Ex. M, Volume I of the deposition
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About this page
- A published decision of the California Workers' Compensation Appeals Board, taken apart by what it turned on. The Board publishes the decision itself; this page adds the extraction and quotes the passage behind every claim.
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