What the panel ordered
Decision of December 5, 2025 affirmed except amended to deny replacement QME panel
Petition for reconsideration granted; decision after reconsideration issued
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.
The issue of whether a QME reevaluation is necessary is deferred due to lack of notice and incomplete evidence.
From the decision · page 102. The issue of whether a QME reevaluation in neurology is needed after the parties' receipt of the reports of James Shaw, MD, dated June 4, 2025, and Robert Posten, Ph.D., dated August 19, 2025, is deferred.
The evidentiary record does not establish medical limitations precluding travel to the QME's new office location, so replacement panel is not warranted.
From the decision · page 84:1), the evidentiary record does not establish medical limitations or other facts or circumstances that would preclude a reevaluation with the current QME. Moreover, applicant's testimony appears to support his ability, "depending on how far he has to go," to engage in air travel and navigate "getting to the airport and through security." (Id. at p. 4:11.) Thus, based on the evidence before us, we cannot conclude that the current record warrants the issuance of a replacement panel of QMEs in neurology. We will grant defendant's Petition and amend the Findings of Fact, accordingly.
The facts that decided it
What the panel treated as outcome-determinative, and which side it favoured.
Applicant's credible testimony establishes travel limitations but does not medically preclude travel to QME's new office
Favours Defendant prevailed
Supports denial of replacement QME panel as travel is possible despite inconvenience
From the decision · page 84:1), the evidentiary record does not establish medical limitations or other facts or circumstances that would preclude a reevaluation with the current QME. Moreover, applicant's testimony appears to support his ability, "depending on how far he has to go," to engage in air travel and navigate "getting to the airport and through security." (Id. at p. 4:11.) Thus, based on the evidence before us, we cannot conclude that the current record warrants the issuance of a replacement panel of QMEs in neurology. We will grant defendant's Petition and amend the Findings of Fact, accordingly.
No medical evidence contraindicates travel to the QME's new office location
Favours Defendant prevailed
No medical basis to justify replacement panel; statutory mandate to use same QME prevails
From the decision · page 84:1), the evidentiary record does not establish medical limitations or other facts or circumstances that would preclude a reevaluation with the current QME. Moreover, applicant's testimony appears to support his ability, "depending on how far he has to go," to engage in air travel and navigate "getting to the airport and through security." (Id. at p. 4:11.) Thus, based on the evidence before us, we cannot conclude that the current record warrants the issuance of a replacement panel of QMEs in neurology. We will grant defendant's Petition and amend the Findings of Fact, accordingly.
Issue of necessity of QME reevaluation deferred due to lack of notice and incomplete evidence
Favours neutral
Preserves due process and allows further development of record
From the decision · page 102. The issue of whether a QME reevaluation in neurology is needed after the parties' receipt of the reports of James Shaw, MD, dated June 4, 2025, and Robert Posten, Ph.D., dated August 19, 2025, is deferred.
What the panel did with the medical opinions
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.
Reports dated June 4, 2025, relevant to the necessity of QME reevaluation.
From the decision · page 102. The issue of whether a QME reevaluation in neurology is needed after the parties' receipt of the reports of James Shaw, MD, dated June 4, 2025, and Robert Posten, Ph.D., dated August 19, 2025, is deferred.
Reports dated August 19, 2025, relevant to the necessity of QME reevaluation.
From the decision · page 102. The issue of whether a QME reevaluation in neurology is needed after the parties' receipt of the reports of James Shaw, MD, dated June 4, 2025, and Robert Posten, Ph.D., dated August 19, 2025, is deferred.
The rules the panel named
Authorities as the decision cited them, with how this panel applied each one.
Labor Code section 4062.3(k)
If a new medical issue arises after an evaluation, the same medical evaluator must be used to the extent possible (Lab. Code, § 4062.3(k))
Applied to require use of same QME for reevaluations unless justified
From the decision · page 6We begin our analysis by observing that section 4062.3, subd. (k) provides that, "If, after a medical evaluation is prepared, the employer or the employee subsequently objects to any new medical issue, the parties, to the extent possible, shall utilize the same medical evaluator who prepared the previous evaluation to resolve the medical dispute." (Lab. Code, § 4062.3(k).)
Administrative Director Rule 34(b)
Initial QME evaluation must be at the office listed on the panel selection form; subsequent evaluations may be at another office within reasonable geographic distance (Cal. Code Regs., tit. 8, § 34(b))
Applied to assess reasonableness of geographic distance for QME replacement
From the decision · page 6Pursuant to AD Rule 34(b) (Cal. Code Regs., tit. 8, § 34(b)), once a QME has been selected, the initial evaluation "shall be conducted at a medical office listed on the panel selection form," unless the parties agree in writing to another office. Thereafter, "[a]ny subsequent evaluation appointments may be performed at another medical office of the selected QME if it is listed with the Medical Director and is within a reasonable geographic distance from the injured worker's residence." (Ibid.)
What proof carried it
The evidence the panel weighed, by kind.
Applicant's credible testimony about travel limitations (needs breaks after one hour driving, can walk about 200 yards)
From the decision · page 3[A]pplicant's credible testimony is that he needs to take break from driving after one hour and that he can only walk about 200 yards. Considering the rigors of travel and the significant amount of preparation the applicant would be expected to do to travel by air, which is also added expense to the applicant, it is appropriate to order a new panel. After taking into consideration the time and distance the applicant is expected to travel and that travel each direction will take a significant toll on the injured worker, a replacement panel was Ordered.
No medical evidence contraindicating travel to QME's new office
From the decision · page 84:1), the evidentiary record does not establish medical limitations or other facts or circumstances that would preclude a reevaluation with the current QME. Moreover, applicant's testimony appears to support his ability, "depending on how far he has to go," to engage in air travel and navigate "getting to the airport and through security." (Id. at p. 4:11.) Thus, based on the evidence before us, we cannot conclude that the current record warrants the issuance of a replacement panel of QMEs in neurology. We will grant defendant's Petition and amend the Findings of Fact, accordingly.
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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.
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