ADJ10598940 — California WCAB decision

What the panel ordered

Petition for Reconsideration denied.

Petition for Reconsideration filed by defendant Starr Indemnity & Liability Company, administered by Gallagher Bassett, seeking review of the January 6, 2026 WCJ Joint Findings of Fact and Order excluding QME Dr. Graham's reports.

Read the official decision →

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.

Jurisdiction / venueDefendant prevailedlow back

The WCAB lacked jurisdiction to issue QME Panel 7404253 on 4/9/21 because the underlying case ADJ16413854 did not exist at that time, and no petition for new and further disability was filed in ADJ10598940. Therefore, the panel was invalid and Dr. Graham's reports were excluded.

From the decision · page 12III DISCUSSION I. The WCAB had no jurisdiction and therefore the Medical Unit had no jurisdiction for Gallagher Bassett to request panel # 7404253 on 4/9/21. The board has no jurisdiction over any aspect of a workers' compensation claim until an application for adjudication has been filed. This rule has been codified in Regulation 10450(b). The Medical Unit, which issues QME panels, operates under the authority of the WCAB. Since the WCAB has no jurisdiction until an application is filed, the Medical Unit cannot issue a QME panel without an underlying case that gives the WCAB jurisdiction. In this case, as of 4/9/21 ADJ16413854 did not exist. There was no petition for new and further disability filed in ADJ10598940. No jurisdiction had been established on 4/9/21 to request panel # 7404253. (Labor Code Section 5500, nor Regulation 10450(b).) Therefore, panel # 7404253 is an invalid panel. a. There is no legal basis to argue Panel #7404253 dated 4/9/21 was requested to enforce a stipulated medical award. Future medical awards are enforced pursuant to LC § 4610. Treating physicians submit requests for authorization (RFAs) for medical treatment. The RFAs are then subject to utilization review (UR). b.

The facts that decided it

What the panel treated as outcome-determinative, and which side it favoured.

QME Panel 7404253 was issued on April 9, 2021, before the filing of the application for adjudication in ADJ16413854 on July 12, 2022.

Favours Defendant prevailed

The WCAB had no jurisdiction to issue the QME panel before the case existed, rendering the panel invalid and the QME reports inadmissible.

From the decision · page 11c. Panel # 7404253 is dated 4/9/21. d. No Petition for New and Further Disability was filed in ADJ10598940 at the time

Applicant and petitioner waived the right to a QME in the Amended Stipulations and addendum executed by both parties.

Favours Defendant prevailed

This waiver supports the finality of the stipulated award and bars reopening or modification via QME.

From the decision · page 2In Case Number ADJ10598940, applicant and petitioner, defendant Snyder Industries, obtained an Award on Amended Stipulations with Request for Award, issued on October 26, 2016. In the Amended Stipulations, petitioner and applicant stipulated that applicant sustained 11 percent permanent disability of the low back for a specific industrial injury of January 27, 2015 while employed by Snyder Industries, insured by Starr Indemnity & Liability Company, administered by Gallagher Bassett. Per the stipulation, applicant was awarded further medical treatment to cure or relieve the effects of the industrial injury. Applicant expressly agreed to waive the right to a QME in both paragraph 9 of the Amended Stipulations and in an attached addendum. Both the Amended Stipulations and the addendum waiving a QME were executed by both applicant and Alina Mazurenko of Gallagher Bassett on behalf of petitioner.

No petition to reopen the Award was filed within five years of the date of injury, making the stipulated award final under Labor Code section 5804.

Favours Defendant prevailed

The finality of the award bars modification or rescission after five years, limiting the WCAB's jurisdiction.

From the decision · page 2Neither applicant nor petitioner filed a petition to reopen the Award within five years of the date of injury, which was confirmed by email between the parties. (Exhibit 10.) More than six years after the date of injury, petitioner obtained QME panel number 7404253 by objecting to a PR-2 report of treating physician Dr. Doobay dated February 1, 2021. Petitioner's objection letter, dated March 9, 2021, objected to "disability status, need for further treatment and permanent disability." ( Exhibit I-1, March 9, 2021, p. 1.)

CorVel's due process rights were violated as it had no opportunity to participate in the QME selection process for Panel 7404253.

Favours Defendant prevailed

Due process violation justified exclusion of QME Dr. Graham's reports from both cases.

From the decision · page 12Petitioner's compensable consequence argument is irrelevant because no board jurisdiction had been established as of 4/9/21 when Panel #7404253 was requested. Please see facts c, d and e in the Facts Section of this Pleading. Section I of this pleading is also incorporated by reference into this section of this Report and Recommendation. c. Regulation 30(b) is irrelevant to this case. Please see facts c, d and e. in the Facts Section of this Pleading. Section I of this pleading is also incorporated by reference into this section of this Report and Recommendation. d. Corvel is Prejudiced by Panel #7404253 because Corvel's Due Process Rights were violated No evidence was presented at trial to prove Applicant Attorney or Corvel waived the jurisdiction defect of Panel #7404253. Applicant Attorney may have objected to the panel but did participate in the strike process, Corvel did not. Corvel's Due Process rights were violated when Gallagher Bassett obtained Panel # 7404253 without Board jurisdiction. This Due Process

The rules the panel named

Authorities as the decision cited them, with how this panel applied each one.

