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

Case No. ADJ3568698 (MON 0246436)
Regular
Nov 15, 2016

ROGER SCHENDEL vs. B&B SALES, STATE COMPENSATION INSURANCE FUND

In this workers' compensation case, the applicant sought renewed prescriptions for Norco and Omeprazole. Defendant contested the award of these medications, arguing the Workers' Compensation Appeals Board lacked jurisdiction due to a timely Utilization Review (UR) denial upheld by Independent Medical Review (IMR). The Board denied reconsideration, affirming the WCJ's award based on a stipulation agreement that waived the UR/IMR process in favor of an Agreed Medical Examiner (AME). The majority found defendant bound by the stipulation to abide by the AME's report, which deemed the prescriptions medically appropriate. A dissenting opinion argued the AME's report was insufficient for an award as it was not based on a current examination or complete review of the applicant's medical records.

WCABPetition for ReconsiderationFindings Award and OrdersStipulations with Requests for AwardsNorcoOmeprazoleSynvisc injectionsRequest for Authorization (RFA)Utilization Review (UR) denialIndependent Medical Review (IMR)
References
2
Case No. ADJ7498085 ADJ7264010
Regular
Dec 03, 2012

SANDRA CATLIN vs. JC PENNEY, INC., AMERICAN HOME ASSURANCE COMPANY

The Appeals Board granted reconsideration, rescinded the WCJ's award, and returned the matter to the trial level. While not finding the Agreed Medical Examiner's (AME) report inadmissible due to a procedural violation, the Board determined it lacked substantial medical evidence. The AME's report was deemed cursory and not based on adequate examination or reasoning to support the award of housekeeping services. Further proceedings are required to develop the record, potentially including a re-evaluation by the AME and cross-examination.

Workers Compensation Appeals BoardJoint Findings and AwardAgreed Medical Examiner (AME)Supplemental ReportLabor Code Section 4062.3Treating Physician ReportHousekeeping ServicesSubstantial Medical EvidenceReconsiderationRescind Decision
References
10
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. 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. 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. ADJ7845799, ADJ7931182
Regular
Jan 04, 2017

GARRY DAWSON vs. COUNTY OF LOS ANGELES

This case involves a Petition for Reconsideration by the defendant, the County of Los Angeles, challenging the admission of an Agreed Medical Examiner's (AME) report. The Workers' Compensation Appeals Board denied the petition, finding that the defendant waived any objection to the report and the communication of non-medical information to the AME. The Board specifically rejected the defendant's argument that the AME's report was improper based on *Blackledge v. Bank of America*. Therefore, the petition for reconsideration was denied.

Workers' Compensation Appeals BoardPetition for ReconsiderationAgreed Medical Examiner (AME)Disability Evaluation Unit (DEU)consultative ratingex parte communicationwaived objectionsLabor Code section 4062.3Rule 35Joint Exhibit
References
1
Case No. ADJ1358966 (SAL 0120850)
Regular
Dec 21, 2015

Beverly Forest (Deceased), James Forest vs. COUNTY OF MONTEREY, Permissibly Self-Insured, administered by INTERCARE HOLDINGS

In this workers' compensation case, the Appeals Board denied the defendant's petition for removal. The defendant sought to prevent a lien claimant's medical reports from being provided to the Agreed Medical Examiner (AME). The Board affirmed the WCJ's order allowing the AME to review the reports, citing the lien claimant's due process rights and the WCJ's discretion to manage discovery. The Board found no substantial prejudice to the defendant in allowing the AME to consider additional medical opinions on the complex issues.

Petition for RemovalAgreed Medical Examiner (AME)Lien ClaimantComprehensive Medical EvaluationLabor Code section 4064(d)Admissibility of Medical ReportsDue Process RightsCumulative TraumaOccupational ExposureMold and Fungus
References
3
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
Case No. ADJ3388749 (VNO 0561016)
Regular
Nov 26, 2018

ROBERTA MOORE vs. CITY OF LOS ANGELES, TRISTAR RISK MANAGEMENT

The Workers' Compensation Appeals Board granted reconsideration to address conflicting medical opinions from the Agreed Medical Examiner (AME) regarding the apportionment of applicant Roberta Moore's fibromyalgia disability. The AME's report initially apportioned 70% of the disability to the industrial injury, but later changed to 100% to the industrial component, citing remission of her non-industrial condition. The Board found this sudden change unexplained and is remanding the case for further clarification from the AME or a new medical examination. Additionally, the Board will allow parties to address permanent total disability findings in light of the *Fitzpatrick* decision.

Agreed Medical ExaminerFibromyalgiaCumulative TraumaApportionmentUndifferentiated Connective Tissue DiseasePermanent Total DisabilityVocational FeasibilityLabor MarketAgreed Medical Examiner (AME)Medical-Legal Expense
References
0
Case No. ADJ1639321 (SDO 0277670) ADJ933626 (SDO 0277671)
Regular
Jan 21, 2014

SOOK JA DAVIS vs. KAISER FOUNDATION HOSPITALS

The Workers' Compensation Appeals Board denied the applicant's petition for reconsideration. The applicant sought to overturn the judge's decision to allow credits for temporary disability indemnity (TDI) paid after the Agreed Medical Examiner (AME) determined the applicant was permanent and stationary. The Board adopted the judge's report, finding that the AME's report, even with a delay in signing, provided substantial medical evidence of the applicant's P&S status on the examination dates. The credits were deemed permissible under Labor Code § 4909 as they were not disruptive to the applicant's benefits.

Workers' Compensation Appeals BoardPetition for ReconsiderationTemporary Disability IndemnityAgreed Medical ExaminerPermanent and StationaryMedical-Legal EvaluationLabor Code § 4909Credit for OverpaymentJoint Findings Award and OrdersSubstantial Medical Evidence
References
7
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