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

Case No. ADJ9376675
Regular
Oct 20, 2015

JESSICA FIELD vs. INGLEWOOD POLICE DEPARTMENT, ADMINSURE

The Workers' Compensation Appeals Board denied the defendant's petition for reconsideration. The defendant challenged the permanent disability rating, arguing the DRE method, rather than the ROM method, was improperly applied by the QME. The Board adopted the WCJ's report, which found the QME's reliance on the DRE method, specifically Category IV, was supported by substantial medical evidence and properly applied under the AMA Guides, Fifth Edition. The defendant's contention that the rating was invalid under *Blackledge* was also rejected, as the QME report met legal and regulatory requirements.

Workers' Compensation Appeals BoardPetition for ReconsiderationDENIEDINGLEWOOD POLICE DEPARTMENTADMINSUREPermanent DisabilityAMA Guides Fifth EditionDRE MethodLumbar Spine Category IVwhole person impairment
References
2
Case No. ADJ9473303
Regular
Oct 30, 2017

PEDRO SOTELO vs. TRI-STATE EMPLOYMENT SERVICES, INC. dba PIRATE STAFFING, INC., CALIFORNIA INSURANCE GUARANTEE ASSOCIATION FOR LUMBERMEN'S UNDERWRITING ALLIANCE in liquidation, SEDGWICK

The Appeals Board granted reconsideration, finding the Agreed Medical Evaluator's (AME) reports lacked substantial evidence for permanent disability and apportionment due to unexplained DRE Category II ratings. However, the Board amended the order to not strike the AME's reports entirely, as good cause was not shown for their exclusion. The case is returned to the trial level for further development of the record regarding permanent disability and apportionment, potentially through a new AME or QME.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and AwardAgreed Medical Evaluator (AME)Permanent DisabilityApportionmentSubstantial EvidenceDRE Category IIAMA GuidesWhole Person Impairment (WPI)
References
9
Case No. ADJ7669411
Regular
Jul 23, 2013

OSCAR HUERTA vs. HIGGINS & LOVETT CONSTRUCTION, TOWER SELECT INSURANCE CO.

This case involves a workers' compensation claim for a laborer injured on November 2, 2010, to his neck and back. The defendant disputes the finding of 51% permanent disability, primarily arguing that the panel qualified medical evaluator's (PQME) report was not substantial evidence. The Appeals Board has granted reconsideration to further review the PQME's lumbar impairment rating, specifically questioning whether "non-verifiable radicular complaints" sufficiently supported the DRE Category III rating. The Board has rescinded the prior award and returned the case for further development of the record.

Occupational Group 480Panel Qualified Medical Evaluator (PQME)Dr. DawdyDRE Category IIIRadiculopathyLumbar ImpairmentSubstantial Medical EvidenceFurther Development of the RecordAmended Findings and AwardLumbar Spine
References
6
Case No. ADJ9344211
Regular
Dec 01, 2017

Patricia Preston vs. Los Angeles Unified School District, SEDGWICK CLAIMS MANAGEMENT SERVICES

The applicant sought reconsideration of a workers' compensation award, challenging the permanent disability rating primarily based on the chosen medical evaluation method. The applicant argued the Range-of-Motion (ROM) method, favored by her treating physician, should have been used instead of the Diagnosis-Related Estimates (DRE) method employed by a Qualified Medical Evaluator (QME). Additionally, she contended that her vocational expert's opinion supported a finding of total permanent disability. The Board denied reconsideration, affirming the administrative law judge's decision, finding the QME's DRE rating supported by substantial evidence and the applicant's vocational evidence insufficient to prove total disability. A dissenting opinion argued that findings of multi-level spinal involvement supported the use of the ROM method for a potentially higher rating and questioned the QME's justification for choosing DRE.

Workers' Compensation Appeals BoardPatricia PrestonLos Angeles Unified School DistrictSedgwick Claims Management ServicesADJ9344211Permanent Disability RatingRange-of-Motion MethodDiagnosis-Related Estimates MethodApportionmentDr. Fenton
References
6
Case No. AHM 0141207
Regular
Jul 13, 2007

JOHN MAGINNIS vs. REED ELSIVIER, CRAWFORD & COMPANY

The Workers' Compensation Appeals Board granted a petition for removal, partially quashing a subpoena duces tecum issued to Reed Elsivier. The Board found that the applicant failed to provide proper notice to non-party employees whose employment records were sought, as required by Code of Civil Procedure section 1985.6, and that some categories were overbroad or irrelevant. The subpoena was affirmed for categories relevant to the applicant's claim and potentially containing disability-related information, but quashed for those violating privacy rights or being overly broad.

