What the panel ordered
The WCAB rescinded the October 4, 2022 Findings and Award and ordered that applicant is entitled to a new QME evaluation; all other issues including costs and sanctions are deferred.
Applicant sought reconsideration of the Findings and Award issued on October 4, 2022, by the WCJ, who found applicant was not entitled to an additional QME evaluation.
This docket was decided more than once. Shown here is the latest released decision; we also hold October 11, 2021.
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 Appeals Board en banc in Navarro held that an employee is entitled to a new QME evaluation for a subsequent claim of injury filed on a new claim form, regardless of whether the injury involves the same body parts or employer, and the Labor Code provisions support this interpretation.
From the decision · page 3In Navarro v. City of Montebello (2014) 79 Cal. Comp. Cases 418 (Appeals Board en banc), the Appeals Board held en banc that the "Labor Code does not require an employee to return to the same panel QME for an evaluation of a subsequent claim of injury." (Navarro, supra, 79 Cal. Comp. Cases at p. 420.)
The facts that decided it
What the panel treated as outcome-determinative, and which side it favoured.
Applicant filed a new claim form on August 13, 2020, for a specific injury to the right knee, different from the prior cumulative trauma claim.
Favours Applicant prevailed
This new claim form filing triggered entitlement to a new QME evaluation under Navarro and Labor Code provisions.
From the decision · page 2Also on August 13, 2020, applicant filed a new Application for Adjudication of Claim alleging a specific injury on October 3, 2017 to the right knee and other body parts. (Joint Exhibit No. 13, Application for Adjudication of Claim, August 13, 2020.) A DWC-1 claim form dated August 13, 2020 for this injury was filed with the Application.1 This claim was assigned ADJ13490319 and has apparently been denied by defendant.
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.
Dr. Uppal opined that applicant's right knee condition resulted from a specific injury on October 3, 2017 and did not report complaints consistent with cumulative trauma injury. He attributed causation to the specific injury date.
From the decision · page 2An orthopedic QME panel was obtained to address ADJ11233436. (Joint Exhibit No. 9, Panel List by the DWC, June 11, 2018.) G. Sunny Uppal, M.D. was the resulting QME from this panel and evaluated applicant in 2018. (Joint Exhibit No. 1, QME Report by Sunny Uppal, M.D., August 6, 2018.) Dr. Uppal opined that applicant's right knee condition resulted from a specific injury on October 3, 2017 and "did not report any complaints or history consistent with a cumulative trauma injury." (Joint Exhibit No. 3, QME Report by Sunny Uppal, M.D., October 2, 2018, p. 4.) Dr. Uppal attributed causation for applicant's right knee condition to the October 3, 2017 specific injury. (Joint Exhibit No. 2, QME Report by Sunny Uppal, M.D., August 13, 2019, p. 2.)
The rules the panel named
Authorities as the decision cited them, with how this panel applied each one.
Navarro v. City of Montebello (2014) 79 Cal. Comp. Cases 418 (Appeals Board en banc)
Labor Code sections 4062.3(j), 4064(a), 5401, and 5813; Navarro v. City of Montebello (2014) 79 Cal. Comp. Cases 418 (Appeals Board en banc)
The Board applied Navarro and the Labor Code provisions to conclude applicant is entitled to a new QME evaluation for a subsequent claim of injury filed on a new claim form.
From the decision · page 3In Navarro v. City of Montebello (2014) 79 Cal. Comp. Cases 418 (Appeals Board en banc), the Appeals Board held en banc that the "Labor Code does not require an employee to return to the same panel QME for an evaluation of a subsequent claim of injury." (Navarro, supra, 79 Cal. Comp. Cases at p. 420.)
What proof carried it
The evidence the panel weighed, by kind.
No testimony or credibility determinations were made regarding applicant's attorney's conduct; no contemporaneous documents established bad faith conduct.
From the decision · page 5As we noted in our prior decision, there is an appearance of impropriety in applicant attorney's conduct in this matter. However, appearances alone are insufficient to find bad faith. A decision "must be based on admitted evidence in the record[.]" (Hamilton v. Lockheed Corporation (Hamilton) (2001) 66 Cal.Comp.Cases 473, 478 (Appeals Board en banc).) No testimony was taken from applicant or applicant's attorney. No credibility determinations were made. No contemporaneous documents were offered as evidence establishing a course of conduct. Thus, the record is presently insufficient to consider whether applicant's attorney's acted in bad faith.
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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.
- Issues, outcomes and weights were extracted by AI and released only where the source passage checked. Read the official decision before relying on anything here. Not legal advice.
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