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

Case No. ADJ4406096 (LAO 0784412)
Regular

JOSE MORFIN vs. WHITE MEMORIAL MEDICAL CENTER

Defendant sought removal from a WCJ's order stipulating to two Agreed Medical Evaluators (AMEs), alleging the WCJ "forced" the agreement. Applicant's attorney and the WCJ countered that defense counsel had agreed to and proposed the AMEs, with the WCJ merely documenting the stipulation. The Appeals Board denied removal as defendant showed no prejudice, but initiated its own removal to address the attorney's alleged false statements and vexatious tactics. Consequently, the Board intends to impose sanctions of up to $2,500 on the defendant and its attorneys for filing a frivolous petition containing misrepresentations.

Workers' Compensation Appeals BoardPetition for RemovalAgreed Medical EvaluatorsWCJSanctionsBad Faith TacticsFrivolousUnnecessary DelayStipulationMisrepresentation of Facts
References
1
Case No. MISSING
Regular Panel Decision

Main Evaluations, Inc. v. State

The claimant, Main Medical Evaluations, entered into contracts with the New York State Office of Temporary and Disability Assistance (OTDA) to perform consultative medical evaluations. OTDA terminated these contracts, alleging the claimant failed to disclose professional disciplinary proceedings against its chief medical officer, Arvinder Sachdev, and submitted false information during the bidding process. Following the dismissal of its claim in the Court of Claims, the claimant appealed. The appellate court affirmed the lower court's judgment, concluding that OTDA had legitimate grounds for termination due to the claimant's misrepresentations and failure to report substantial contract-related issues concerning Sachdev's integral role. Additionally, the court rejected the claimant's equal protection argument, finding no evidence of selective enforcement based on impermissible considerations.

Contract TerminationProfessional MisconductFalse RepresentationEqual ProtectionGovernment ContractsAppellate ReviewBreach of ContractMedical LicensingAdministrative ProceedingsDue Diligence
References
5
Case No. ADJ4494290 (SAL 0118345)
Regular
Apr 22, 2016

JEANETTE VAUGHN vs. CENTRAL COAST COMMUNITY HEALTHCARE, AMTRUST NORTH AMERICA

The Workers' Compensation Appeals Board granted the applicant's Petition for Removal, rescinding the WCJ's prior order allowing the Agreed Medical Evaluator (AME) to continue. This decision stemmed from the defendant's violation of Labor Code section 4062.3 and Rule 35 by providing the AME with a Consultative Rating without proper prior service on the applicant. Consequently, the applicant is entitled to select a new Qualified Medical Evaluator (QME) if a new AME cannot be agreed upon. Prior AME reports remain admissible if they predate the improper submission of information.

RemovalPetition for RemovalFindings and OrdersAgreed Medical EvaluatorAMEQualified Medical EvaluatorPQMELabor Code Section 4062.3Administrative Director Rule 35Consultative Rating
References
1
Case No. ADJ10356570
Regular
Oct 20, 2017

SYRUS YARBROUGH vs. SOUTHERN GLAZER'S WINE AND SPIRITS, TRUMBALL INSURANCE COMPANY

The Workers' Compensation Appeals Board (WCAB) granted applicant Syrus Yarbrough's Petition for Removal, rescinding a previous order compelling him to attend an Agreed Medical Evaluator (AME) appointment. The WCAB found that Labor Code section 4067, relied upon by the judge, did not apply as applicant had not yet attended a formal AME evaluation. Furthermore, the WCAB clarified that Labor Code section 4062.2(f) only applies after an AME evaluation has occurred and does not preclude withdrawal from an AME agreement before such an evaluation. The WCAB noted that the applicant could still be ordered to see his regular physician or a Qualified Medical Evaluator.

Petition for RemovalAgreed Medical EvaluatorPetition to CompelMedical ExaminationSignificant PrejudiceIrreparable HarmLabor Code Section 4067Labor Code Section 4062.2(f)Withdraw from AMEWCAB
References
1
Case No. ADJ10856280
Regular
Aug 16, 2019

JOHN CAMPBELL, (deceased) vs. CITY OF RED BLUFF FIRE DEPARTMENT, YORK RISK SERVICES GROUP, INC.

The Workers' Compensation Appeals Board granted applicant's petition for removal, rescinding a prior order and finding all four Qualified Medical Evaluator (QME) panels invalid due to errors in claim numbers and procedural missteps. The Board determined that due to multiple panel failures and the employee's passing, the parties must agree to an Agreed Medical Evaluator (AME) within 15 days. If an AME cannot be agreed upon, the administrative law judge will appoint a physician.

