What the panel ordered
The WCAB granted the petition for reconsideration, rescinded the Joint Findings and Order, and ordered an additional QME panel in neurology to evaluate the applicant's sleep issues.
Applicant sought removal of the Joint Findings and Order issued by the WCJ on September 8, 2021, challenging the denial of an additional QME panel in neurology for sleep disorder evaluation.
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 processApplicant prevailedsleep disorder
Applicant showed good cause for an additional QME panel in neurology to evaluate her sleep disorder, and the WCAB found that the absence of such a panel prevented necessary medical-legal discovery to meet the burden of proof for compensability.
From the decision · page 4Applicant has pled injury in the form of a sleep disorder. Defendant disputes compensability for this condition. Section 4062.2 governs the process to obtain a medical-legal evaluation from a panel QME in a represented case if the parties do not agree on an AME. (Lab. Code, § 4062.2.) In the absence of an additional panel in neurology, applicant is prevented from conducting necessary medical-legal discovery to meet her burden of proof to show compensability for her sleep disorder. We therefore agree with applicant that an additional QME panel in neurology is warranted. (See McClune v. Workers' Comp. Appeals Bd. (1998) 62 Cal.App.4th 1117, 1121-1122 [63 Cal.Comp.Cases 261]; Tyler v. Workers' Comp. Appeals Bd. (1997) 56 Cal.App.4th 389, 394 [62 Cal.Comp.Cases 924]; Lab. Code, § 5701, 5906 [the Appeals Board has the discretionary authority to develop the record when the medical record is not substantial evidence or when appropriate to provide due process or fully adjudicate the issues].)
The facts that decided it
What the panel treated as outcome-determinative, and which side it favoured.
Applicant claimed injury including sleep disorder related to work.
Favours Applicant prevailed
Supported the need for additional QME panel to evaluate sleep issues.
From the decision · page 2FACTUAL BACKGROUND Applicant claims two injuries while employed as a social worker by the County of Los Angeles-LAC/USC: to the cervical spine, lumbar spine, bilateral knees, right shoulder, bilateral hands and wrists, bilateral fingers, psyche and sleep disorder through December 3, 2013 (ADJ9313956); and to the hands, psyche and sleep disorder on November 5, 2013 (ADJ9313954). Defendant denies compensability for the psyche and sleep disorder. (Minutes of Hearing, July 15, 2021, pp. 2-3.) The parties have agreed to use Laura Wertheimer Hatch, M.D. as the orthopedic agreed medical evaluator (AME). Dr. Hatch noted that applicant complains of "sleep disorder associated with her work injuries." (Joint Exhibit No. 2, Report of AME Laura Wertheimer Hatch, M.D., March 5, 2018, p. 9.) Baba Singh, Psy.D. is the psychological panel QME. Dr. Singh also reported issues with applicant's sleep purportedly related to both her mood and chronic pain. (Joint Exhibit No. 1, Report of QME Baba Singh, Psy.D., January 25, 2019, pp. 4-5.) The matter proceeded to trial on July 15, 2021 on the sole issue of whether there is a need for an additional QME panel in the specialty of neurology or another specialty to address applicant's sleep issues. (Minutes of Hearing, July 15, 2021, p. 3.) The WCJ issued the Joint F&O as outlined above.
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.
AMERelied upon · orthopedic
Noted applicant's complaint of sleep disorder associated with work injuries.
From the decision · page 2FACTUAL BACKGROUND Applicant claims two injuries while employed as a social worker by the County of Los Angeles-LAC/USC: to the cervical spine, lumbar spine, bilateral knees, right shoulder, bilateral hands and wrists, bilateral fingers, psyche and sleep disorder through December 3, 2013 (ADJ9313956); and to the hands, psyche and sleep disorder on November 5, 2013 (ADJ9313954). Defendant denies compensability for the psyche and sleep disorder. (Minutes of Hearing, July 15, 2021, pp. 2-3.) The parties have agreed to use Laura Wertheimer Hatch, M.D. as the orthopedic agreed medical evaluator (AME). Dr. Hatch noted that applicant complains of "sleep disorder associated with her work injuries." (Joint Exhibit No. 2, Report of AME Laura Wertheimer Hatch, M.D., March 5, 2018, p. 9.) Baba Singh, Psy.D. is the psychological panel QME. Dr. Singh also reported issues with applicant's sleep purportedly related to both her mood and chronic pain. (Joint Exhibit No. 1, Report of QME Baba Singh, Psy.D., January 25, 2019, pp. 4-5.) The matter proceeded to trial on July 15, 2021 on the sole issue of whether there is a need for an additional QME panel in the specialty of neurology or another specialty to address applicant's sleep issues. (Minutes of Hearing, July 15, 2021, p. 3.) The WCJ issued the Joint F&O as outlined above.
QMERelied upon · psychology
Reported issues with applicant's sleep related to mood and chronic pain.
