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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. MISSING
Regular Panel Decision

Texas State Board of Examiners v. Texas Medical Ass'n

The Texas Medical Association challenged a rule by the Texas State Board of Examiners of Marriage and Family Therapists that permits licensed marriage and family therapists (MFTs) to provide diagnostic assessments. The Medical Association argued that this rule is invalid because the Texas Occupations Code does not authorize MFTs to provide such assessments, reserving this authority primarily for medical licensees. The Therapists Board contended that their authorizing statute, the Texas Licensed Marriage and Family Therapists Act, permits evaluations which encompass diagnostic assessments, and that "diagnose" is a type of "evaluate" in this context. The Supreme Court of Texas agreed with the Therapists Board, concluding that the Therapists Act authorizes MFTs to provide diagnostic assessments as described in the rule, and the Medical Practice Act does not prohibit it. The Court reversed the court of appeals' judgment and rendered judgment that the rule is valid.

Marriage and Family TherapyDiagnostic AssessmentTexas Occupations CodeMedical Practice ActScope of PracticeStatutory InterpretationAdministrative LawProfessional LicensingMental Health DiagnosisRule Validity
References
42
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. 2016-08-1486
Regular Panel Decision
Nov 30, 2018

Nance, Amy v. JCSD Emergency Medical Group d/b/a Medic One Response

Ms. Nance, an emergency medical technician, injured her left upper extremity while moving a patient. After conservative treatment, she was diagnosed with cubital tunnel syndrome and later recommended for a cervical spine evaluation by Dr. Cole. Medic One denied the requested benefits, claiming misrepresentation and non-work-related activity. The Court found Ms. Nance likely to prevail for medical benefits, ordering Medic One to authorize a cervical spine evaluation and allow her to select a specialist. However, Ms. Nance was not found eligible for temporary disability benefits due to insufficient medical proof of disability.

Workers' CompensationMedical BenefitsTemporary Disability BenefitsCubital Tunnel SyndromeCervical Spine EvaluationMedical MisrepresentationCausal ConnectionExpedited HearingPermanent ImpairmentTreating Physician
References
3
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. MISSING
Regular Panel Decision

Davis v. Medical Evaluation Specialists, Inc.

Justice Wilson dissents from the majority's decision on a motion for rehearing, arguing that the majority improperly considered non-evidence and engaged in speculation. The dissent contends that Lennie Davis's controverting affidavit by Dr. Bergeron, which stated a 17% impairment rating compared to the defendants' 0%, was conclusory and insufficient to establish bad faith by Medical Evaluation Specialists, Inc., Dr. DeFrancesco, and Dr. Dozier. Justice Wilson believes that the affidavit failed to meet the objective 'no reasonable doctor' standard for controverting good faith, and therefore, the trial court's summary judgment in favor of the defendants should have been affirmed based on official immunity.

Summary JudgmentOfficial ImmunityGood FaithImpairment RatingMedical AffidavitConclusory StatementsTexas Workers' Compensation ActAppellate ReviewDissenting OpinionPermanent Disability
References
7
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
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