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When You Suffer New Injuries to the Same Body Area Do You Have to Use the Same Panel Qualified Medical Evaluator (QME)?

Workers' compensation cases often involve intricate questions like this — and claims frequently require appeal when controversies arise over whether the proper procedure was followed.

Recently, in April 2014, the Workers' Compensation Appeal Board heard the case Ismael Navarro vs. City of Montebello, administered by Corvel Corporation. The attorney for the plaintiff asserted that the client was entitled to a new panel QME for the two new injury claims he submitted. The defense argued that all three claimed injuries involved the same parties and one of the same body parts. The defense contended that the original panel QME for the first claimed injury must evaluate the subsequent claimed injuries according to Rule 35.5 (e).

Navarro worked as a police officer for the City of Montebello. He filed his injury claims during his employment there and while represented by an attorney. The original claim alleged cumulative injury to his back and ear during the period from February 8, 2009 through February 9, 2009. On October 4, 2010 he filed applications alleging a specific injury to his back, lower extremities and legs along with another claim for a specific injury to his back and left leg.

The Workers Compensation Appeals Board rendered the following decision:

  • The Labor Code does not require employees to return to the same panel QME for evaluation of later injury claims
  • The Rule 35.5 (e) that required employees to return to the same evaluator for new injuries or illnesses is invalid because it is inconsistent with the Labor Code

By obtaining an experienced Orange County workers’ compensation law firm, you can receive the legal guidance necessary to address procedural disputes like the one in the Navarro case.

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