Labor Code section 5804

Labor Code section 5804 prohibits rescinding, altering, or amending an award more than five years from the date of injury except upon timely petition.

The stipulated award was final as no timely petition to reopen was filed within five years, barring modification via QME.

From the decision · page 5California Labor Code Section 5804 states, in relevant part: No award of compensation shall be rescinded, altered, or amended after five years from the date of the injury except upon a petition by a party in interest filed within such five years and any counterpetition seeking other relief filed by the adverse party within 30 days of the original petition raising issues in addition to those raised by such original petition...

Labor Code section 4610

Labor Code section 4610 establishes utilization review (UR) as the exclusive means to resolve disputes over specific medical treatment requests.

Disputes over specific treatment requests must be resolved by UR, not by QME reports, limiting WCAB jurisdiction.

From the decision · page 5Defendant's argument is correct regarding the WCAB's ability to enforce an award, but it is outdated in its assumption that a QME controls the scope of medical treatment on an award that can no longer be rescinded, altered, or amended. Although it is true that the WCAB can issue orders enforcing the right to medical treatment more than five years after the date of injury without rescinding, altering, or amending the award in violation of section 5804, the resolution of any dispute over what medical treatment is appropriate is currently decided by utilization review (UR) pursuant to section 4610, and not by WCJs using the opinions of QMEs.

Labor Code section 4061

Labor Code section 4061 prohibits using the AME/QME process to dispute a utilization review decision under section 4610.

QME Panel 7404253 could not be used to dispute UR decisions, limiting its validity and WCAB jurisdiction.

From the decision · page 7the "medical necessity" of the proposed treatment. (§ 4610.5(c)(2), (c)(3), (k), 4610.6(a), (c), (e).) (Dubon v. World Restoration (2014) 79 Cal.Comp.Cases 1298, 1304-1305 (Appeals Board en banc) (Dubon II).) In Dubon II, the Appeals Board held that while the WCAB may determine whether a UR decision was timely, it may not determine any dispute over whether a specific item of treatment is reasonable or necessary if there is a timely UR decision. (Dubon II, supra, 79 Cal.Comp.Cases 1298, 1309 ff.) Furthermore, section 4061, the Labor Code section pursuant to which petitioner requested QME Panel number 7404253, "shall not apply to the employee's dispute of a utilization review decision under Section 4610, nor to the employee's dispute of the medical provider network treating physician's diagnosis or treatment recommendations under Sections 4616.3 and 4616.4." (Lab.

Labor Code section 4064

Labor Code section 4064 directs QMEs not to address medical treatment recommendations subject to utilization review or independent medical review.

QME Dr. Graham's reports were excluded as QMEs are statutorily barred from addressing treatment disputes subject to UR and IMR.

From the decision · page 7Code, § 4061.) Moreover, under section 4064, a QME is statutorily directed not to address "medical treatment recommendations, which are subject to utilization review as provided by Section 4610, and objections to utilization review determinations, which are subject to independent medical review as provided by Section 4610.5." (Lab. Code, § 4064(a).) We note that petitioner does not appear to be addressing a specific medical treatment issue, but rather the entirety of treatment under the stipulated award. This is not permitted under section 5804.

Labor Code section 5909

Labor Code section 5909 requires the Appeals Board to act on petitions for reconsideration within 60 days of case transmission.

The Board timely acted on the petition for reconsideration within the 60-day period.

From the decision · page 3I Former Labor Code section 59091 provided that a petition for reconsideration was deemed denied unless the Appeals Board acted on the petition within 60 days from the date of filing. (Lab. Code, § 5909.) Effective July 2, 2024, section 5909 was amended to state in relevant part that: (a) A petition for reconsideration is deemed to have been denied by the appeals board unless it is acted upon within 60 days from the date a trial judge transmits a case to the appeals board.

Regulation 10450(b)

Regulation 10450(b) states the WCAB has no jurisdiction until an application for adjudication is filed.

The Medical Unit cannot issue a QME panel without an underlying case that gives the WCAB jurisdiction.