RemovalSubpoena Duces TecumPetition to QuashCode of Civil Procedure section 1985.6Non-party employeesRight of privacyEmployment recordsOverbroadIndustrial injuryPsych/stress
References
0
Case No. ADJ10489999
Regular
Feb 01, 2019

Sean Lawson vs. Zenith Insurance Company

This case involves a dispute over the permanent disability rating for applicant Sean Lawson's low back injury. The defendant, Zenith Insurance Company, argues that the Range of Motion (ROM) method used by the Qualified Medical Evaluator (QME) was inappropriate, and the Diagnosis-Related Estimates (DRE) method should have been applied as there was only one level of radiculopathy. The Workers' Compensation Appeals Board (WCAB) affirmed the WCJ's finding that the ROM method was appropriate based on the QME's expert opinion and the AMA Guides' provision for its use with multi-level involvement. However, one Commissioner dissented, believing the DRE method was mandated given the lack of evidence for multi-level radiculopathy.

WCABPetition for ReconsiderationPermanent DisabilityApportionmentNon-industrial factorsDiagnosis-Related Estimates (DRE) methodRange of Motion (ROM) methodQualified Medical Evaluator (QME)AMA GuidesMultilevel radiculopathy
References
1
Case No. 2021 NY Slip Op 03509 [195 AD3d 1133]
Regular Panel Decision
Jun 03, 2021

Matter of Broach & Stulberg, LLP v. New York State Dept. of Labor

Petitioner, Broach & Stulberg, LLP, filed a Freedom of Information Law (FOIL) request with the New York State Department of Labor for records pertaining to various apprenticeship training programs. Respondent partially granted the request but denied access to specific categories of documents, stating they did not possess them. Petitioner commenced a CPLR article 78 proceeding, and the Supreme Court partially granted the petition. The Appellate Division, Third Department, reversed the Supreme Court's decision regarding the contested categories of documents, holding that records maintained by a private entity for regulatory compliance are not necessarily 'records held for an agency' under FOIL unless the agency actually possesses, controls, or uses them for its decision-making process. The court modified the judgment, dismissing the petition to that extent, and otherwise affirmed.

Freedom of Information LawPublic RecordsAgency ResponsibilityRegulatory OversightApprenticeship TrainingThird-Party RecordsStatutory InterpretationAppellate DivisionArticle 78 ProceedingGovernment Transparency
References
10
Case No. MISSING
Regular Panel Decision

Sanchez v. TRAVELERS COMPANIES, INC.

Plaintiff Natividad Sanchez was injured in a car accident on March 3, 2003, caused by another driver. She sought insurance benefits under a Supplemental Uninsured/Uninsured Motorist (SUM) policy issued by the Defendants, who are insurers. Sanchez claimed serious injuries, including the aggravation of a pre-existing degenerative disc disease, which significantly limited her daily activities and ability to work. The Court granted Sanchez's motions for partial summary judgment, affirming that the other driver's negligence caused the accident and that she sustained a 'serious injury' under New York Insurance Law § 5102(d) under the 'permanent consequential limitation' and 'significant limitation' categories. The Defendants' cross-motion for partial summary judgment was granted in part regarding 'permanent loss of use' but denied concerning the '90/180 day limitation' category.

Insurance BenefitsAutomobile PolicySUM PolicySerious Injury ThresholdNew York Insurance LawPermanent Consequential LimitationSignificant Limitation of UseSummary JudgmentPre-existing Condition AggravationMedical Testimony
References
26
Case No. MISSING
Regular Panel Decision

Taher v. Valerio-Mena

This court opinion addresses a "serious injury" case under Insurance Law § 5102 (d) stemming from a May 6, 2001 motor vehicle accident in Queens County. The central issue is whether a computerized inclinometer provides objective measurements sufficient for a plaintiff to overcome a summary judgment motion on the "serious injury" threshold. The defendant presented expert reports denying serious injury and argued a "gap in treatment" defense. Judge Charles J. Markey, J., discusses the applicability of the "gap in treatment" defense to permanent limitations and examines precedents regarding inclinometer use. The court grants summary judgment in part, dismissing claims under "permanent loss of use" and "90/180-day" categories, but allows the case to proceed to trial on "permanent consequential limitation" and "significant limitation" categories.

Serious Injury ThresholdInsurance Law § 5102 (d)InclinometerObjective Medical MeasurementsLimitation of MotionSummary JudgmentGap in Treatment DefensePermanent Consequential LimitationSignificant LimitationMotor Vehicle Accident
References
43
Case No. MISSING
Regular Panel Decision

Mancuso v. Collins

Plaintiff appealed an order from the Supreme Court, Monroe County, which had granted summary judgment to defendants John A. Camille, Todd M. Collins, Sharon R. Collins, and a fourth-party defendant in a multi-vehicle personal injury action, thereby dismissing the plaintiff's second amended complaint. The appellate court found that the defendants failed to meet their initial burden to establish that the plaintiff did not sustain a serious injury under the permanent consequential limitation of use and significant limitation of use categories of Insurance Law § 5102 [d]. The defendants' own medical submissions indicated serious injuries with objective evidence. Although the defendants met their burden regarding the 90/180 category, the plaintiff successfully raised a factual issue. Consequently, the appellate order unanimously reversed the lower court's decision, denying all motions and cross-motions, and reinstated the second amended complaint.

Personal InjuryMulti-Vehicle AccidentSummary JudgmentSerious Injury ThresholdInsurance Law 5102(d)Appellate ReversalMedical EvidenceRange of MotionObjective EvidenceSpinal Injury
References
3
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