WCPanelIQ
PanelQMEMed-legalDenied

Paula Garcia — ADJ14954569

PAULA GARCIA, Applicant vs. RAMCO ENTERPRISES, Permissibly Self-Insured; INTERCARE HOLDINGS INSURANCE SERVICES, INC., Defendants

ADJ number
ADJ14954569
Decision date
Aug 16, 2022
District office
Salinas
WCJ
—
Claim administrator
Intercare Holdings Insurance Services, Inc. (TPA for Ramco Enterprises, Permissibly Self-Insured)
Commissioners
CRAIG SNELLINGS, COMMISSIONER, KATHERINE A. ZALEWSKI, CHAIR, KATHERINE WILLIAMS DODD, COMMISSIONER

Injury / body parts: various body parts (unspecified, deferred)

LC §4062.3LC §5904CCR §30CCR §31.1CCR §31.5CCR §31.7CCR §10955

Summary

Applicant Paula Garcia, initially unrepresented, obtained an orthopedic QME panel in 2020. After becoming represented in July 2021, her counsel filed a Romero replacement panel request on August 6, 2021 seeking a chiropractic panel, followed by defendant's competing Romero request on August 11, 2021 seeking orthopedic. The Medical Unit rejected applicant's request pending information on whether she had been evaluated by an original panel QME, then issued orthopedic panels in response to defendant's requests. The WCJ found the Medical Unit improperly conditioned applicant's first-in-time request on additional information and ordered the orthopedic panels replaced with a chiropractic panel. On reconsideration, the Board affirmed the F&O but amended Finding of Fact 3 to clarify that the Medical Unit was entitled to request information about whether an examination had occurred, while holding that this request could not strip applicant of her first-in-time priority to designate the specialty.

Issues

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Holding

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Analysis

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Applicant takeaway

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Defense takeaway

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Provider takeaway

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