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Case Law Database

Access over workers' compensation decisions, including En Banc, Significant Panel Decisions, and writ-denied cases.

Case No. MISSING
Regular Panel Decision

Colindres v. Carpenito

Plaintiff Rochelle Colindres sought a protective order to deny defendants' demand for a medical report from her former treating psychologist, Diane Henry, or alternatively, relief from compliance with Uniform Rules for Trial Courts § 202.17(b)(1). Colindres argued that the defendants waived their right to the report as the independent medical examination (IME) already occurred, and that obtaining the report would be an undue hardship since Henry ceased treatment due to Colindres' attendance issues. Defendants Mario Carpenito, Jr., City of White Plains, and White Plains Parking Department opposed, asserting that the report was necessary to clarify alleged injuries, prepare for cross-examination, and facilitate settlement, highlighting Colindres' complex medical history predating the incident. The court denied both branches of Colindres' motion, finding that the rule applies broadly to personal injury actions, defendants did not waive their entitlement, and Colindres failed to prove it was impossible to obtain the report. The court ordered Colindres to exchange a compliant medical report from Diane Henry by March 27, 2017.

protective ordermedical report disclosurediscovery disputepsychological treatmentindependent medical examinationCPLR 310322 NYCRR 202.17waiver of discoveryundue hardshippersonal injury damages
References
12
Case No. ADJ1958969 (WCK 0041753) ADJ3020638 (WCK 0041752) ADJ3068271 (OAK 0324422)
Regular
May 03, 2010

LORA MAYBERRY vs. ADDUS HEATHCARE, AIG INSURANCE COMPANY, ALTA BATES MEDICAL CENTER, SUTTER HEALTH WORKERS' COMPENSATION

This case involves an applicant with multiple industrial injuries, including three against Addus Healthcare in 1997 and one against Alta Bates Medical Center in 2005. The administrative law judge found the 1997 low back injury contributed 40% to the medical treatment need for the 2005 injury, with the 2005 injury causing the remainder. Addus sought reconsideration, arguing a medical report was improperly admitted into evidence. The Appeals Board granted reconsideration, rescinded the prior order, and returned the case for further proceedings to determine the admissibility of the report under Labor Code § 5703(a)(2).

Workers' Compensation Appeals BoardAddus HealthcareAlta Bates Medical Centerlicensed vocational nurseindustrial injuryneck injuryshoulder injuryarm injurylow back injuryleft knee injury
References
0
Case No. MISSING
Regular Panel Decision

Claim of Clark v. Siara Management, Inc.

Claimant, a custodian, sustained two work-related injuries in 2000, and his workers' compensation benefits were approved. In 2003, the employer's workers' compensation carrier requested an independent medical examination (IME) by Charles Totero. Claimant moved to preclude Totero's report, arguing it was improperly mailed by UMC Medical Consultants, EC., an IME services company, instead of Totero himself, in violation of Workers' Compensation Law § 137. Both a Workers' Compensation Law Judge and the Board denied the motion, finding UMC, as Totero's direct employer and a registered IME company, was authorized to perform administrative services like mailing reports under 12 NYCRR 300.2 (e) (1). The appellate court affirmed the decision, concluding that the submission substantially complied with statutory requirements.

IME Report AdmissibilityWorkers' Compensation Law § 137Procedural ComplianceMedical Report MailingIME Services CompanyAppellate AffirmationStatutory InterpretationIndependent Medical Examiner12 NYCRR 300.2
References
1
Case No. TI11710087
Regular
Nov 20, 2018

Theodore Davis vs. CITY OF MODESTO, YORK INSURANCE SERVICES, GROUP, INC.

This case involves applicant Theodore Davis's prostate cancer claim against the City of Modesto. The core dispute centers on the admissibility and review of a medical report by Dr. Besses. The Appeals Board initially denied review of Dr. Besses' report but, following a court of appeal remittitur, is now granting removal. The matter is returned to the trial level for the WCJ to re-evaluate the admissibility of Dr. Besses' report under Labor Code section 4605 and related rules, and whether it can be provided to the QME. This decision clarifies that while QME evaluations are required for compensability disputes, privately obtained medical reports may still be admissible.

RemittiturPetition for RemovalPetition for ReconsiderationQualified Medical EvaluatorLabor Code Section 4060Labor Code Section 4605Admissibility of Medical ReportsEx Parte CommunicationCumulative TraumaSpecific Injury
References
9
Case No. MISSING
Regular Panel Decision

Claim of Coratti v. Jon Josef Hair & Colour Group

The Workers' Compensation Board denied a claimant's motion to preclude a workers’ compensation carrier’s consultant report, which was based solely on a review of medical records, not an independent medical examination (IME). The claimant argued non-compliance with Workers’ Compensation Law § 137 (1) (b), a provision requiring notice if an IME is performed. The Board concluded the statute does not apply to records-review-only reports. An appellate court affirmed, holding that the plain language of § 137 (1) (b) explicitly refers to practitioners who have performed or will perform an IME, thereby excluding those who solely review records. The court emphasized that statutory interpretation must adhere to plain language, leaving policy arguments to the Legislature.