Qualified Medical EvaluatorQME panelPetition for RemovalFindings and OrderAgreed Medical EvaluatorAMELabor Code Section 5701Administrative Director Rule 31.5Administrative Director Rule 30(c)Code of Civil Procedure Section 1013
References
2
Case No. ADJ8302614
Regular
Jan 25, 2018

MILTON HUNTER vs. RYERSON STEEL SERVICE, TRAVELERS

The Appeals Board denied the defendant's petition for removal, treating it as a petition for reconsideration of an order to have the applicant evaluated by an Agreed Medical Evaluator (AME) for new and further disability. The Board found that the WCJ had the authority to develop the record by ordering the AME evaluation, especially given the apparent lack of medical evidence for the new claim. Furthermore, the timely filing of the applicant's petition to reopen preserved the Board's jurisdiction, and the defendant failed to demonstrate prejudice warranting removal. The defendant's objection to the AME evaluation cost was deemed standard employer liability.

Petition to ReopenNew and Further DisabilityAgreed Medical Evaluator (AME)WCJRemovalReconsiderationTimelinessSupporting Medical EvidenceDevelop the RecordThreshold Issue
References
12
Case No. ADJ2458433, ADJ3638211, ADJ7362994, ADJ9026581
Regular
Apr 21, 2014

ROY NORWOOD vs. SAN FRANCISCO MUNICIPAL TRANSPORTATION AGENCY

The Workers' Compensation Appeals Board denied the defendant's Petition for Removal, upholding the Workers' Compensation Judge's decision. The defendant sought to compel the applicant to undergo an evaluation by a previously used Agreed Medical Evaluator (AME) and to prevent the issuance of a Qualified Medical Evaluator (QME) panel for a new injury claim. The Board found that Labor Code section 4062.3(k) does not mandate using the same AME for all future claims and cited a pending en banc decision supporting this interpretation. Furthermore, the Board noted that the prior judge's order regarding the AME did not apply to the new claim where no agreement for that AME existed.

WCABPetition for RemovalMandatory Settlement ConferenceAgreed Medical EvaluatorQualified Medical EvaluatorMedical UnitEx Parte CommunicationLabor Code section 4062.3(k)Propria PersonaInconsistent with Labor Code
References
1
Case No. STK 0204368
Regular
Jun 20, 2008

JUDITH KNOX vs. DOCTOR'S MEDICAL CENTER, SPECIALTY RISK SERVICES

The Workers' Compensation Appeals Board (WCAB) granted reconsideration and rescinded a prior finding that the applicant did not sustain a cumulative trauma injury. The Board found the Agreed Medical Evaluator's (AME) opinion lacked substantial evidence due to an incomplete medical history regarding the applicant's actual job duties and work schedule. The case is returned to the trial level for further development of the record, including a supplemental report from the AME.

Workers' Compensation Appeals BoardCumulative TraumaAgreed Medical EvaluatorSubstantial EvidenceMedical OpinionCausationReturn to Trial LevelFurther Development of RecordRescinded OrderSupplemental Report
References
6
Case No. ADJ1346416 (ANA 0390656)
Regular
Jan 19, 2010

ADAM TRAN vs. LAIDLAW TRANSIT SERVICE, BROADSPIRE CLAIMS SERVICES, INSURANCE CO. OF THE STATE OF PENNSYLVANIA

The Workers' Compensation Appeals Board denied the applicant's petition for removal, which sought to rescind an order compelling a medical examination. The applicant argued he could withdraw from an Agreed Medical Evaluator (AME) agreement due to prior difficulties obtaining a Qualified Medical Evaluator (QME). The Board found the petition timely filed but denied it, as the applicant failed to demonstrate significant prejudice or irreparable harm from the AME evaluation, despite a prolonged, unsuccessful attempt to secure a QME.

Petition for RemovalAgreed Medical EvaluatorQualified Medical EvaluatorQME PanelLabor Code section 4062.2TimelinessWCJSignificant PrejudiceIrreparable HarmWCAB Rule 10843(a)
References
0
Case No. ADJ8314520
Regular
Aug 25, 2015

EULOGIO SANCHEZ-AGUILAR vs. PODESTA PACKING, U.S. FIRE INSURANCE COMPANY

The Workers' Compensation Appeals Board denied the applicant's petition for reconsideration regarding an award of 26% permanent disability. The applicant argued the agreed medical evaluator's (AME) report lacked substantial evidence due to alleged improper communication by the defense regarding x-ray reports. However, the Board found the applicant waived any objection by agreeing to the AME's review of the x-rays and cooperating with their creation. Furthermore, the Board agreed with the trial judge that the applicant failed to demonstrate how any purportedly unreviewed medical reports would have changed the AME's opinion.

Eulogio Sanchez-AguilarPodesta PackingU.S. Fire Insurance CompanyADJ8314520Petition for ReconsiderationFindings of FactAwardand OrdersWorkers' Compensation Administrative Law JudgeWCJ
References
1
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