ADJ11930717 — California WCAB decision

ADJ11930717 · October 23, 2025

Petition for removal granted; February 19, 2025 Findings of Fact and Orders rescinded; new Finding and Order that an additional panel in internal medicine is warranted substituted; matter returned to trial level for further proceedings.

Issues decided

Medical opinions weighed

Authorities named

District office

Van Nuys

What the panel ordered

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.

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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

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

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...

ADJ11930717 · October 23, 2025

What the panel ordered

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