LISA SIMMONS vs. STATE OF CALIFORNIA, DEPARTMENT MENTAL HEALTH, Legally Uninsured; STATE COMPENSATION INSURANCE FUND/STATE CONTRACT SERVICES, Adjusting Agency

is a case involving Lisa Simmons, an applicant, and the State of California, Department of Mental Health, Legally Uninsured; State Compensation Insurance Fund/State Contract Services, Adjusting Agency, defendants. The case involves a petition for reconsideration and/or removal from the Findings and Award, issued August 1, 2012, in which a workers' compensation administrative law judge (WCJ) appointed an Independent Medical Examiner (IME) to evaluate applicant. The WCJ found the medical record was not sufficient to determine applicant's need for home health care, nursing services, maid and cleaning services, and whether defendant appropriately terminated these services, as an element of her 2006 award of further medical treatment for her 2002 industrial injury. The WCJ indicated that the

STATE OF CALIFORNIA, DEPARTMENT MENTAL HEALTH, Legally Uninsured; STATE COMPENSATION INSURANCE FUND/STATE CONTRACT SERVICES, Adjusting Agency LISA SIMMONS WORKERS’ COMPENSATION APPEALS BOARDSTATE OF CALIFORMALISA SIMMONS, Applicant,vs.STATE OF CALIFORNIA, DEPARTMENT MENTAL HEALTH, Legally Uninsured;STATE COMPENSATION INSURANCE FUND/STATE CONTRACT SERVICES,Adjusting Agency, Defendants.Case No. ADJ4211516 (LBO 0340807)OPINION AND ORDER DISMISSING PETITION FOR RECONSIDERATION, GRANTINGPETITION FOR REMOVAL AND DECISION AFTER REMOVAL            Defendant, State of California, Department of Mental Health, legally uninsured, has filed a petition seeking reconsideration and/or removal from the Findings and Award, issued August 1, 2012, in which a workers’ compensation administrative law judge (WCJ) appointed an Independent Medical Examiner (IME) to evaluate applicant. The WCJ found the medical record was not sufficient to determine applicant’s need for home health care, nursing services, maid and cleaning services, and whether defendant appropriately terminated these services, as an element of her 2006 award of further medical treatment for her 2002 industrial injury. The WCJ indicated that the reason for the referral to an IME to resolve the disputed issues was to avoid the appearance of impropriety or bias due to the unrepresented applicant’s complaints of bias on the part of Dr. Kanter, the Qualified Medical Evaluator, who had concluded applicant was not in need of the requested services.            Defendant contests the WCJ’s appointment of an IME, contending that there was no bias demonstrated by the conduct in this case as well as there being is no basis for the WCJ’s assertion that there was an appearance of impropriety or bias that needed to be ameliorated. Defendant further contends that the opinion of Dr. Kanter is sufficient to support a decision that applicant is not in need of home health care, nursing services, maid and cleaning services. Alternatively, defen

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