This is a Workers’ Compensation Appeals Board (WCAB) Panel decision
- Posted By: Harvey Brown
- December 31, 2021
This is a very significant case for workers’ compensation principles.
The applicant claimed a cumulative trauma through May 2020. The applicant applied for benefits on March 23,2021. Defendant sent a delay notice on April 23, 2021.
Defendant indicated that in order to make a decision they needed a med-legal examination, prior medical records, and applicant’s statement.
Applicant requested a chiropractic before defendant issued the denial notice.
An expedited hearing was held and the Workers’ Compensation Judge (WCJ) held that the panel QME list was invalid because it was obtained before the defendant denied the claim. Further the WCJ ruled there was no dispute while the claim was in delay.
Applicant petitioned for removal arguing the QME panel was valid. The WCJ recommended removal be denied. The WCAB heard the case on removal.
The WCAB saw in defendant’s delay letter a need for a med-legal exam to determine the compensability of the claim. The Board rejected the WCJ opinion that there must be a dispute before applicant can initiate the QME process. They indicated that a delay letter initiates the dispute because the claim is not accepted. Waiting until a denial letter issued would be against public policy. The Board indicated the applicant properly obtained the QME.
Cervantes v. Classic Cosmetics, Inc
Samuelsen, Gonzalez, Valenzuela & Brown
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