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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

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. 2016-03-0413
Regular Panel Decision
Oct 05, 2017

Dodson, Deborah v. LHC Group

Deborah Dodson, an employee of LHC Group, injured her left ankle and right knee in May 2015. She underwent knee surgery and was placed at maximum medical improvement by Dr. Johnson. She later developed small fiber neuropathy, and despite a referral, faced difficulties obtaining a neurologic impairment evaluation. The Court granted Ms. Dodson's request for a neurologic impairment evaluation, either by Dr. Butler or another neurologist, referring Dr. Butler to the Penalty Program for failure to provide an impairment opinion. However, the Court denied her claim for additional temporary total disability benefits, finding she reached MMI on March 23, 2017, when Dr. Butler ceased active treatment.

Workers' CompensationNeurologic Impairment EvaluationTemporary Total Disability BenefitsMaximum Medical ImprovementSmall Fiber NeuropathyPain ManagementExpedited HearingMedical TreatmentImpairment RatingPenalty Program
References
3
Case No. ADJ10304125
Regular
Oct 04, 2019

EDUARDO VEGA vs. REDWOOD EMPIRE SAWMILL, ZURICH NORTH AMERICA

This case involves a worker seeking to reopen his claim for new and further disability following a 2014 lumbar spine injury. The applicant contended his disability had worsened to permanent total disability, citing vocational expert testimony and medical reports indicating increased work restrictions. However, the Qualified Medical Evaluator (QME) found no change in industrial disability, and his recent evaluation supported the original finding of no new and further disability. The Appeals Board affirmed the WCJ's decision, finding the applicant's vocational evidence unpersuasive without a medical basis for increased disability.

New and further disabilityPetition for ReconsiderationVocational expertPermanent disabilityQualified Medical Evaluator (QME)Petition to ReopenPrimary treating physicianWork restrictionsPermanent total disabilityLabor Code section 5410
References
2
Case No. 2016-08-1001
Regular Panel Decision
Feb 17, 2017

Adams, Byron v. Savage Construction Co.

Byron Adams filed a request for an expedited hearing seeking medical and temporary disability benefits for a right foot injury sustained on August 3, 2016. The employer, Savage Construction Co., contested the claim, arguing the injury was not work-related or an aggravation of a preexisting condition. The Court found Mr. Adams' testimony credible and, after evaluating conflicting medical opinions, accredited Dr. Grear's assessment that the work injury contributed over 50% to Mr. Adams' need for treatment. Consequently, the Court granted Mr. Adams' request, ordering Savage Construction Co. and Builders Mutual Ins. Co. to pay related medical bills and temporary total disability benefits for the stipulated period.

Workers' CompensationExpedited HearingMedical BenefitsTemporary Disability BenefitsFoot InjuryLisfranc InjuryCausationPreexisting ConditionMedical Expert OpinionCredibility of Testimony
References
8
Case No. No. 13
Regular Panel Decision

Fagg v. Hutch Manufacturing Co.

This workers' compensation case involved an appeal by Hutch Manufacturing Company and its insurance carrier concerning an employee, Mrs. Fagg, who sustained a compensable injury. The appeal raised issues regarding the duration of temporary total disability (TTD) benefits, the extent of permanent partial disability (PPD), a 6% penalty for unpaid installments, and medical expenses. The Court dismissed a preliminary appeal as interlocutory. It found the trial court erred in determining the termination date of TTD, concluding that Mrs. Fagg's TTD benefits should cease on October 9, 1984, the latest date for maximum medical recovery according to Dr. Coughlin's evaluations. The Court affirmed the trial court's award of 65% PPD to the body as a whole, emphasizing the consideration of non-medical factors in assessing disability. Furthermore, the Court upheld the 6% penalty on unpaid compensation installments due to the employer's demonstrated bad faith. The case was remanded for a more explicit allocation of medical expenses.

Temporary Total DisabilityPermanent Partial DisabilityMedical Impairment RatingJudicial ReviewRemandPenalty for Non-PaymentMedical EvidenceObjective SymptomsSubjective ComplaintsWorkers' Compensation Appeal
References
12
Case No. ADJ2906412 (SJO 0241532) ADJ121679 (SJO 0241533) ADJ 405246 (SJO 0245064)
Regular
Dec 05, 2008

WANG LE vs. EL CAMINO HOSPITAL, TRISTAR RISK MANAGEMENT

The Appeals Board granted reconsideration, rescinded the prior decision, and returned the case for further proceedings due to the WCJ's inadequate findings on permanent disability and apportionment. The Board found the WCJ erred by relying on an AME's opinion that she acknowledged was insufficient without further medical record development or a clear explanation of how vocational expert testimony was integrated into the permanent disability rating. The matter will be returned to the trial level for the WCJ to obtain adequate apportionment and permanent disability assessments, potentially through further medical evaluations or a formal rating by the Disability Evaluation Unit.

