On March 21, 2023, the Workers’ Compensation Board of Appeals (WCAB) overturned a work injury “apportionment” made by a Qualified Medical Evaluator (QME) in the case of Monter v. Randstad North America, Inc.. In doing so, the WCAB awarded additional workers’ compensation benefits to the claimant. The decision is instructive for employers and insurers. Here, our Salinas workers’ compensation defense lawyers provide a detailed overview of the decision from the Workers’ Compensation Appeals Board (WCAB).
Case Review: Monter v. Randstad North America, Inc.
Background and Facts
The worker (Monter) was employed as a “packer” for Randstad North America, Inc. in California. In 2019, she sustained a lower back injury while on the job. She filed for workers’ compensation benefits. In January of 2022, the worker was assessed by a Qualified Medical Evaluator (QME). The QME determined that she had reached Maximum Medical Improvement (MMI). The QME determined that the injured worker had an 8% permanent impairment. Additionally, the QME determined that half of the impairment was caused by the work injury and half was non-job related.
Note: in California, a QME is a licensed physician who is certified by the Division of Workers’ Compensation – Medical Unit to perform medical evaluations in workers’ compensation cases. QMEs are independent medical experts who assess injured workers when there are disputes between the employee and the insurance company over the extent or nature of the worker’s injury, the treatment necessary, or the level of permanent disability.
The Key Legal Issue
The injured worker appealed the decision by the QME. Specifically, the injured worker argued that the disability rating assigned by the QME was too low given the circumstances. She sought to have the disability rating increased to 14%. As disability rating is used to determine the amount of permanent disability benefits, even a seemingly modest difference in disability rating —8% versus 14%—can represent a difference of many thousands of dollars. Further, the injured worker argued that the entire disability (whether 8% or 14%) was work-related.
The Decision of the WCAB
Upon review, the WCAB ruled in favor of the employee and against the employer/insurer—and the QME. Notably, the opinion of a Qualified Medical Evaluator is given significant weight in workers’ compensation claims in California. However, the opinion of the QME can be challenged. It will not automatically be accepted by an Appeals Court.
Further, it is important to emphasize that defendants in workers’ compensation disputes in California have the burden of proof in apportionment cases. In other words, if an employer or insurer wishes to blame a non-work-related issue is responsible for a worker’s permanent impairment, they must present compelling evidence.
Speak to Our Salinas Work Injury Claims Defense Attorneys Today
At Yrulegui & Roberts, our Salinas work injury defense lawyers are skilled, experienced, and reliable advocates for employers and insurance carriers. If you have any specific questions or concerns about a case involving a QME, we are more than ready to help. Call us now or contact us online for your completely confidential initial appointment. We provide workers’ compensation defense services in Salinas, the Salinas Valley, and throughout the wider region.