IME reportsrecords reviewWorkers' Compensation Lawstatutory interpretationpreclusion motioncausationoccupational illnessdue processlegislative intent
References
3
Case No. MISSING
Regular Panel Decision

Queens Blvd. Medical, P.C. v. Travelers Indemnity Co.

The plaintiff, Queens Blvd. Medical, P.C., sought $950 in first-party no-fault benefits for biofeedback medical services provided to its assignor for lower back and chronic pain syndrome. The central issue at trial was the medical necessity of these services under Insurance Law § 5102 (a) (1). The plaintiff established a prima facie case with expert testimony from a board-certified neurologist affirming the medical appropriateness of biofeedback. The defendant insurance company failed to present admissible evidence to disprove medical necessity, as its expert was deemed incompetent to testify on biofeedback for back pain. Consequently, the court granted the plaintiff's motion for a directed verdict, awarding judgment for $950 along with statutory costs, interest, and attorney's fees.

No-fault benefitsMedical necessityBiofeedback treatmentExpert testimonyDirected verdictInsurance lawChronic pain syndromeBack injuryCPT codesBurden of proof
References
9
Case No. ADJ1700793 (SAC 0307437) ADJ3714832 (SAC 0307399)
Regular
Jun 13, 2011

JUANITA BRADLEY (Deceased) vs. COUNTY OF PLACER

This case involves a dispute over liability for a medical-legal report cost. The defendant seeks reconsideration of a prior award holding them responsible for Dr. Adelberg's $4,237.50 report. The defendant argues the judge ignored a prior order for an Agreed Medical Evaluation (AME) and that the applicant's attorney improperly proceeded with Dr. Adelberg's exam. The Board granted reconsideration, preliminarily finding it may be inequitable to place the full cost on the defendant, and intends to split the expense between the defendant and applicant's attorney. A dissenting opinion argues the defendant's own correspondence shows an ongoing dispute regarding the AME, supporting the original award of liability.

Workers' Compensation Appeals BoardReconsiderationMedical-Legal ReportAgreed Medical EvaluationQualified Medical EvaluatorJoint Findings and AwardLabor Code Section 4062(a)Stipulation and OrderEquitable PowersLien Claimant
References
1
Case No. ADJ9011624
Regular
Dec 13, 2019

ELISHA HARDEN vs. COUNTY OF SACRAMENTO

This case concerns whether specific medical reports obtained for a disability retirement claim are admissible in a workers' compensation proceeding. The Appeals Board rescinded the prior ruling, holding these reports are relevant and may be provided to the orthopedic Agreed Medical Evaluator (AME) and psychiatric Qualified Medical Evaluator (QME). The Board found the reports relevant to the medical issues, even though they were not obtained through the standard workers' compensation medical-legal evaluation process. Consequently, the applicant's objection to providing these reports to the evaluators was overruled.

RemovalReconsiderationAgreed Medical Evaluator (AME)Qualified Medical Evaluator (QME)Medical-legal evaluatorsMedical recordsLabor CodeFindings and Orders (F&O)Disability retirementPermanent impairment
References
9
Case No. ADJ8460289
Regular
Sep 11, 2013

JUAN LUNA vs. CAPITAL DRYWALL, L.L.P.; SEABRIGHT INSURANCE

This case concerns a dispute over the admissibility of medical reports from physicians outside the defendant's Medical Provider Network (MPN). The Appeals Board rescinded the original findings and award, remanding the case for a new decision. This decision hinges on the employer's failure to provide adequate notice of the MPN and their denial of the employee's claim, entitling the employee to self-procure treatment and rendering those medical reports admissible. The arbitrator must now reconsider the findings regarding self-procured medical expenses and mileage reimbursement.

Workers' Compensation Appeals BoardReconsiderationMedical Provider Network (MPN)Collective Bargaining Agreement (ADR)Admissibility of ReportsSelf-Procured Medical TreatmentLabor Code Section 4600Notice RequirementsDenial of ClaimIndustrial Injury
References
1
Case No. MISSING
Regular Panel Decision
Jul 07, 2004

Claim of Stoudenmyre v. Loretto Rest Nursing Home

Claimant, a personal care aide, sustained a foot injury and her workers' compensation claim was established. Subsequently, an independent medical examination (IME) report was requested to address permanency. Claimant moved to preclude the IME report, arguing it was improperly mailed by Brookside Consultants, Inc., an IME services company, instead of the physician, violating Workers' Compensation Law § 137. The Workers' Compensation Law Judge denied the motion, which the Board affirmed. This Court affirmed the Board's decision, ruling that properly registered IME services companies are authorized to perform administrative functions like mailing reports, thereby substantially complying with Workers' Compensation Law § 137, as established in Matter of Clark v Siara Mgt., Inc.

IME reportmailing proceduresWorkers' Compensation Lawadministrative functionspermanency of injuryindependent medical examinationmedical reportsreport submissionappellate reviewBoard affirmation
References
1
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