Workers' Compensation Appeals BoardReconsiderationFindings and AwardCumulative TraumaPermanent DisabilityApportionmentAgreed Medical Evaluator (AME)Vocational ExpertMedical Record DevelopmentLabor Code section 4663(c)
References
13
Case No. E2013-01329-WC-R3-WC
Regular Panel Decision
Apr 29, 2014

Tracy W. Hamilton v. Pemberton Truck Lines, Inc.

The employee, Tracy W. Hamilton, a tractor-trailer driver, sustained a work-related cervical spine injury on August 30, 2007. The trial court found the employee to be permanently and totally disabled as a result of the injury and awarded benefits. The employer, Pemberton Truck Lines, Inc., appealed, contending that the evidence did not preponderate against the trial court’s finding of total disability. The Special Workers’ Compensation Appeals Panel affirmed the judgment, emphasizing that the determination of permanent total disability considers vocational factors beyond solely medical expert testimony. The panel concluded that the evidence supported the finding of complete vocational disability, based on the employee's testimony and vocational evaluations.

cervical spine injurypermanent total disabilityworkers' compensation appealmedical impairment ratingvocational evaluationgainful employmentTennessee Supreme Court Rule 51AMA Guideslight-duty restrictionspain management
References
16
Case No. MISSING
Regular Panel Decision

Johnson v. Schevenell Ready Mix, Inc.

Thomas Johnson appealed the dismissal of his worker's compensation claim for permanent disability benefits due to traumatic neurosis from an on-the-job accident in 1978. He sustained a scalping injury and other minor injuries when his "pay-loader" went over a cliff. While employer-selected physicians found no neurological disability, appellant's psychiatrist, Dr. Nancy H. Duckworth, diagnosed permanent disability from traumatic neurosis based on subjective complaints. The trial judge rejected Dr. Duckworth's testimony, citing an incorrect legal principle that medical evidence must have a basis other than subjective complaints. The Supreme Court clarified that T.C.A. § 24-718 allows medical opinions based on subjective findings from qualified experts to establish disability if found credible. The Court vacated the dismissal and remanded the case to the trial court for a new evaluation of witness testimony, including Dr. Duckworth's, and the introduction of further evidence regarding appellant's psychiatric treatment.

Disability BenefitsTraumatic NeurosisMedical EvidenceSubjective FindingsCredibility of WitnessRemandAppellate ReviewStatutory InterpretationPsychiatric EvaluationOn-the-job Injury
References
4
Case No. MISSING
Regular Panel Decision

Humphrey v. David Witherspoon, Inc.

The Tennessee Supreme Court reviewed an appeal from an employer and its insurance carrier regarding a workers' compensation award for a truck driver's back injury. The primary issues involved the extent of permanent partial disability and the admissibility of a chiropractor's expert testimony. The Court found error in the trial judge's reliance on the chiropractor's disability rating, as it did not conform to statutory requirements regarding the use of the American Medical Association Guides. Additionally, the award for temporary total disability benefits was found to be inaccurate because the employee had worked for several weeks. The judgment of the trial court was reversed, and the case was remanded for a new trial to address these issues, allowing for further testimony and re-evaluation.

Workers' Compensation AppealPermanent Partial Disability AssessmentChiropractic Expert TestimonyAMA Guides to ImpairmentTemporary Total DisabilityStatutory ComplianceMedical Report AdmissibilityRemand for New TrialTennessee Appellate LawBack Injury Claim
References
3
Case No. 2021-07-0056
Regular Panel Decision
Dec 22, 2021

Edwards, Jo Carol v. Peoplease

Ms. Jo Carol Edwards sought medical and temporary disability benefits for knee, chest, and foot injuries sustained in a truck accident. The employer, Peoplease, disputed the causal relation of some injuries and the need for evaluation of others, arguing that the accident only exacerbated a pre-existing condition without anatomical change. The Court found Ms. Edwards credible and, disagreeing with the employer's medical expert's interpretation of compensability, held that an aggravation of a pre-existing condition is compensable if it arises primarily out of employment. Relying on Dr. Sweo's opinion and Ms. Edwards's testimony, the Court ordered Peoplease to pay for left and right knee replacements, temporary total disability, a shortfall in disability payment, and mileage, but denied claims for chest and foot injury evaluations.

Workers' CompensationKnee InjuryTruck AccidentPre-existing ConditionAggravation of InjuryCausationMedical BenefitsTemporary Disability BenefitsMileage ReimbursementExpedited Hearing
References
6
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