What the panel ordered
Petition for Reconsideration granted; February 19, 2025 Findings and Award rescinded and substituted; issues deferred and additional QME panels ordered; matter returned to trial judge for further proceedings
Petition for Reconsideration granted, Findings and Award rescinded and substituted, matter returned to trial judge for further proceedings
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.
The WCAB found good cause for additional QME panels based on Dr. Schaffzin's recommendation and the need for further development of the evidentiary record to ensure substantial justice.
From the decision · page 6Based upon the foregoing, and Dr. Shaffzin's recommendation in his report of December 19, 2023 for further evaluations by "a pulmonologist, an internist for diabetes mellitus, ophthalmologist, ENT, and possibly a neurologist regarding chronic headaches[,]" we believe good cause for the additional QME panels has been established. (Exhibit Q, p. 15.)
The facts that decided it
What the panel treated as outcome-determinative, and which side it favoured.
Dr. Schaffzin recommended further evaluations by specialists in pulmonology, internal medicine for diabetes, ophthalmology, ENT, and neurology.
Favours Applicant prevailed
This recommendation established good cause for additional QME panels, leading to the grant of the petition for reconsideration.
From the decision · page 6Based upon the foregoing, and Dr. Shaffzin's recommendation in his report of December 19, 2023 for further evaluations by "a pulmonologist, an internist for diabetes mellitus, ophthalmologist, ENT, and possibly a neurologist regarding chronic headaches[,]" we believe good cause for the additional QME panels has been established. (Exhibit Q, p. 15.)
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.
Found injury AOE/COE and permanent disability to cervical and lumbar spine, bilateral shoulders, and right thumb; recommended further evaluations by pulmonologist, internist for diabetes mellitus, ophthalmologist, ENT, and possibly neurologist regarding chronic headaches.
Dr. Schaffzin's recommendation for further evaluations established good cause for additional QME panels.
From the decision · page 2FACTS Applicant, while employed by defendant as a licensed vocational nurse during the period from April 1, 2000 through January 29, 2022, claimed injury AOE/COE to her cervical and lumbar spine, shoulders, and right thumb. Applicant also claimed injury AOE/COE to the additional body parts of stress, psyche, sleep, head (headaches), eyes (vision), ears (hearing), and internal body systems (diabetes, kidney, pulmonary). The parties proceeded with discovery and retained Dr. Elliott Schaffzin as the orthopedic panel QME. On December 19, 2023, Dr. Schaffzin completed an initial evaluation. His corresponding report was issued on January 18, 2024. (Exhibit Q.) A supplemental report, dated July 31, 2024, was also prepared and issued by Dr. Schaffzin. (Exhibit P.) In his initial report, Dr. Schaffzin found injury AOE/COE and permanent disability to the cervical and lumbar spine, bilateral shoulders, and right thumb. (Exhibit Q, pp.
The rules the panel named
Authorities as the decision cited them, with how this panel applied each one.
Cal. Code Regs., tit. 8, 31.7(b)
WCAB Rule 31.7 regarding additional QME panels
The Board applied this rule to determine good cause for additional QME panels.
From the decision · page 4II. Turning now to the merits of the Petition, WCAB Rule 31.7 states that when a new medical dispute arises after the Agreed Medical Evaluator (AME), agreed panel QME, or panel QME has issued a comprehensive medical-legal report, the parties are to obtain a follow-up evaluation or supplemental report from the same evaluator. (Cal. Code Regs., tit. 8, § 31.7(a).) If a panel QME
Hamilton v. Lockheed Corporation (2001) 66 Cal.Comp.Cases 473, 476 (Appeals Bd. en banc)
Substantial evidence standard for decisions
The Board applied this standard to require decisions be based on admitted evidence and supported by substantial evidence.
From the decision · page 5We note, however, that applicant need not establish causation to disputed body parts in order to request QME panels for those body parts. Further, in our en banc decision in Hamilton v. Lockheed Corporation (2001) 66 Cal.Comp.Cases 473, 476 (Appeals Bd. en banc), we concluded that a decision "must be based on admitted evidence in the record" (Id. at p. 478) and must be supported by substantial evidence. (Lab. Code, § 5903, 5952, subd. (d); Lamb v. Workmen's Comp. Appeals Bd. (1974) 11 Cal.3d 274 [39 Cal.Comp.Cases 310]; Garza v. Workmen's Comp. Appeals Bd. (1970) 3 Cal.3d 312 [35 Cal.Comp.Cases 500]; LeVesque v. Workers' Comp. Appeals
What proof carried it
The evidence the panel weighed, by kind.
Dr. Schaffzin's recommendation for further evaluations by specialists in pulmonology, internal medicine for diabetes, ophthalmology, ENT, and neurology
From the decision · page 6Based upon the foregoing, and Dr. Shaffzin's recommendation in his report of December 19, 2023 for further evaluations by "a pulmonologist, an internist for diabetes mellitus, ophthalmologist, ENT, and possibly a neurologist regarding chronic headaches[,]" we believe good cause for the additional QME panels has been established. (Exhibit Q, p. 15.)
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About this page
- A published decision of the California Workers' Compensation Appeals Board, taken apart by what it turned on. The Board publishes the decision itself; this page adds the extraction and quotes the passage behind every claim.
- The injured worker is not named here, and the case caption is not printed. Physicians appear as the decision names them, because a medical opinion is an act in a public proceeding.
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