Can You Get a New PQME in California? Navarro and Cowell Case Explained

• Mar 25, 2022
• Blog
• Michael Burgis & Associates, P.C

If you are an injured worker or an applicant attorney handling a California workers’ compensation claim, you may have encountered an adverse medical report from a Panel Qualified Medical Examiner (PQME).

This is a common challenge. Many PQMEs issue conservative reports that minimize impairment, deny causation, or apportion disability away from work injury. For years, insurers and defense attorneys argued that workers were “stuck” with the same PQME for all related claims.

But case law — particularly Navarro (2014, en banc) and Cowell v. County of Los Angeles — clarified that injured workers are not bound to reuse an adverse PQME for new or subsequent claims.

This article examines the implications of these cases, the legal process behind PQME disputes, and how applicants can leverage this precedent to secure more equitable evaluations.

PQME vs AME: What’s the Difference?

In California, medical-legal evaluations are critical to determining entitlement to benefits.

• PQME (Panel Qualified Medical Examiner)
  • Selected from a three-doctor panel issued by the Division of Workers’ Compensation (DWC).
  • Requested when parties cannot agree on a doctor.
  • Governed by Labor Code §4062.1 (unrepresented workers) and §4062.2 (represented workers).
  • One party strikes a doctor, leaving the final choice.
• AME (Agreed Medical Examiner)
  • Chosen by mutual agreement between the applicant and the defense attorneys.
  • Common in represented cases.
  • Reports are usually afforded greater credibility by WCAB judges because both sides selected the examiner.

Why this matters: If you’re assigned a biased PQME who issues an adverse report, you need to know whether you can request a new panel.

The Navarro Decision (2014, En Banc)

Navarro v. City of Montebello (2014) 79 Cal. Comp. Cases 418 (en banc) was a landmark case that clarified the rights of PQMEs.

The Issue

• The worker received an adverse PQME report.
• The defense argued that the worker must continue using the same PQME for all related injuries.
• Applicants argued that new claims or different dates of injury entitled them to fresh panels.

The Holding

The WCAB en banc held:

• A new claim = new panel.
• Injured workers are not obligated to return to the same PQME for subsequent claims.
• The adverse PQME only applies to the original claim and date of injury.

This protected workers from being tied indefinitely to conservative examiners.

The Cowell Case

Cowell v. County of Los Angeles (WCAB panel decision) built on Navarro.

The Dispute

• Defense argued that prior PQME reports remained binding on older dates of injury.
• Applicants argued that timely filed claims should still allow new panels, regardless of the original date of injury.

The Holding

Cowell clarified:

• It is not the date of injury that controls.
• It is the date the claim is filed.
• Even for older injuries, if a claim form is filed after an adverse PQME, the injured worker may request a new PQME panel.

This distinction gave applicants more flexibility in challenging biased reports.

Why This Matters for Injured Workers

Adverse PQME reports can lead to:

• Denials of medical treatment.
• Low Permanent Disability (PD) ratings.
• Reduced settlement offers.

With Navarro and Cowell, injured workers and attorneys can:

• File new claims to access fresh panels.
• Increase settlement leverage in Compromise & Release (C&R) negotiations.
• Secure more favorable medical evidence for the trial.

PQME Procedure: Key Rules & Timelines

PQME disputes are governed by strict rules under Labor Code §4062.1 and §4062.2.

• Panel Requests: Must be submitted within 10 days of objection to a medical issue.
• Strike Rights: Each party has 10 days to strike a doctor from the panel.
• Exam Scheduling: Exams must be scheduled within 30 days of the assignment.
• Evidentiary Standard: PQME/AME reports must constitute “substantial medical evidence” under WCAB law.

Missed deadlines or procedural missteps can lock workers into unfavorable examiners.

Historical Context: SB 863 and PQME Disputes

• SB 863 (2013) restructured California workers’ comp, introducing Independent Medical Review (IMR) for treatment disputes.
• Post-reform, PQMEs became even more crucial because treatment denials often hinge on PQME causation and impairment findings.
• PQME delays have worsened: the DWC reported average panel assignment delays exceeding 90 days in recent years due to examiner shortages.

Insurer & Defense Tactics

Defense attorneys often argue:

• Res judicata (prior PQME binding across claims).
• Doctor shopping (claiming that applicants are gaming the system to obtain favorable opinions).

Applicant attorneys counter with the Navarro/Cowell precedent, ensuring workers’ rights to fair medical-legal evaluation.

Frequently Asked Questions (FAQs)

1. What is a PQME in California workers’ comp?

A PQME is a Panel Qualified Medical Examiner chosen through a DWC panel to resolve disputed medical issues.

2. Can I request a new PQME after an adverse report?

Yes — under Navarro (2014 en banc) and Cowell (2017), new claims or later filings entitle workers to new PQME panels.

3. What is the difference between PQME and AME?

• PQME: Assigned via DWC panel.
• AME: Chosen by agreement between both parties.

4. How long does it take to get a PQME?

Delays are common — DWC reports average 90+ days for panel assignments due to shortages.

5. Can I depose a PQME?

Yes. Attorneys often depose PQMEs to challenge adverse reports, clarify apportionment, or highlight inconsistencies in their findings.

6. What if PQME and my treating doctor disagree?

WCAB judges weigh both, but PQME/AME reports are generally considered substantial evidence unless successfully rebutted.

7. Does Navarro apply to cumulative trauma claims?

Yes. Cumulative trauma and subsequent injury claims filed after an adverse PQME may entitle workers to new panels.

Contact Michael Burgis & Associates

Adverse PQME reports can feel devastating — but they do not end your claim. Thanks to Navarro and Cowell, injured workers have tools to challenge biased medical opinions.

At Michael Burgis & Associates, we:

• Challenge adverse PQME reports.
• File new claims to obtain fresh panels.
• Represent clients at WCAB hearings and depositions.
• Maximize settlement value through strong medical evidence.

Free consultations
No upfront fees
You only pay if we win

Contact us today to fight back against unfair PQMEs and secure the benefits you are entitled to.