What the panel ordered
Denial of Defendant's Petition for Reconsideration; telehealth evaluation with QME Dr. Bahman Omrani upheld
Petition for Reconsideration of the Findings and Order issued by the WCJ on November 16, 2020, denying reconsideration and affirming the order for telehealth QME 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.
The Appeals Board agreed with the WCJ that defendant unreasonably denied agreement to a telehealth evaluation under emergency regulation section 46.2, considering the applicant's health concerns and the QME's written attestation that a physical exam was not required.
From the decision · page 9Under the circumstances here, we agree with the WCJ that defendant unreasonably denied agreement to a telehealth evaluation per the emergency regulation. Applicant meets the elements of section 46.2(a)(3) for a telehealth QME evaluation for his internal medicine complaints. We decline to order him to risk his health and the health of his household, in addition to potentially other members of the public, to attend an in-person evaluation with Dr. Omrani.
The facts that decided it
What the panel treated as outcome-determinative, and which side it favoured.
Dr. Bahman Omrani attested in writing that he would conduct the QME appointment via telehealth without a physical examination.
Favours Applicant prevailed
This attestation satisfied the emergency regulation requirements for telehealth evaluation without physical exam, supporting the applicant's position.
From the decision · page 2On August 26, 2020, Dr. Omrani faxed applicant's August 21st letter back with the following in handwriting: "I Dr. Omrani will conduct the PQME appointment for patient Rosenbook, Kenneth via telehealth w/o a physical examination." (Id.) Dr. Omrani's signature is under this statement.
Applicant testified about health concerns and unwillingness to travel to California for in-person evaluation due to COVID-19 risks.
Favours Applicant prevailed
Applicant's credible testimony about health risks supported the reasonableness of telehealth evaluation and rejection of in-person evaluation.
From the decision · page 3He currently lives in Washington State. The appointment with Dr. Omrani was set for California. To attend that examination, he would need to travel and have lodging and meals.
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. Omrani confirmed he would conduct the QME appointment via telehealth without a physical examination.
From the decision · page 2On August 26, 2020, Dr. Omrani faxed applicant's August 21st letter back with the following in handwriting: "I Dr. Omrani will conduct the PQME appointment for patient Rosenbook, Kenneth via telehealth w/o a physical examination." (Id.) Dr. Omrani's signature is under this statement.
The rules the panel named
Authorities as the decision cited them, with how this panel applied each one.
Cal. Code Regs., tit. 8, 46.2
Emergency regulation section 46.2 allowing telehealth QME evaluations when physical exam is not necessary and agreement is not unreasonably denied.
Applied to determine the reasonableness of denial of telehealth evaluation.
From the decision · page 5Emergency regulation section 46.2 provides as follows in relevant part:
Lab. Code, 4628(a)
Labor Code section 4628(a) permitting parts of medical-legal examination to be performed by a nurse and not necessarily the physician.
Considered in evaluating the necessity of physical examination by the QME.
From the decision · page 8(a) Except as provided in subdivision (c), no person, other than the physician who signs the medical-legal report, except a nurse performing those functions routinely performed by a nurse, such as taking blood pressure, shall examine the injured employee or participate in the nonclerical preparation of the report, including all of the following:
What proof carried it
The evidence the panel weighed, by kind.
Applicant's testimony about health concerns and unwillingness to travel to California for in-person evaluation due to COVID-19 risks.
From the decision · page 3He currently lives in Washington State. The appointment with Dr. Omrani was set for California. To attend that examination, he would need to travel and have lodging and meals.
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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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