From the decision · page 12III DISCUSSION I. The WCAB had no jurisdiction and therefore the Medical Unit had no jurisdiction for Gallagher Bassett to request panel # 7404253 on 4/9/21. The board has no jurisdiction over any aspect of a workers' compensation claim until an application for adjudication has been filed. This rule has been codified in Regulation 10450(b). The Medical Unit, which issues QME panels, operates under the authority of the WCAB. Since the WCAB has no jurisdiction until an application is filed, the Medical Unit cannot issue a QME panel without an underlying case that gives the WCAB jurisdiction. In this case, as of 4/9/21 ADJ16413854 did not exist. There was no petition for new and further disability filed in ADJ10598940. No jurisdiction had been established on 4/9/21 to request panel # 7404253. (Labor Code Section 5500, nor Regulation 10450(b).) Therefore, panel # 7404253 is an invalid panel. a. There is no legal basis to argue Panel #7404253 dated 4/9/21 was requested to enforce a stipulated medical award. Future medical awards are enforced pursuant to LC § 4610. Treating physicians submit requests for authorization (RFAs) for medical treatment. The RFAs are then subject to utilization review (UR). b.

What proof carried it

The evidence the panel weighed, by kind.

Documentary evidencefavours Defendant prevailed

Applicant and petitioner waived the right to a QME in the Amended Stipulations and addendum, executed by both parties.

From the decision · page 2In Case Number ADJ10598940, applicant and petitioner, defendant Snyder Industries, obtained an Award on Amended Stipulations with Request for Award, issued on October 26, 2016. In the Amended Stipulations, petitioner and applicant stipulated that applicant sustained 11 percent permanent disability of the low back for a specific industrial injury of January 27, 2015 while employed by Snyder Industries, insured by Starr Indemnity & Liability Company, administered by Gallagher Bassett. Per the stipulation, applicant was awarded further medical treatment to cure or relieve the effects of the industrial injury. Applicant expressly agreed to waive the right to a QME in both paragraph 9 of the Amended Stipulations and in an attached addendum. Both the Amended Stipulations and the addendum waiving a QME were executed by both applicant and Alina Mazurenko of Gallagher Bassett on behalf of petitioner.

Documentary evidencefavours Defendant prevailed

No petition to reopen the Award was filed within five years of the date of injury, making the stipulated award final under Labor Code section 5804.

From the decision · page 2Neither applicant nor petitioner filed a petition to reopen the Award within five years of the date of injury, which was confirmed by email between the parties. (Exhibit 10.) More than six years after the date of injury, petitioner obtained QME panel number 7404253 by objecting to a PR-2 report of treating physician Dr. Doobay dated February 1, 2021. Petitioner's objection letter, dated March 9, 2021, objected to "disability status, need for further treatment and permanent disability." ( Exhibit I-1, March 9, 2021, p. 1.)

Documentary evidencefavours Defendant prevailed

QME Panel 7404253 was obtained before the filing of the application for adjudication in ADJ16413854, violating jurisdictional rules.

From the decision · page 12III DISCUSSION I. The WCAB had no jurisdiction and therefore the Medical Unit had no jurisdiction for Gallagher Bassett to request panel # 7404253 on 4/9/21. The board has no jurisdiction over any aspect of a workers' compensation claim until an application for adjudication has been filed. This rule has been codified in Regulation 10450(b). The Medical Unit, which issues QME panels, operates under the authority of the WCAB. Since the WCAB has no jurisdiction until an application is filed, the Medical Unit cannot issue a QME panel without an underlying case that gives the WCAB jurisdiction. In this case, as of 4/9/21 ADJ16413854 did not exist. There was no petition for new and further disability filed in ADJ10598940. No jurisdiction had been established on 4/9/21 to request panel # 7404253. (Labor Code Section 5500, nor Regulation 10450(b).) Therefore, panel # 7404253 is an invalid panel. a. There is no legal basis to argue Panel #7404253 dated 4/9/21 was requested to enforce a stipulated medical award. Future medical awards are enforced pursuant to LC § 4610. Treating physicians submit requests for authorization (RFAs) for medical treatment. The RFAs are then subject to utilization review (UR). b.

Documentary evidencefavours Defendant prevailed

CorVel's due process rights were violated as it had no opportunity to participate in the QME selection process for Panel 7404253.

From the decision · page 12Petitioner's compensable consequence argument is irrelevant because no board jurisdiction had been established as of 4/9/21 when Panel #7404253 was requested. Please see facts c, d and e in the Facts Section of this Pleading. Section I of this pleading is also incorporated by reference into this section of this Report and Recommendation. c. Regulation 30(b) is irrelevant to this case. Please see facts c, d and e. in the Facts Section of this Pleading. Section I of this pleading is also incorporated by reference into this section of this Report and Recommendation. d. Corvel is Prejudiced by Panel #7404253 because Corvel's Due Process Rights were violated No evidence was presented at trial to prove Applicant Attorney or Corvel waived the jurisdiction defect of Panel #7404253. Applicant Attorney may have objected to the panel but did participate in the strike process, Corvel did not. Corvel's Due Process rights were violated when Gallagher Bassett obtained Panel # 7404253 without Board jurisdiction. This Due Process

ADJ10598940 · April 10, 2026

What the panel ordered

What was disputed, and how it came out

Your case already resembles someone else’s. Find whose.

The facts that decided it

What the panel did with the medical opinions

The rules the panel named

What proof carried it

About this page