What the panel ordered
Petition for reconsideration granted. The WCJ's order was amended to permit provision of the prior QME's report to the current QME and to allow defendant to advise the QME of certain reasons for claim denial, but not to detail contested facts.
Applicant sought removal of the WCJ's Findings and Order dated March 3, 2021, which precluded the current QME from reviewing the prior QME's report and required revision of defendant's QME letter. The WCAB treated the petition as one for reconsideration and reviewed the merits.
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.
Dr. Taylor's report is relevant to the medical issues in dispute and may be provided to the current QME. Defendant may advise the QME of claim denial for lack of medical evidence and the good faith personnel action defense, but not detail contested facts.
The facts that decided it
What the panel treated as outcome-determinative, and which side it favoured.
Dr. Taylor's report was obtained in accordance with the Labor Code and there is no basis to preclude its review by the current QME.
Favours Applicant prevailed
Established that the prior QME's report is a relevant medical record and should be provided to the current QME.
From the decision · page 5An adequate history and examination by the current QME should include review of the previous QME's report in the absence of a basis for excluding the report from the record. The record reflects that Dr. Taylor's report was obtained in accordance with the Labor Code. She was replaced as the QME because she retired. The record does not indicate a basis to preclude review of her report by the current QME. (See e.g., State Farm Ins. Co. v. Workers' Comp. Appeals Bd. (Pearson) (2011) 192 Cal.App.4th 51 [76 Cal.Comp.Cases 69] [reports of an independent medical examiner should have been stricken because the applicant engaged in ex parte communication with the examiner prior to the evaluation]); Batten v. Workers' Comp. Appeals Bd. (2015) 241 Cal.App.4th 1009 [80 Cal.Comp.Cases 1256] [a report obtained from a private expert solely to rebut the opinion of the panel qualified medical evaluator is inadmissible].)
Disclosure of claim denial for lack of medical evidence and the good faith personnel action defense is relevant to the QME's evaluation, but not further detail of contested facts.
Favours Applicant prevailed
Defined the permissible scope of advocacy letters to the QME, ensuring only relevant reasons for denial are disclosed.
From the decision · page 97. Exhibit A, defendant's proposed QME letter, must be revised to only disclose reasons for the claim's denial that are relevant to determination of the medical issues in dispute including the denial for lack of medical evidence and the good faith personnel action defense. Defendant's letter may not detail the contested facts about applicant's claim.
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.
Dr. Taylor conducted a psychological evaluation of applicant and addressed her psychiatric claim of injury. Her report is relevant to the medical issues in dispute and may be provided to the current QME.
Dr. Taylor's report is relevant to the medical issues in dispute and there is no basis to preclude its review by the current QME.
From the decision · page 6Dr. Taylor conducted a psychological evaluation of applicant and addressed her psychiatric claim of injury. Causation for applicant's psychiatric claim remains in dispute since defendant has not accepted it as compensable. Dr. Taylor's report is consequently relevant to determination of the medical issues in dispute and may be provided to the current QME for his review.
The rules the panel named
Authorities as the decision cited them, with how this panel applied each one.
Lab. Code § 4062.3(a)-(b)
Any party may provide to the QME records prepared or maintained by the employee's treating physician or other medical and nonmedical records relevant to determination of the medical issue. The trier of fact determines what information may be provided if the parties cannot agree.
Permitted provision of prior QME's report to current QME as relevant medical record.
From the decision · page 4Section 4062.3 provides in relevant part, as follows:
Cal. Code Regs., tit. 8, § 41(c)(2)-(4)
QMEs are required to review all available relevant medical and non-medical records and/or facts necessary for an accurate and objective assessment of the contested medical issues.
Dr. Poston must review relevant records, including Dr. Taylor's report, to conduct an objective evaluation.
From the decision · page 6With respect to the WCJ's concern that review of Dr. Taylor's report will impact the impartiality of Dr. Poston's evaluation, QMEs are required to "[r]eview all available relevant medical and non-medical records and/or facts necessary for an accurate and objective assessment of the contested medical issues in an injured worker's case before generating a written report." (Cal. Code Regs., tit. 8, § 41(c)(2), emphasis added.) Administrative Director (AD) Rule 41 further requires QMEs to reach conclusions as follows: "All conclusions shall be based on the facts and on the evaluator's training and specialty-based knowledge and shall be without bias either for or against the injured worker or the claims administrator, or if none the employer." (Cal. Code Regs., tit. 8, § 41(c)(4).) There is nothing in the record to indicate that review of Dr. Taylor's report will prevent Dr.
What proof carried it
The evidence the panel weighed, by kind.
Dr. Taylor's report was obtained in accordance with the Labor Code and is relevant to the medical issues in dispute.
From the decision · page 5An adequate history and examination by the current QME should include review of the previous QME's report in the absence of a basis for excluding the report from the record. The record reflects that Dr. Taylor's report was obtained in accordance with the Labor Code. She was replaced as the QME because she retired. The record does not indicate a basis to preclude review of her report by the current QME. (See e.g., State Farm Ins. Co. v. Workers' Comp. Appeals Bd. (Pearson) (2011) 192 Cal.App.4th 51 [76 Cal.Comp.Cases 69] [reports of an independent medical examiner should have been stricken because the applicant engaged in ex parte communication with the examiner prior to the evaluation]); Batten v. Workers' Comp. Appeals Bd. (2015) 241 Cal.App.4th 1009 [80 Cal.Comp.Cases 1256] [a report obtained from a private expert solely to rebut the opinion of the panel qualified medical evaluator is inadmissible].)
The same issues, filtered across the whole corpus — or paste your own facts and let the search rank by factor match.
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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