In a recent panel decision by the Workers’ Compensation Appeals Board (WCAB), Byers v. Sonsray Machinery, the Board provided critical insights into the standards for Qualified Medical Evaluator (QME) disqualification and the burden of proof required to challenge the adequacy of a QME’s examination. The decision, which addresses a petition filed by an applicant challenging the findings of a workers’ compensation administrative law judge (WCJ), underscores the procedural and evidentiary hurdles applicants must overcome when raising such objections.
As a California defense law firm, understanding the nuances of this decision helps us strategically defend against similar claims and ensure that procedural safeguards are upheld. Below, we outline the key points from the WCAB’s opinion and their implications for employers and insurance carriers.
Case Background
The applicant, a senior mechanic, claimed an industrial injury to multiple body parts while employed from 2012 to 2019. The parties selected Dr. Charles Sonu as the QME in orthopedic surgery, and he conducted an evaluation in February 2023.
In April 2024, the applicant filed a Declaration of Readiness to Proceed (DOR), asserting that the QME failed to perform a physical examination and was unavailable for deposition. At trial, the WCJ found that the QME’s evaluation was credible, and the applicant had failed to meet the burden of proving disqualification or unavailability for deposition.
The applicant subsequently petitioned the WCAB, arguing that his testimony—stating no physical examination occurred—was unrebutted and that the QME’s evaluation was inadequate.
WCAB’s Key Findings
1. QME Disqualification Requires Credible Evidence
The WCJ found the QME’s detailed physical findings and attestations of having conducted an examination persuasive. The WCAB concurred, emphasizing that the applicant’s testimony alone was insufficient to disqualify the QME, particularly in the absence of timely objections or corroborating evidence.
This decision reinforces the principle that medical reports containing specific findings and affirmations under penalty of perjury carry significant weight in determining credibility. Defense attorneys should highlight the detailed nature of QME reports to counter vague or unsupported claims of inadequacy.
2. Timeliness of Objections is Critical
The applicant did not raise concerns about the QME’s examination until over a year after the evaluation. The WCAB noted that such delays weaken the credibility of the objections. Employers and carriers should encourage prompt objections to procedural issues to avoid prolonged litigation and preserve the integrity of QME evaluations.
3. Burden of Proof for Deposition Availability Lies with the Applicant
The WCAB rejected the applicant’s argument that the QME was unavailable for deposition due to scheduling conflicts during “normal business hours.” The Board clarified that the applicant failed to provide evidence supporting unavailability.
Defense counsel should remind applicants that they bear the burden of proving deposition-related claims and ensure that QME depositions are appropriately documented to prevent such challenges.
Practical Implications for Defense Counsel
This decision offers valuable guidance for California workers’ compensation defense attorneys:
- Ensure Timely Objections: Encourage prompt communication with applicants regarding QME evaluations to avoid untimely objections that may disrupt the claims process.
- Highlight QME Credibility: Emphasize the detailed nature of QME findings and the statutory attestations under penalty of perjury during litigation.
- Defend Deposition Scheduling: Be prepared to demonstrate good faith efforts in scheduling depositions and remind opposing counsel of their evidentiary burden.
- Preserve the Record: Document all communications, objections, and procedural steps to ensure that defense arguments are well-supported at trial or on appeal.
Conclusion
The WCAB’s denial of the applicant’s petition highlights the high bar for disqualifying a QME and reinforces the importance of procedural compliance and evidentiary support in workers’ compensation claims. As defense counsel, understanding these procedural standards helps us protect our clients’ interests and uphold the integrity of the workers’ compensation process.
For employers and carriers, this case serves as a reminder to work closely with defense attorneys to ensure procedural safeguards are in place and disputes are effectively managed.
For more information on workers’ compensation defense strategies, contact Yrulegui & Roberts today.
