WCPanelIQ
PanelQMEMed-legalDenied

John Swartz — ADJ12292905, ADJ12292906

JOHN SWARTZ, Applicant vs. SARATOGA RETIREMENT COMMUNITY; permissibly self-insured, administered by ATHENS ADMINISTRATORS, Defendants

ADJ number
ADJ12292905, ADJ12292906
Decision date
Feb 2, 2021
District office
San Jose
WCJ
—
Claim administrator
Athens Administrators (for permissibly self-insured Saratoga Retirement Community)
Commissioners
KATHERINE A. ZALEWSKI, CHAIR, DEIDRA E. LOWE, COMMISSIONER, ANNE SCHMITZ, DEPUTY COMMISSIONER
LC §5904LC §5900LC §5903LC §4062.3LC §5813CCR §10507CCR §10605CCR §10843CCR §10955CCR §10561CCR §10421CCR §10341CCR §10325

Summary

Defendant Saratoga Retirement Community (self-insured, administered by Athens Administrators) petitioned for reconsideration or removal of a November 2, 2020 F&O that found applicant John Swartz sustained injury AOE/COE and denied defendant's request for a replacement QME panel. Although the AOE/COE finding made the decision final/reconsiderable, defendant only challenged the interlocutory denial of a replacement QME panel, so the Board applied the removal standard. Defendant conceded there was no evidence the QME, Dr. Robert Weinmann, received information applicant sent in violation of section 4062.3(b), but cited Pettit to argue a replacement panel was warranted regardless. The Board found defendant misrepresented the facts of Pettit—where the QME indisputably did receive the pivotal information—and warned that such misrepresentation could be sanctionable. Finding no significant prejudice or irreparable harm, the Board denied the Petition as one seeking reconsideration.

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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