Authorities as the decision cited them, with how this panel applied each one.
California Labor Code
Labor Code sections 4062.3(j), 4064(a), 5401 regarding claim forms and QME evaluations.
Determines when a QME must address all injuries reported on claim forms filed before the evaluation date.
From the decision · page 5III.
Turning now to the merits of the Petition, pursuant to Navarro, the "Labor Code does not
require an employee to return to the same panel QME for an evaluation of a subsequent claim of
injury." (Navarro, supra, 79 Cal. Comp. Cases at p. 420.) However, sections 4062.3(j) and 4064(a)
taken together state that a medical evaluation shall address "all medical issues arising from all
injuries reported on one or more claim forms." Section 5401 outlines the requirements pertaining
to workers' compensation claim forms, and pursuant to this section, an employer must provide a
claim form, and the injured worker must file the claim form with the employer. (Id.) Further, "a
claim form is deemed filed when it is personally delivered to the employer or received by the
employer by first-class or certified mail.
California Code of Regulations, title 8
WCAB Rules 10803(a) and 10945(c) regarding evidentiary record and attachment of documents to petitions.
Documents not admitted into evidence are not part of the record; improper attachments may lead to dismissal or sanctions.
From the decision · page 5A dated copy of the completed form shall [then] be
provided by the employer to the employer's insurer and to the employee, dependent, or agent who
filed the claim form." (Id.)
In keeping with the requirements set forth in sections 4062.3(j) and 4064(a), Navarro
clarifies that at the time of an evaluation, the evaluator shall consider all issues arising out of any
claims reported before the evaluation, and if several subsequent claims of injury are filed before
the evaluation takes place, the evaluator shall also consider those claims. (Navarro, supra, 79 Cal.
Comp. Cases at p. 425, emphasis added.)
Under Navarro, the date the claim form is filed is the operative act in determining the right
to request a new QME panel. If a claim form for an additional injury is filed before the evaluation
with the panel QME, then that QME shall remain as the QME for all injuries with submitted claim
forms. However, if a claim form for the additional injury is filed after the QME evaluation, the
parties may request an additional QME panel.
Defendant apparently attached the claim forms to its Petition and its July 11, 2024 Points
and Authorities. Attachment of the documents, however, does not equate to entry of said
documents into the evidentiary record.
WCAB Rule 10803(a) states that:
(a) The Workers' Compensation Appeals Board's adjudication file shall consist of:
Appeals Board en banc
Navarro v. City of Montebello (2014) 79 Cal.Comp.Cases 418 (Appeals Board en banc) on QME panel assignment for multiple claims.
If multiple claim forms are filed before a QME evaluation, the same QME must address all injuries; if filed after, separate panels may be requested.
From the decision · page 1Defendant contends that pursuant to Navarro v. City of Montebello (2014) 79
Cal.Comp.Cases 418 (Appeals Board en banc), when claim forms for multiple injuries are filed
before a QME exam takes place, those claims should be addressed by the same QME. Defendant
argues that both the specific and the cumulative injury claims were filed before the QME exam.
As such, applicant has no right to a separate QME panel for the cumulative injury.