ADJ15539216 — California WCAB decision

What the panel ordered

Petition for reconsideration dismissed; petition for removal granted; prior decision rescinded and matter returned for further proceedings

Petition for reconsideration dismissed and treated as petition for removal; decision after removal issued

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What was disputed, and how it came out

Each issue the panel decided, with the reasoning it gave. An outcome is what this panel did on this record — not a rule, and not a prediction.

QME/AME processMixedneck · back · spine

The Appeals Board found that the defendant waived the right to object to Dr. Achackzad as QME and that the request for an additional panel in spine specialty was not sufficiently justified as the existing hand specialty panel could address the orthopedic complaints.

From the decision · page 1Applicant seeks reconsideration of the "Findings and Orders" (F&O) issued on June 30, 2025. The workers' compensation administrative law judge (WCJ) found, in relevant part, that an additional panel in the specialty of spine (MNB) is appropriate to address alleged injury to the back and neck.

The facts that decided it

What the panel treated as outcome-determinative, and which side it favoured.

What the panel did with the medical opinions

The role the physician served, and the weight the opinion carried. Physicians are named here as the decision names them; we do not score them.

QMERelied upon · hand

Found cumulative injury to right wrist, right hand, and right thumb; diagnosed injuries in left hand and bilateral shoulders unrelated to cumulative injury; deferred opinion on psyche and spine to another specialty.

From the decision · page 2FACTS On December 8, 2021, applicant filed two applications. The case at issue here, ADJ15539216, alleges a cumulative trauma injury from December 15, 2019 through December 15, 2020 to the upper extremity and wrist while employed as a correctional supervising cook. The accompanying claim form dated September 23, 2021 alleges cumulative trauma to the right upper extremity and right wrist. (Joint 109). The other application, assigned ADJ15538700, alleges a specific injury of January 1, 2018 to the upper extremity and wrist due to "opening metal food carts" while employed as a correctional supervising cook. The claim form dated November 13, 2021 alleges right hand and right wrist. (Joint 108). On December 16, 2021, defendant obtained a panel in the specialty of "hand." (Joint 106). Michael Moore, M.D., was selected as the panel QME. On January 3, 2022, applicant obtained a panel in the specialty of physical medicine and rehabilitation without objection from defendant. (Joint 107). Nader Achackzad, M.D., was selected from this panel. Dr. Moore evaluated applicant on February 8, 2022, issuing a report dated the same. (Joint 102). He found cumulative injury to the right wrist, right hand, and right thumb. (Id. at p. 20).

QMERelied upon · physical medicine and rehabilitation

Found cumulative injury to right upper extremity, left shoulder, and left hand; provided impairment ratings for cervical spine, right shoulder, right wrist, left shoulder, and left wrist.

From the decision · page 2FACTS On December 8, 2021, applicant filed two applications. The case at issue here, ADJ15539216, alleges a cumulative trauma injury from December 15, 2019 through December 15, 2020 to the upper extremity and wrist while employed as a correctional supervising cook. The accompanying claim form dated September 23, 2021 alleges cumulative trauma to the right upper extremity and right wrist. (Joint 109). The other application, assigned ADJ15538700, alleges a specific injury of January 1, 2018 to the upper extremity and wrist due to "opening metal food carts" while employed as a correctional supervising cook. The claim form dated November 13, 2021 alleges right hand and right wrist. (Joint 108). On December 16, 2021, defendant obtained a panel in the specialty of "hand." (Joint 106). Michael Moore, M.D., was selected as the panel QME. On January 3, 2022, applicant obtained a panel in the specialty of physical medicine and rehabilitation without objection from defendant. (Joint 107). Nader Achackzad, M.D., was selected from this panel. Dr. Moore evaluated applicant on February 8, 2022, issuing a report dated the same. (Joint 102). He found cumulative injury to the right wrist, right hand, and right thumb. (Id. at p. 20).

The rules the panel named

Authorities as the decision cited them, with how this panel applied each one.

Navarro v. City of Montebello (2014) 79 Cal.Comp.Cases 418

The Appeals Board applied Navarro to find Dr. Moore should have been the QME for both claims but defendant waived objection to Dr. Achackzad.

