Workers' compensation tribunal rules claimant is entitled to more panels of medical evaluators
The Workers' Compensation Appeals Board of California recently ruled that an applicant was unable to conduct the medical-legal discovery needed to determine compensability for the alleged workplace injuries without the additional panels in neurology and psychology that she requested.
The applicant in the case of Bautista vs. The Beauty Box; Employers Preferred Insurance Company claimed that she sustained injuries to her back, neck, shoulders, legs, pelvis, head, and sleep and “COVID” while working for The Beauty Box from January to August 2020. The defendant denied that the injuries arose out of and in the course of employment.
The treating physician evaluated the applicant and diagnosed injury to her cervical and lumbar spine.
A qualified medical evaluator in orthopedics diagnosed cervical and lumbar spine injuries but found that the applicant’s eight months of employment did not cause the injuries. The evaluator stated that the applicant would have to consult with a spine “subspecialist” about specific restrictions and impairment before the report could be finalized.
The applicant asked for the issuance of additional panels of qualified medical evaluators in neurology and psychology to evaluate the alleged injuries under Administrative Director Rule 31.7, which addressed the matter of additional panels in other specialties.
The workers’ compensation administrative law judge determined that the evaluator and the treating physician did not identify a medical issue requiring consultation outside their areas of expertise. Thus, the judge found that the applicant was not entitled to the additional panels that she requested.
The applicant filed a petition seeking reconsideration. The applicant argued that the orthopedic evaluator’s deferral of all issues, including psychiatric and neurological, outside his medical specialty showed that there was a good cause for the issuance of additional panels in those specialties.
A panel of the Workers' Compensation Appeals Board of California rescinded the judge’s factual findings. A new decision was issued finding it appropriate to issue additional panels in neurology and psychology to fully address the alleged injury.
The panel noted that the applicant claimed injuries to body parts beyond the field of orthopedic medicine and that the evaluator specializing in orthopedics stated that he would defer evaluation in neurology and psychology to the appropriate specialists in those medical fields.
The workers’ compensation administrative law judge said in his report that, if the evaluator’s identification of a body part as beyond their specialty was enough for an applicant to obtain an additional panel, applicants would be able to acquire endless numbers of panels simply by claiming injuries in other areas.
In response, the panel said that the judge had broad discretion under California’s Labor Code and under the rules on discovery to issue interlocutory orders on discovery as needed to ensure a full and fair adjudication, to expedite litigation, and to protect the parties against unfair surprise.