WCPanelIQ
PanelQMEMed-legalDenied

Rosny Aguilar — ADJ11448738

ROSNY AGUILAR, Applicant vs. WM OF ALAMEDA COUNTY, INC.; ACE AMERICAN INSURANCE COMPANY, administered by GALLAGHER BASSETT SERVICES, INC., Defendants

ADJ number
ADJ11448738
Decision date
Feb 28, 2021
District office
Fresno District Office
WCJ
—
Claim administrator
Gallagher Bassett Services, Inc. (administering ACE American Insurance Company)
Commissioners
KATHERINE A. ZALEWSKI, CHAIR, MARGUERITE SWEENEY, COMMISSIONER, DEIDRA E. LOWE, COMMISSIONER
LC §5904LC §5900LC §5903LC §5701LC §5906LC §5313LC §4064LC §5703LC §5708CCR §10507CCR §10605CCR §10845CCR §10940CCR §10392CCR §10615CCR §10843CCR §10955CCR §10500CCR §10628

Summary

Defendant petitioned for reconsideration of a WCJ's October 16, 2020 Findings of Fact, Order and Opinion on Decision, which found that the QME reporting of Dr. Ernest Miller was not substantial evidence and ordered appointment of an independent medical evaluator. Although the F&O contained a final threshold finding, defendant only challenged the interlocutory determinations regarding the QME reporting and IME appointment, so the Board applied the removal standard. The Board found service of the F&O on defendant appears to have been defective (defendant reported never receiving the emailed F&O and only discovered it on EAMS December 8, 2020), and thus treated the December 29, 2020 Petition as timely. On the merits, the Board found defendant failed to show significant prejudice or irreparable harm, noted the WCJ has discretionary authority under section 5701 to develop the record, and clarified that the F&O's findings and orders did not actually strike the QME reports (the striking language appeared only in the Opinion on Decision). The Board denied the Petition.

Issues

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Holding

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Analysis

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Defense takeaway

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