WCPanelIQ
PanelQMEMed-legalDenied

Gilberto Martinez — ADJ19984698, ADJ20043335

GILBERTO MARTINEZ, Applicant vs. CVS PHARMACY; INDEMNITY INSURANCE COMPANY OF NORTH AMERICA administered by SEDGWICK CLAIMS MANAGEMENT SERVICES, Defendants

ADJ number
ADJ19984698, ADJ20043335
Decision date
Apr 13, 2026
District office
Marina del Rey
WCJ
—
Claim administrator
Sedgwick Claims Management Services (administering for Indemnity Insurance Company of North America)
Commissioners
ANNE SCHMITZ, DEPUTY COMMISSIONER, CRAIG L. SNELLINGS, COMMISSIONER, JOSÉ H. RAZO, COMMISSIONER

Injury / body parts: right shoulder, neck, back, hand, wrist, knees

LC §5909LC §5900LC §5902LC §5903LC §5904CCR §31.5CCR §31.3CCR §10955

Summary

Applicant Gilberto Martinez had two industrial claims against CVS Pharmacy. After the initial orthopedic QME panel process produced Dr. Willoughby as the remaining panelist, Dr. Willoughby's office emailed applicant on February 20, 2025 stating his schedule was completely booked within the 120-day timeframe and that the parties would need to jointly execute a waiver to proceed. Applicant requested a replacement panel on March 5, 2025 under AD Rule 31.5(a)(2), which produced panel 3622506 leaving Dr. Agyeman as the QME. Defendant sought removal of the WCJ's January 12, 2026 F&O validating the replacement panel, arguing only 64 days elapsed and a later call generated a timely April 25, 2025 appointment. The Board treated the petition as one for reconsideration (because the decision was hybrid containing final findings), applied the removal standard to the interlocutory QME issue, and denied the petition, agreeing that once Dr. Willoughby definitively stated he could not schedule within 120 days, applicant properly relied on that statement to request a replacement panel.

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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