Xchanging; Granite States Insurance Company; and Sedgwick Claims Management Services, Inc. (Claims Administrator), Tracy Lee, WORKERS’ COMPENSATION APPEALS BOARDSTATE OF CALIFORNIATRACYLEE,Applicant,vs.XCHANGING; GRANITE STATES INSURANCE COMPANY; and SEDGWICK CLAIMS MANAGEMENT SERVICES, INC. (Claims Administrator),Defendants.Case No. ADJ7643460(Sacramento Dist. Office)OPINION AND ORDER DENYING PETITION FOR REMOVAL Defendant, Granite States Insurance Company, has filed a Petition for Removal requesting that the Appeals Board reverse the February 1, 2017 order issued by the workers’ compensation administrative law judge (WCJ) that denied defendant’s request for a replacement qualified medical evaluator (QME) panel. In its Petition, defendant contends that the February 1, 2017 order denying a new QME panel causes it substantial prejudice and/or irreparable harm because: (1) Phillip Hay, M.D., the current panel QME in orthopedics, did not issue a timely supplemental report in violation of Rule 38(i) (Cal. Code Regs., tit. 8, § 38(i)) and, therefore, it is entitled to a new QME panel under Rule 31.5(a)(12) (Cal. Code Regs., tit. 8, § 31.5(a)(12)); and (2) defendant is entitled to a replacement QME panel because the prejudice caused by an untimely supplemental report is more substantial than the prejudice caused by recommencing the panel QME process. Applicant, in propria persona, has filed an Answer in response to defendant’s Petition. Further, the WCJ has filed a Report and Recommendation on Petition for Removal (Report) recommending that the Petition be denied./// , I, BACKGROUND On November 3, 2010, applicant, Tracy Lee, sustained an injury arising out of and in the course of employment to her left shoulder, elbow, and wrist while employed as a claims adjuster by XChanging. (See Findings of Fact with Opinion on Decision, 5/24/13.)1 A QME panel in orthopedics was issued from which applicant selected Dr. Hay. As
Tracy Lee, vs. Xchanging; Granite States Insurance Company; And Sedgwick Claims Management Services, Inc. (claims Administrator),
This case involves Xchanging, Granite States Insurance Company, and Sedgwick Claims Management Services, Inc. (Claims Administrator). Granite States Insurance Company filed a Petition for Removal requesting that the Appeals Board reverse the February 1, 2017 order issued by the workers’ compensation administrative law judge (WCJ) that denied defendant’s request for a replacement qualified medical evaluator (QME) panel. The WCJ recommended that the Petition be denied, and the Appeals Board agreed, finding that the WCJ had good cause not to order a replacement QME given the evaluator's longstanding involvement in the case and the absence of a statutory or regulatory mandate that he be replaced.
- Filed On:
- Court: California, Sacramento
- Case No. ADJ7643460
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