From the decision · page 2FACTUAL BACKGROUND Applicant claims two injuries while employed as a social worker by the County of Los Angeles-LAC/USC: to the cervical spine, lumbar spine, bilateral knees, right shoulder, bilateral hands and wrists, bilateral fingers, psyche and sleep disorder through December 3, 2013 (ADJ9313956); and to the hands, psyche and sleep disorder on November 5, 2013 (ADJ9313954). Defendant denies compensability for the psyche and sleep disorder. (Minutes of Hearing, July 15, 2021, pp. 2-3.) The parties have agreed to use Laura Wertheimer Hatch, M.D. as the orthopedic agreed medical evaluator (AME). Dr. Hatch noted that applicant complains of "sleep disorder associated with her work injuries." (Joint Exhibit No. 2, Report of AME Laura Wertheimer Hatch, M.D., March 5, 2018, p. 9.) Baba Singh, Psy.D. is the psychological panel QME. Dr. Singh also reported issues with applicant's sleep purportedly related to both her mood and chronic pain. (Joint Exhibit No. 1, Report of QME Baba Singh, Psy.D., January 25, 2019, pp. 4-5.) The matter proceeded to trial on July 15, 2021 on the sole issue of whether there is a need for an additional QME panel in the specialty of neurology or another specialty to address applicant's sleep issues. (Minutes of Hearing, July 15, 2021, p. 3.) The WCJ issued the Joint F&O as outlined above.
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(a) and (b)(3)
Good cause for an additional QME panel in another specialty includes an order by a WCJ for such a panel.
Applied to find good cause for additional QME panel in neurology.
From the decision · page 3Administrative Director (AD) Rule 31.7(b) provides for an additional QME panel in another specialty as follows in relevant part:
Lab. Code, 4062.2
Process for obtaining medical-legal evaluation from a panel QME in a represented case if parties do not agree on an AME.
Applied to support the need for an additional QME panel in neurology.
From the decision · page 4Applicant has pled injury in the form of a sleep disorder. Defendant disputes compensability for this condition. Section 4062.2 governs the process to obtain a medical-legal evaluation from a panel QME in a represented case if the parties do not agree on an AME. (Lab. Code, § 4062.2.) In the absence of an additional panel in neurology, applicant is prevented from conducting necessary medical-legal discovery to meet her burden of proof to show compensability for her sleep disorder. We therefore agree with applicant that an additional QME panel in neurology is warranted. (See McClune v. Workers' Comp. Appeals Bd. (1998) 62 Cal.App.4th 1117, 1121-1122 [63 Cal.Comp.Cases 261]; Tyler v. Workers' Comp. Appeals Bd. (1997) 56 Cal.App.4th 389, 394 [62 Cal.Comp.Cases 924]; Lab. Code, § 5701, 5906 [the Appeals Board has the discretionary authority to develop the record when the medical record is not substantial evidence or when appropriate to provide due process or fully adjudicate the issues].)
Lab. Code, 5701, 5906
The Appeals Board has discretionary authority to develop the record when the medical record is not substantial evidence or when appropriate to provide due process or fully adjudicate the issues.
Applied to support the need for an additional QME panel in neurology.
From the decision · page 4Applicant has pled injury in the form of a sleep disorder. Defendant disputes compensability for this condition. Section 4062.2 governs the process to obtain a medical-legal evaluation from a panel QME in a represented case if the parties do not agree on an AME. (Lab. Code, § 4062.2.) In the absence of an additional panel in neurology, applicant is prevented from conducting necessary medical-legal discovery to meet her burden of proof to show compensability for her sleep disorder. We therefore agree with applicant that an additional QME panel in neurology is warranted. (See McClune v. Workers' Comp. Appeals Bd. (1998) 62 Cal.App.4th 1117, 1121-1122 [63 Cal.Comp.Cases 261]; Tyler v. Workers' Comp. Appeals Bd. (1997) 56 Cal.App.4th 389, 394 [62 Cal.Comp.Cases 924]; Lab. Code, § 5701, 5906 [the Appeals Board has the discretionary authority to develop the record when the medical record is not substantial evidence or when appropriate to provide due process or fully adjudicate the issues].)
What proof carried it
The evidence the panel weighed, by kind.
Medical recordsfavours Applicant prevailed
Applicant's claim of sleep disorder related to work injuries was supported by reports from the AME and QME.
From the decision · page 2FACTUAL BACKGROUND Applicant claims two injuries while employed as a social worker by the County of Los Angeles-LAC/USC: to the cervical spine, lumbar spine, bilateral knees, right shoulder, bilateral hands and wrists, bilateral fingers, psyche and sleep disorder through December 3, 2013 (ADJ9313956); and to the hands, psyche and sleep disorder on November 5, 2013 (ADJ9313954). Defendant denies compensability for the psyche and sleep disorder. (Minutes of Hearing, July 15, 2021, pp. 2-3.) The parties have agreed to use Laura Wertheimer Hatch, M.D. as the orthopedic agreed medical evaluator (AME). Dr. Hatch noted that applicant complains of "sleep disorder associated with her work injuries." (Joint Exhibit No. 2, Report of AME Laura Wertheimer Hatch, M.D., March 5, 2018, p. 9.) Baba Singh, Psy.D. is the psychological panel QME. Dr. Singh also reported issues with applicant's sleep purportedly related to both her mood and chronic pain. (Joint Exhibit No. 1, Report of QME Baba Singh, Psy.D., January 25, 2019, pp. 4-5.) The matter proceeded to trial on July 15, 2021 on the sole issue of whether there is a need for an additional QME panel in the specialty of neurology or another specialty to address applicant's sleep issues. (Minutes of Hearing, July 15, 2021, p. 3.) The WCJ issued the Joint F&O as outlined above.
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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.
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