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.
QMERejected · orthopedics
Found injury AOE/COE to cervical spine, left shoulder, and left wrist; apportioned cervical spine and left wrist/grip between injury and cumulative trauma; non-industrial apportionment invalid; reports do not constitute substantial evidence due to inadequate examination and AMA Guides non-compliance (rejected by WCJ).
Reports do not review all diagnostic testing, do not conduct adequate examination, and do not comply with AMA Guides, thus not substantial evidence.
From the decision · page 7A. That the five Orthopedic Panel Qualified Medical Evaluator reports of Clive Segil, M.D. do not
constitute substantial evidence because the doctor does not review all diagnostic testing, does not
conduct an adequate medical examination, does not comply with the AMA Guides, and does not
sufficiently explain both the assigned whole person impairment and apportionment conclusions;
QMERelied upon · internal medicine
Found injury AOE/COE to cervical spine, lumbar spine, left wrist, gastrointestinal system, hypertension, and allergic rhinitis; diabetes and hearing loss not industrial; apportionment to hypertension, GI, and allergic rhinitis with 20% industrial and 80% non-industrial for hypertension; reports found substantial evidence.
Reports sufficiently explain apportionment and review extensive medical records, constituting substantial evidence.
From the decision · page 1Applicant contends that the reports from orthopedic qualified medical examiner (QME)
Clive M Segil, M.D., and from internal medicine QME Anthony G. Rodas, M.D., are not
substantial evidence; that the reports from treating physicians Arthur Harris, M.D., and Harout
Balian, M.D., are substantial evidence; and that the record should be further developed with respect
to treating physician Gary Zagelbaum, M.D.
PTPRejected · orthopedics
Reports do not review all medical records and provide lower WPI ratings than PQME; reports found not substantial evidence.
Did not review all medical records and provided lower WPI than PQME, thus not substantial evidence.
From the decision · page 17The petitioner's prayer for relief is for the court to rule on Dr. Harris' and Dr. Balian's conclusions.
If that were to happen, the petitioner's lumbar spine disability would actually be less than the
PQME she seeks to void. Dr. Harris does not review either MRI, and he does not provide for any
lumbar spine WPI or even injury AOE/COE to the petitioner's lumbar spine. His report justifies a
finding of non-industrial injury. As to Dr. Balian's reporting, only that dated July 26, 2017 reviews
any medical records at all (which total a mere four reports). One of them is indeed the MRI of
April 26, 2017. But Dr. Balian, assigns an even lower WPI at 7%. He bases his opinion on his
clinical history and examination as well as the MRI. That said, he still reviews none of the other
medical reports that the PQME did. Dr. Balian fails to constitute substantial evidence, but even
assuming it did, again, it is a lower WPI than the PQME provided.
PTPRejected · physical medicine and rehabilitation
Reports reviewed limited medical records and provided lower WPI ratings than PQME; reports found not substantial evidence.
Reviewed limited records and provided lower WPI than PQME, thus not substantial evidence.
From the decision · page 17The petitioner's prayer for relief is for the court to rule on Dr. Harris' and Dr. Balian's conclusions.
If that were to happen, the petitioner's lumbar spine disability would actually be less than the
PQME she seeks to void. Dr. Harris does not review either MRI, and he does not provide for any
lumbar spine WPI or even injury AOE/COE to the petitioner's lumbar spine. His report justifies a
finding of non-industrial injury. As to Dr. Balian's reporting, only that dated July 26, 2017 reviews
any medical records at all (which total a mere four reports). One of them is indeed the MRI of
April 26, 2017. But Dr. Balian, assigns an even lower WPI at 7%. He bases his opinion on his
clinical history and examination as well as the MRI. That said, he still reviews none of the other
medical reports that the PQME did. Dr. Balian fails to constitute substantial evidence, but even
assuming it did, again, it is a lower WPI than the PQME provided.
PTPRejected · internal medicine
Record development requested but denied; reports not substantial evidence due to lack of review of extensive medical records.
Did not review extensive medical records; record development not justified after seven years of discovery.
From the decision · page 25The petitioner attempts to argue a variety of deficiencies with the PQMEs and argues in favor of a
finding on the treating physicians for her orthopedic disability and then a finding to develop the
record for her internal medicine diabetic condition. There is no justification for either. Discovery
lasted for seven years. An MSC held as a result of her own DOR was taken off calendar for further
discovery. The petitioner had years and years to request supplemental reports or cross-examine
any of the physicians, including the PQMEs. A host of issues are more like queries and
hypotheticals that could have been and should have been handled during the preceding seven years.
Any disagreements with the PQME's conclusions could have been addressed then not on appeal.
PQME Dr. Clive Segil and Dr. Anthony Rodas are the only physicians who produce opinions and
reports that constitute substantial evidence. There cannot be reliance on the others, and there need
not be any further development of the record.