California Labor Code § 4060

Determinative passage · p.5Turning now to the merits of the Petition, section 4060 provides guidance as to the QME panel process in cases wherein compensability is disputed and applicant is represented. It provides in relevant part that:

Defendant's QME panel request was premature because it used an incorrect date, violating the timing requirements of these statutes.

Determinative passage · p.8As stated by the WCJ in his Opinion, "[b]ased upon Labor Code 4062.2(b) the earliest the request could have been made was 10/29/25, therefore the request was prematurely made, untimely, not properly served and invalid." (Opinion on Decision, at pp. 1-2.)

Panel 7875837 was stricken as untimely; subsequent requests' validity could not be determined due to inadequate record.

Determinative passage · p.11Accordingly, we concur with the WCJ's determination that the reports of Michael Einbund, M.D., Rosabel Young, M.D., Michael Wells, M.D., and Koruon Daldalyan, M.D., are admissible in proceedings before the WCAB, and may further be submitted for review by the appropriately selected panel QMEs in this matter. We express no opinion as to the evidentiary weight the reports should be accorded, either by the QMEs selected by the parties pursuant to current section 4060 and 4062.2, or by the WCJ.

The panel found that applicant's self-procured reports were obtained prior to the parties' selection of QMEs under current law and were not solely for rebuttal, thus admissible.

Determinative passage · p.8To obtain a QME panel in a represented case, section 4062.2 provides, in relevant part:

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

Determinative passage · p.9A medical evaluation is required where there is a dispute over limitations, if any, resulting from an injury, or the existence or extent of permanent impairment. (Lab. Code, § 4060, et seq.) When deciding a medical issue, the WCJ must utilize expert medical opinion. (See Insurance Company of North America v. Workers' Comp. Appeals Bd. (Kemp) (1981) 122 Cal.App.3d 905 [46 Cal.Comp.Cases 913].) The number and nature of the injuries sustained are questions of fact for the WCJ. (Western Growers Ins. Co. v. Workers' Comp. Appeals Bd. (Austin) (1993) 16 Cal.App.4th 227, 234 [58 Cal.Comp.Cases 323].)

The WCJ must base decisions on substantial medical evidence and expert opinion when there is a dispute over permanent disability.

Determinative passage · p.4While the applicant's claim was delayed, she was referred to Dr. Haghighinia as her primary treating physician. Her attorney also requested a comprehensive medical legal report. (See exhibit 3.) Dr. Haghighinia, evaluated the applicant on June 20, 2022, after her claim had been denied by the defendant and issued a report of the same date. (See exhibit 4.) Subsequently, the parties obtained a panel qualified medical evaluator (PQME) pursuant to Labor Code section 4060. Dr. Uppal M.D. served as the PQME. Dr. Uppal issued two reports dated November 11, 2022, and August 14, 2023. The case proceeded to trial on the morning of August 4, 2025.

Dr. Uppal served as the PQME and issued reports used to determine injury compensability.

Determinative passage · p.6It is well established that decisions by the Appeals Board must be supported by substantial evidence. (Lab. Code, § 5903, 5952(d); Lamb v. Workmen's Comp. Appeals Bd. (1974) 11 Cal.3d 274 [39 Cal.Comp.Cases 310]; Garza v. Workmen's Comp. Appeals Bd. (1970) 3 Cal.3d 312, 319 [35 Cal.Comp.Cases 500, 505]); LeVesque v. Workmen's Comp. Appeals Bd. (1970) 1 Cal.3d 627 [35 Cal.Comp.Cases 16].) To constitute substantial evidence "... a medical opinion must be framed in terms of reasonable medical probability, it must not be speculative, it must be based on pertinent facts and on an adequate examination and history, and it must set forth reasoning in support of its conclusions." (Escobedo v. Marshalls (2005) 70 Cal.Comp.Cases 604, 621 (Appeals Bd. en banc).) Applicant bears the burden of proving injury AOE/COE by a preponderance of the evidence. (South Coast Framing v. Workers' Comp. Appeals Bd. (Clark) (2015) 61 Cal.4th 291, 297-298, 302 [80 Cal.Comp.Cases 489]; Lab. Code, § 3600(a); 3202.5.)

QME Dr. Retodo's reports met these criteria and were relied upon by the WCAB.

Determinative passage · p.6July 14, 2014. Accordingly, the WCJ concluded that the report was appropriately obtained under the auspices of section 4060, which at the time of the claimed injury provided that for compensability disputes, "each party may select a qualified medical evaluator to conduct a comprehensive medical-legal evaluation." (Lab. Code, § 4060(c) (2003).) Accordingly, the WCJ concludes "it is clear that [the Dr. Miller] report should have been admitted into evidence." (Report, at p. 7.)

The WCJ concluded Dr. Miller's report was admissible under this statute due to the existence of a compensability dispute and a notice of denial of claim before the report date.