ADJ20798821 · February 6, 2026

From the decision · page 1Applicant seeks reconsideration of the Findings and Order Regarding Validity of QME Panel Number 7821226 (F&O) issued by the workers' compensation administrative law judge (WCJ) on November 14, 2025, wherein the WCJ found, in pertinent part, that applicant, while employed by defendant, on February 28, 2025, as a compounding lead, sustained injury arising out of and in the course of employment (AOE/COE) to the head, facial fracture, nasal fracture, collar bone, ribs, and claims injury to the eyes, ears, neck, chest, shoulder, abdomen, back, right arm, right elbow, right wrist, legs, memory loss, and psyche (ADJ20798822); that applicant, while employed by defendant, during the period August 30, 2023 to August 30, 2024, as a compounding lead, claims injury AOE/COE to the neck, back, shoulder, wrists, legs, knees, heels, feet, dry skin, dry eyes, gastrointestinal pain, hearing loss, lungs, and psyche (ADJ20798821); and that Qualified Medical Evaluation (QME) Panel 7821226 is valid and overruled applicant's objection to that panel.

Favours Defendant prevailed

This allowed the panel request to be upheld despite the error, supporting the defendant's position.

From the decision · page 12both claimed injuries, including the issues of whether there are one or two injuries and the dates of injury. As discussed above in Silveira, supra, our WCAB Rule 10517 allows pleadings to be amended according to proof. (Cal. Code Regs., tit. 8, § 10517.) While it is incumbent on all parties to provide accurate information, here, we believe that defendant's error in listing one of the claim numbers rather than the other is harmless.

The supporting letter submitted with the panel request clearly referred to the denied cumulative trauma claim despite listing the specific injury claim number.

Favours Defendant prevailed

This supported the validity of the QME panel request despite the incorrect claim number, as the letter clarified the dispute was over the cumulative trauma claim.

From the decision · page 4In the November 14, 2025 F&O, the WCJ found that the panel issued in orthopedic surgery (Panel number 7821226) is valid in the CT case (ADJ20798821) and ordered that applicant's objection to that panel is overruled. (F&O, at p. 2.) The WCJ explained his reasoning in the Opinion on Decision (OOD), writing that defendant's QME panel request was first in time; that the support letter submitted by defendant lists the SI rather than the CT date of injury but "the contents of the delay letter clearly and exclusively refer to the denied cumulative trauma claim" and leave no doubt that the CT injury was denied; and that the claim numbers for the two dates of injury are "virtually identical except for one digit being different" which "lends credence to the

Selected by applicant as the panel QME in pain medicine.

From the decision · page 311.) Applicant argued that the June 3, 2025 QME panel in orthopedic surgery, requested by defendant, was invalid because it requested a panel in the accepted SI case, rather than in the CT case that was in dispute; it erroneously requested the panel pursuant to section 4060, which only applies to compensability disputes, despite the SI claim being accepted; and it relied on a supporting document that was inapplicable because the document did not constitute a "request for medical evaluation pursuant to Section 4060" as required by section 4062.2(b). (Id. at p. 4, item 4.) Applicant noted that after obtaining the QME panel in pain medicine, applicant selected Dr. Hamilton Chen as the panel QME. (Id. at pp. 4-5, items 5 and 7.) Applicant's primary treating physician (PTP) since April 9, 2025 is Dr. Nimish Shah, a specialist in pain medicine. (Id. at p. 5, item 8.)

Applicant's primary treating physician since April 9, 2025.

From the decision · page 311.) Applicant argued that the June 3, 2025 QME panel in orthopedic surgery, requested by defendant, was invalid because it requested a panel in the accepted SI case, rather than in the CT case that was in dispute; it erroneously requested the panel pursuant to section 4060, which only applies to compensability disputes, despite the SI claim being accepted; and it relied on a supporting document that was inapplicable because the document did not constitute a "request for medical evaluation pursuant to Section 4060" as required by section 4062.2(b). (Id. at p. 4, item 4.) Applicant noted that after obtaining the QME panel in pain medicine, applicant selected Dr. Hamilton Chen as the panel QME. (Id. at pp. 4-5, items 5 and 7.) Applicant's primary treating physician (PTP) since April 9, 2025 is Dr. Nimish Shah, a specialist in pain medicine. (Id. at p. 5, item 8.)

Labor Code section 4060

Labor Code section 4060 and section 4062.2 requirements for QME panel requests.

The panel request was evaluated for compliance with statutory requirements for QME panel requests under Labor Code section 4060 and 4062.2.

From the decision · page 8To obtain a QME panel in a represented case, section 4062.2 provides, in relevant part:

Cal. Code Regs., tit. 8, 30

AD Rule 30 requirements for QME panel requests.

The panel request was evaluated for compliance with AD Rule 30 requirements for QME panel requests.

From the decision · page 7III. Turning now to the Petition, we address applicant's contention that the QME panel requested by defendant is invalid because a UR deferral letter regarding treatment authorization in applicant's SI case cannot stand in for a claim denial letter addressing compensability, as required under section 4060. (Petition, at pp. 4-5.) Applicant argued that "the WCJ erred because the panel request did not arise from a compensability dispute and therefore could not legally trigger a § 4060 evaluation." (Id. at p. 5.) The process by which a party may seek the issuance of a panel of QMEs is addressed in AD Rule 30. (Cal. Code Regs., tit. 8, § 30.) The Rule requires, in relevant part, that represented parties submit a request for a panel of QMEs electronically to the DWC Medical Unit, and that they identify the following elements: 1. Panel Request Information Section

The supporting letter submitted with the panel request indicated it was issued in regard to the denied cumulative trauma claim, and the incorrect claim number was a clerical or typographical error.

From the decision · page 4In the November 14, 2025 F&O, the WCJ found that the panel issued in orthopedic surgery (Panel number 7821226) is valid in the CT case (ADJ20798821) and ordered that applicant's objection to that panel is overruled. (F&O, at p. 2.) The WCJ explained his reasoning in the Opinion on Decision (OOD), writing that defendant's QME panel request was first in time; that the support letter submitted by defendant lists the SI rather than the CT date of injury but "the contents of the delay letter clearly and exclusively refer to the denied cumulative trauma claim" and leave no doubt that the CT injury was denied; and that the claim numbers for the two dates of injury are "virtually identical except for one digit being different" which "lends credence to the