Workers’ Compensation · Primary-source case analysis

Willette: An Unrepresented Worker Must Use the Panel-QME Path After UR

Decision: Workers’ Compensation Appeals Board, SJO 0245781, decided October 5, 2004. Document: WCAB en banc opinion and decision after reconsideration.

Willette v. AU Electric Corporation addressed the medical-legal path for an unrepresented employee after utilization review did not approve requested treatment in full.

A timely objection begins the dispute process

An unrepresented employee who contests the UR determination must object within the governing period rather than allow the decision to become final.

A panel QME resolves the medical dispute

The statutory procedure calls for a panel evaluator after the worker makes the timely objection.

The treating and UR physicians do not reopen the contest

After the QME evaluation, those physicians may not issue additional reports addressing the same post-UR treatment dispute.

No single medical report automatically controls

At trial the QME, treating-physician, and UR reports may all be considered, with weight determined from the complete record.

Key takeaways

Discuss the procedural record

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