ADJ14300773 — California WCAB decision

ADJ14300773 · June 24, 2024

The WCAB granted the Petition for Reconsideration, rescinded the April 9, 2024 Findings and Order, substituted new findings that applicant is entitled to a QME panel in internal medicine for case ADJ14300773, and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.

Issues decided

Medical opinions weighed

Authorities named

District office

Oxnard

What the panel ordered

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.

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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.

QME/AME processApplicant prevailedinternal medicine

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 The WCJ's denial based on timeliness and procedural grounds was found erroneous and rescinded.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 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:

ADJ14300773 · June 24, 2024

What the panel ordered

What was disputed, and how it came out

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The facts that decided it

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