Martinez v. Santa Clarita Community College

Martinez v. Santa Clarita Community College (BPD) (ADJ 8897155):

This case involves a denied continuous trauma injury. The applicant objected to the report from the treating orthopedist based upon the disability status of applicant’s medical condition.

Applicant simultaneously filed three separate requests for panels of Qualified Medical Evaluators in specialties of orthopedics, psychiatry and internal medicine. All of the requests were dated January 9, 2014. In each of the form 106’s, the applicant marked the box indicating the reason that the QME panel is being requested is 4062 (nonmedical treatment dispute under 4062).

The Division of Workers Compensation Medical Unit issued an orthopedic panel on February 7, 2014 and panels in psychiatry and internal medicine on February 10, 2014.

Defendant objected to the internal and psychiatric panels.

At the time of the hearing the applicant had not undergone a PQME evaluation in any of the three specialties requested. The parties proceeded to trial regarding the limited issue of whether applicant is entitled to undergo QME panels in orthopedic, psychiatry and internal medicine.

The WCJ ordered the defendant authorize the PQME in orthopedics, and found that the applicant was not entitled undergo a PQME evaluation in psychiatry and internal medicine at this time. The WCJ found the issue regarding applicant’s entitlement to psychiatric and internal PQME’s would be deferred until after the orthopedic PQME with jurisdiction reserved.

Applicant filed a Petition for Removal.

The WCJ indicated that applicant’s request for panel QME evaluations in specialties of internal and psychiatry were premature. The applicant must first complete an initial PQME examination prior to obtaining PQME evaluations in other specialties. The applicant had not met the criteria in §31.7 for obtaining different specialties at this time.

In addition, it is noted that applicant also failed to submit the appropriate form to request QME panels regarding other specialties. Pursuant to regulation §31.7, a party shall use Form 31.7 to request an additional QME panel in a different specialty. It is noted that Form 31.7 requires that the prior PQME panel number be identified when requesting other specialties, which could not have been done in this case as all three QME panels were improperly requested at the same time.

Notwithstanding the foregoing, the applicant failed to comply with the requirements of Labor Code §4062 regarding psychiatric and internal PQME’s. The applicant stated in the three QME requests that the reason for the QME panel is 4062 (nonmedical treatment dispute under 4062). However, the letter attached to each PQME objects to the opinions rendered by the orthopedist in his report. There is no reference in the report to any alleged internal or psychiatric injuries. Moreover, the applicant did not object to the findings of a psychiatrist or internal doctor prior to requesting PQME panels. Accordingly, the applicant failed to comply with the requirements of 4062 with regard to obtaining a panel of QME’s in specialties other than orthopedics at this time.

As the applicant was treating with an orthopedist at the time of the PQME request, and as applicant only objected to the findings of the orthopedist, it is appropriate to have the applicant PQME panel in orthopedics first.

The Petition for Removal was denied.

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