What the panel ordered
Petition for removal granted; February 19, 2025 Findings of Fact and Orders rescinded; new Finding and Order that an additional panel in internal medicine is warranted substituted; matter returned to trial level for further proceedings.
Petition for removal from Findings of Fact and Orders issued on February 19, 2025, by the WCJ, which denied applicant's request for an additional QME in internal medicine.
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.
Applicant showed good cause for an additional QME panel in internal medicine because the current QME stated the claim of injury (diabetes) is outside their expertise, constituting substantial prejudice and irreparable harm if removal was not granted.
From the decision · page 1Applicant has filed a petition for removal from the Findings of Fact and Orders (F&O) issued on February 19, 2025, by the workers' compensation administrative law judge (WCJ), which denied applicant's request for an additional qualified medical evaluator (QME) in internal medicine.
The facts that decided it
What the panel treated as outcome-determinative, and which side it favoured.
Current QME stated applicant's claim of injury (diabetes) is outside QME's expertise.
Favours Applicant prevailed
This established good cause for an additional QME panel in internal medicine, justifying removal.
From the decision · page 1Applicant contends that an additional QME is warranted because the current QME has already stated that applicant's claim of injury in the form of diabetes is outside the QME's area of expertise.
The rules the panel named
Authorities as the decision cited them, with how this panel applied each one.
Cal. Code Regs., tit. 8, 10955(a)
Removal is granted only if petitioner shows substantial prejudice or irreparable harm if removal is not granted, and reconsideration is not an adequate remedy.
Applied to determine if removal was proper due to legal error precluding discovery and irreparable harm.
From the decision · page 1Removal is an extraordinary remedy rarely exercised by the Appeals Board. (Cortez v. Workers' Comp. Appeals Bd. (2006) 136 Cal.App.4th 596, 599, fn. 5 [71 Cal.Comp.Cases 155]; Kleemann v. Workers' Comp. Appeals Bd. (2005) 127 Cal.App.4th 274, 280, fn. 2 [70
Lab. Code, 4062; Cal. Code Regs., tit. 8, 9785(d), 9785(e)(3), 9785(e)(4), 31.7(b)
Primary treating physician should render opinions on all medical issues necessary to determine eligibility for compensation; secondary physicians report to primary physician; parties may object and seek additional panel if needed.
Described the ordinary procedure for obtaining an additional panel in accepted claims and the alternative procedure in denied claims.
From the decision · page 2Where defendant has accepted liability for an injury, the compensability of an additional body part is ordinarily a medical determination to be made by the primary treating physician pursuant to section 4062. (See Lab. Code, § 4060(a), 4062.) In cases where applicant is being provided treatment, the ordinary procedure is to first obtain the opinion of the primary treating physician who "shall render opinions on all medical issues necessary to determine the employee's eligibility for compensation[.]" (Cal. Code Regs., tit. 8, § 9785(d).) In cases where the additional body part is outside the expertise of the primary physician, the primary physician should refer applicant to a secondary physician who "shall report to the primary physician in the manner required by the primary physician." (Id. at § 9785(e)(3).) Then, the primary physician "shall be responsible for obtaining all of the reports of the secondary physicians and...
What proof carried it
The evidence the panel weighed, by kind.
Current QME stated applicant's claim of injury (diabetes) is outside QME's expertise, supporting good cause for additional panel.
From the decision · page 1Applicant contends that an additional QME is warranted because the current QME has already stated that applicant's claim of injury in the form of diabetes is outside the QME's area of expertise.
The same issues, filtered across the whole corpus — or paste your own facts and let the search rank by factor match.
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.
- The injured worker is not named here, and the case caption is not printed. Physicians appear as the decision names them, because a medical opinion is an act in a public proceeding.
- Issues, outcomes and weights were extracted by AI and released only where the source passage checked. Read the official decision before relying on anything here. Not legal advice.
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