ADJ16964158 — California WCAB decision

What the panel ordered

Petition for reconsideration/removal denied by WCAB on September 10, 2024.

Petition for reconsideration/removal filed by applicant challenging WCJ findings regarding validity of nurse practitioner's PTP report and defendant's objection letter triggering panel process; WCJ issued Findings and Orders on June 19, 2024; WCAB decision issued September 10, 2024.

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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 processDefendant prevailedneck · back · both shoulders · both arms

Applicant challenged the validity of the nurse practitioner's PTP report and defendant's objection letter; the WCJ found the objection valid and the Appeals Board denied removal, finding no significant prejudice or irreparable harm to applicant.

From the decision · page 1Applicant seeks removal of the Findings and Orders (F&O) issued by the workers' compensation administrative law judge (WCJ) on June 19, 2024, wherein the WCJ found that while employed by defendant on September 26, 2022, applicant sustained injury and that "the parts of body injured are not at issue for this trial"; that a nurse practitioner's report constitutes a valid Primary Treatment Physician (PTP) report; that defendant filed a valid objection letter to the determination of the primary treating physician; and that after the strike process, the remaining doctor will serve as the Panel Qualified Medical Examiner (PQME).

The facts that decided it

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

Applicant filed a petition for removal challenging the validity of the nurse practitioner's PTP report and defendant's objection letter.

Favours Applicant prevailed

This challenge was the basis for the petition and the Appeals Board's review.

From the decision · page 1Applicant seeks removal of the Findings and Orders (F&O) issued by the workers' compensation administrative law judge (WCJ) on June 19, 2024, wherein the WCJ found that while employed by defendant on September 26, 2022, applicant sustained injury and that "the parts of body injured are not at issue for this trial"; that a nurse practitioner's report constitutes a valid Primary Treatment Physician (PTP) report; that defendant filed a valid objection letter to the determination of the primary treating physician; and that after the strike process, the remaining doctor will serve as the Panel Qualified Medical Examiner (PQME).

The WCJ found the nurse practitioner's report to be a valid PTP report and the defendant's objection letter to be valid to trigger the panel process.

Favours Defendant prevailed

These findings supported denial of the petition and upheld the objection process.

From the decision · page 1Applicant seeks removal of the Findings and Orders (F&O) issued by the workers' compensation administrative law judge (WCJ) on June 19, 2024, wherein the WCJ found that while employed by defendant on September 26, 2022, applicant sustained injury and that "the parts of body injured are not at issue for this trial"; that a nurse practitioner's report constitutes a valid Primary Treatment Physician (PTP) report; that defendant filed a valid objection letter to the determination of the primary treating physician; and that after the strike process, the remaining doctor will serve as the Panel Qualified Medical Examiner (PQME).

Applicant failed to show significant prejudice or irreparable harm if removal was denied and failed to show reconsideration would be inadequate remedy.

Favours Defendant prevailed

Lack of these showings justified denial of the petition for removal.

From the decision · page 5that reconsideration will not be an adequate remedy if a final decision adverse to the petitioner ultimately issues. (Cal. Code Regs., tit. 8, § 10955(a).) Here, applicant made neither required showing. Thus, we are not persuaded that significant prejudice or irreparable harm will result if removal is denied and/or that reconsideration will not be an adequate remedy.

The rules the panel named

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

Labor Code

Labor Code section 5909

The Appeals Board must act on a petition for reconsideration within 60 days of transmission of the case to the Appeals Board.

From the decision · page 3Under Labor Code section 5909(a), the Appeals Board must act on a petition for reconsideration within 60 days of transmission of the case to the Appeals Board. Transmission is reflected in Events in the Electronic Adjudication Management System (EAMS). Specifically, in Case Events, under Event Description is the phrase "Sent to Recon" and under Additional Information is the phrase "The case is sent to the Recon board." Here, according to Events, the case was transmitted to the Appeals Board on July 12, 2024, and 60 days from the date of transmission is September 10, 2024. This decision is issued by or on September 10, 2024, so that we have timely acted on the petition as required by Labor Code section 5909(a).

Labor Code

Labor Code sections 4061 and 4062

Defendant's objection letter to the nurse practitioner's PTP report was filed pursuant to these sections and found valid to trigger the panel process.

From the decision · page 2BACKGROUND Applicant, a food worker for Fresno Foods, LLC, filed an application alleging a specific injury to her neck, back, both shoulders and both arms, when she fell at work on September 26, 2022. (11/18/22 Application.) She received medical treatment from Kings Industrial Occupational Medical Center, Inc., which served as her PTP. (Joint Exh. AA1.) A PTP report written by nurse practitioner Beltran was issued May 26, 2023. (Ibid.) The report was not signed by a supervising physician. (Ibid.) On October 10, 2023, defendant issued an objection letter to the PTP report, pursuant to Labor Code sections 4061 and 4062. (Joint Exh. BB.) Defendant subsequently obtained a QME panel in Orthopedic Surgery. (Defendant's Exh. A.) In a letter dated November 7, 2023, applicant acknowledged defendant's objection to the PTP report, defendant's request for a panel, and defendant's strike of one doctor from that panel. (Applicant's Exh.

ADJ16964158 · September 10, 2024

What the panel ordered

What was disputed, and how it came out

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The facts that decided it

The rules the panel named

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