Applicant is entitled to a new Qualified Medical Examiner ( QME ) pursuant to Navarro v. City of Montebello (2014) 79 ccc 418 when applicant filed a new injury claim after being examined by the original QME for the prior claims. Defendant claimed that applicant intentionally delayed filing new claim to obtain new QME. No evidence to support allegation.
Date of Injury- Injured employee is generally not charged with knowledge that disability is job related absent medical advice to that effect unless nature of disability and employee’s training, intelligence and qualifications are such that employee should have recognized relationship between known adverse factors involved.
Section 10324, California Code of Regulations provides that no document, including letters or other writings, shall be filed by a party or lien claimant with the Worker’s Compensation Appeals Board unless service of a copy thereof is made on all parties together with the filing of a proof of service as provided for in Rule 10505.
Calif Code of Regulations, Section 38-(a) The time frame for an initial or a follow up comprehensive medical legal evaluation report to be prepared and submitted shall not exceed thirty (30) days after the QME, Agreed Panel QME or AME has seen the employee or otherwise commenced the comprehensive medical-legal evaluation procedure.
Provides the procedure to be followed to secure a physician in a different specialty.
AMA Guides: The impairment ratings provided in the AMA Guides are “designed to reflect functional limitations… that is, they, ..reflect the severity of the medical condition and the degree to which the impairment decreases an individual’s ability to perform activities of daily living.”
An opinion of a Vocational Rehabilitation expert must be based on a labor market survey or research or exploration into the issue of whether applicant can work outside his home to constitute substantial evidence and be relied on by the WCAB.
Whether a person is an independent contractor will be based on various facts surrounding the relationship with the “employer.” (1) The ability to control an individual’s work; (2) the worker’s opportunity for profit or loss; (3) Whether the service rendered required a special skill; (4) The degree of permanence of the working relationship; (5) Whether the service rendered was an integral part of the alleged employer’s business; (6) Which party provides the tools and materials used at the job; (7) How the worker is paid for his services.
Medically Required Equipment.
In Green v. WCAB, 74 CCC 998, the Court held that an applicant was not required to relocate to another home at defendant’s request to avoid cost of installing medically required elevator and defendant was required to construct and install elevator in applicant’s home.
Regents of the University of California V WCAB (2011) 76 CCC 1237. Applicant found to be Permanently Totally Disabled(PTD) based on her inability to engage in gainful employment in the open labor market. Of significance was the judge’s determination that no apportionment to prior injuries was warranted because apportionment is not appropriate when PTD is based on the inability to compete in the open labor market