Workers’ Compensation · Primary-source case analysis

Simi: A New Knee Question Required a Different Medical Specialty

By Aneeta Mishra and Timothy Chan

Published May 19, 2026

Decision: Simi v. Sav-Max Foods, No. SAC 323226 (WCAB Feb. 1, 2005) (en banc).

A prior examination by a podiatrist did not require the employer to send a new knee dispute back to that same specialist. In Simi, the WCAB explained why the older medical-evaluation procedure allowed a different specialty when the original examiner could not address the new problem. The decision concerns represented workers with injuries before January 1, 2005; it is not a current panel-selection shortcut. Simi.

The new question concerned a different body part

The accepted injury involved the right foot and ankle. The treating podiatrist later recommended care for a left-knee Baker’s cyst. The employer objected, unsuccessfully sought an agreed medical evaluator, and scheduled a defense QME. The worker argued that the employer had to return to its earlier podiatrist. The Board treated the knee’s different specialty as a real obstacle to that proposal. Simi.

Returning to the same QME was not possible here

Under former section 4062(c), returning to the same QME was required only to the extent possible. The Board found it was not possible here because a specialist outside podiatry was needed for the knee. An unsatisfactory opinion alone was not the reason: The Board distinguished Alie, where the original psychiatrist could still address the judge’s concerns. Simi.

The older injury procedure still supplied authority

Before reaching that specialty question, the Board had to identify a lawful examination procedure. Senate Bill 899 created a represented-worker panel process for injuries on or after January 1, 2005, while deleting the earlier language. The Board held that former section 4062 continued to govern older injuries rather than leaving no procedure at all. Representation, injury date and the medical issue all mattered. Simi.

Explain the specialty need, not dissatisfaction

For an older claim, compare the first examiner’s specialty with the actual new question. Preserve the original report, the treating recommendation, the objection and the explanation for a different specialist. Simi did not approve changing doctors merely to obtain a better result. The separate examination-enforcement analysis explains why the Board corrected the warning about lost benefits.

Key takeaways

• Identify the injury date and representation status.
• Compare the original specialty with the new medical issue.
• Explain why the first evaluator cannot address that issue.
• Do not treat this historical decision as permission to bypass today’s panel rules.