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).

Adverse PQME reports. Why injured workers want a new medical-legal evaluation

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 in California workers’ comp: 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.

Navarro (2014 en banc): When a new claim means a new PQME panel

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.

Navarro holding: A new claim equals a new panel

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.

Cowell v. County of Los Angeles: Why the claim filing date controls

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.

Cowell holding: Later filed claims can support a new panel request

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 Navarro and Cowell matter: Treatment denials, PD ratings, and settlement leverage

Adverse PQME reports can lead to:

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

Compromise and Release leverage: Stronger medical evidence for trial and settlement

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

PQME procedure rules and timelines: Panel requests, strike rights, exam scheduling

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.

SB 863 context: Why PQMEs became even more critical after reform

• 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.

Defense tactics in PQME disputes: Res judicata and doctor shopping arguments

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.