From the decision · page 5III We turn now to the merits. At the outset, we clarify Dr. Moore should have been the proper QME for both cases as both claim forms were dated prior to Dr. Moore's initial evaluation on February 8, 2022. Pursuant to Navarro v. City of Montebello, (2014) 79 Cal.Comp.Cases 418, sections 4062.3(j) and 4064(a) taken together state that a medical evaluation shall address "all medical issues arising from all injuries reported on one or more claim forms." (Navarro v. City of Montebello (2014) 79 Cal.Comp.Cases 418 (Appeals Board en banc).) In keeping with the requirements set forth in sections 4062.3(j) and 4064(a), Navarro clarifies that at the time of an evaluation, the evaluator shall consider all issues arising out of any claims reported before the evaluation, and if several subsequent claims of injury are filed before the evaluation takes place, the evaluator shall also consider those claims. (Id. at p. 425). Under Navarro, the date the claim form is filed is the operative act in determining the right to request a new QME panel. If a claim form for an additional injury is filed before the evaluation with the panel QME, then that QME shall remain as the QME for all injuries with submitted claim

Cal. Code Regs., tit. 8, 31.7

Good cause required for additional panel in different specialty per Cal. Code Regs., tit. 8, 31.7.

The Appeals Board found no sufficient good cause shown for an additional panel in spine specialty.

From the decision · page 7(a) Once an Agreed Medical Evaluator, an Agreed Panel QME, or a panel Qualified Medical Evaluator has issued a comprehensive medical-legal report in a case and a new medical dispute arises, the parties, to the extent possible, shall obtain a follow-up evaluation or a supplemental evaluation from the same evaluator.

What proof carried it

The evidence the panel weighed, by kind.

Testimony and credibilityfavours Applicant prevailed

Defendant waived right to object to Dr. Achackzad as QME by failing to object to initial panel request, evaluation setting, and reports.

From the decision · page 6However, defendant waived the right to object to Dr. Achackzad evaluating applicant as a QME when they failed to object to the initial panel request made January 3, 2022, the setting of the initial evaluation on May 13, 2024, the report from the initial evaluation dated June 13, 2024, or the supplemental report July 19, 2024. Waiver is the intentional relinquishment of a known right after knowledge of the facts, and it may be either express or implied. (Supervalu, Inc. v. Wexford Underwriting Managers, Inc. (2009) (Supervalu) 74 Cal.Comp.Cases 720, 728.) "To make a case of abandonment or waiver of a legal right there must be a clear, unequivocal, and decisive act of the party showing such a purpose, or acts amounting to an estoppel on his part." (First Nat'l Bank v. Maxwell (1899) 123 Cal. 360, 367-368.) Here, the second panel request was clearly made after the first panel was obtained.

Medical recordsfavours neutral

Dr. Moore's medical opinions are incomplete as to the spine, deferring to another specialty.

From the decision · page 8Last, the Appeals Board has the discretionary authority to develop the record when the medical record is not substantial evidence to determine causation of a disputed body part. (See Lab. Code, § 5701, 5906; Tyler v. Workers' Comp. Appeals Bd. (1997) 56 Cal.App.4th 389, 394 [62 Cal.Comp.Cases 924]; see McClune v. Workers' Comp. Appeals Bd. (1998) 62 Cal.App.4th 1117 [63 Cal.Comp.Cases 261].) In our en banc decision in McDuffie v. Los Angeles County Metropolitan Transit Authority (2002) 67 Cal.Comp.Cases 138 (Appeals Board en banc), we stated that "[s]ections 5701 and 5906 authorize the WCJ and the Board to obtain additional evidence, including medical evidence, at any time during the proceedings (citations) [but] [b]efore directing augmentation of the medical record... the WCJ or the Board must establish as a threshold matter that specific medical opinions are deficient, for example, that they are inaccurate, inconsistent or incomplete." (McDuffie, supra, 67 Cal.Comp.Cases at 141.) Here there seems to be no dispute that Dr. Moore's medical opinions are incomplete as to the spine.

ADJ15539216 · October 3, 2025