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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. MISSING
Regular Panel Decision

55th Management Corp. v. Goldman

This case addresses whether an out-of-court statement made to a court evaluator in an Article 81 guardianship proceeding is protected by absolute privilege, thereby defeating a defamation claim. The defendant, a tenant, made allegedly defamatory remarks about a landlord to a court evaluator during the evaluator's investigation for a guardianship proceeding. The court considered if the remarks were pertinent, if a statement to a court evaluator is considered part of a judicial proceeding, and if the speaker had standing. The court found the remarks pertinent, extended the absolute privilege to statements made to court evaluators given their role as court agents, and affirmed the defendant's standing as a potential witness. Consequently, the defendant's motion to dismiss the defamation complaint was granted.

DefamationAbsolute PrivilegeJudicial ProceedingsCourt EvaluatorGuardianshipMental Hygiene Law Article 81Tenant-Landlord DisputeMotion to DismissCPLR 3211 (a) (7)Scope of Privilege
References
44
Case No. ADJ9317724
Regular
Jul 23, 2015

JUAN TORRES vs. LINEAGE LOGISTICS COLD STORAGE, TRAVELERS INSURANCE COMPANY

The Workers' Compensation Appeals Board denied the applicant's Petition for Removal. The applicant sought to overturn a Minute Order compelling an orthopedic QME evaluation, arguing the existing orthopedic panel was improperly obtained and preferred a treating doctor. The Board adopted the WCJ's recommendation, finding no substantial prejudice or irreparable harm, as removal is an extraordinary remedy not warranted here. The applicant's preference for a treating doctor did not override the WCJ's order for a QME evaluation requested to clarify a prior medical opinion regarding potential knee surgery.

Petition for RemovalQualified Medical EvaluatorOrthopedic QMEChiropractic QMEKnee SurgeryIndependent Medical OpinionMPNMedical Treatment AuthorizationPrimary Treating PhysicianReconsideration
References
2
Case No. SAL 96100; 96096
Regular
Jul 03, 2007

JEANNE LAWRENCE vs. CYPRESS URGENT CARE and PREFERRED EMPLOYERS INSURANCE, TENET/DOCTORS HOSPITAL OF MANTECA

This case involves a worker who sustained two industrial injuries, the first in 2001 with Cypress Urgent Care and the second in 2001 with Tenet/Doctors Hospital of Manteca. The defendant, Tenet/Doctors Hospital, sought reconsideration of a joint findings and award that attributed 25% of the worker's temporary disability and vocational rehabilitation costs to their injury. The WCAB granted reconsideration, finding that while the second injury occurred after the first, evidence indicated the first injury contributed to the worker's need for benefits, thus supporting the apportionment.

WCABReconsiderationJoint Findings and AwardPetition for ReconsiderationTemporary Total Disability (TTD)Vocational RehabilitationApportionmentConsecutive InjuriesMedical TreatmentSelf-Insured
References
0
Case No. ADJ5738297
Regular
Apr 13, 2011

Douglas Riedo vs. REGENTS OF UNIVERSITY OF CALIFORNIA, UCSB & SEDGWICK CMS

The Workers' Compensation Appeals Board (WCAB) granted the applicant's petition for removal and rescinded an order compelling attendance at a medical evaluation. The WCAB found that the employer failed to comply with Administrative Director Rule 32(d) regarding the selection of a consulting physician and rejected the employer's reliance on Labor Code section 4064(d). The Board clarified that parties cannot obtain multiple evaluations on the same issue until they receive a favorable opinion, a practice known as "doctor shopping."

Petition for RemovalRescind OrderLabor Code section 4050Labor Code section 4060Labor Code section 4062Labor Code section 4062.2compensable consequence injuriesorthopedic qualified medical evaluator (QME)Administrative Director Rule 32(d)Labor Code section 4064(d)
References
0
Case No. ADJ9007348
Regular
Jul 31, 2014

THERESA MERENKOV vs. ORACLE USA, INC.; SAFETY NATIONAL CASUALTY COMPANY, administered by MATRIX ABSENCE MANAGEMENT, INC.

The Workers' Compensation Appeals Board denied Oracle USA, Inc.'s petition for reconsideration. Defendant challenged the $50\%$ permanent disability award, claiming the Qualified Medical Evaluator's impairment ratings were incorrect. The Board found the WCJ reasonably relied on the doctor's expert opinion and sufficient reasoning. Defendant also failed to adequately challenge the doctor's findings during deposition. Additionally, the petition contained procedural defects regarding verification and attorney identification.

Permanent disability ratingPanel Qualified Medical EvaluatorAMA Guides 5th Editionwhole person impairmentdisability evaluation raterPetition for ReconsiderationFindings and Awardindustrial injuryfuture medical treatmentWCJ Report and Recommendation
References
5
Case No. ADJ1813115
Regular
Sep 17, 2012

JOSE GALARRETA vs. H.R. STAFFING, STATE COMPENSATION INSURANCE FUND

This case involves a worker seeking to reopen his workers' compensation claim based on alleged new and further disability. The applicant argued that a Qualified Medical Evaluator's report used by the judge was improperly admitted. However, the Board denied reconsideration, finding the applicant waived his objection by not raising it until trial, effectively permitting "doctor shopping." The Board also affirmed the administrative law judge's reliance on the evaluator's report over the treating physician's, finding no compelling reason to overturn the determination of no new and further disability.

new and further disabilitypetition to reopenqualified medical evaluatorLabor Code section 4062.3(j)waiver of objectioninvited errorTelles TransportFajardoCounty of Sonomamedical evaluator timeliness
References
3
Case No. ADJ1211801
Regular
Apr 13, 2012

GUISELA REYNOSO vs. UNIVERSAL PROTECTION SERVICES, AMERICAN CASUALTY COMPANY OF READING, PENNSYLVANIA, CNA CLAIMPLUS

The Workers' Compensation Appeals Board dismissed the defendant's Petition for Reconsideration because the WCJ's decision denying a replacement QME was an intermediate procedural order, not a final determination of substantive rights. The defendant sought a new panel after the QME allegedly violated a regulation by evaluating the applicant at an unlisted address and missed a deposition. The Board found the defendant's objection to the evaluation was untimely and that the request for a new panel appeared to be an attempt to "doctor shop" after receiving unfavorable reports. Even if considered for removal, the petition would be denied due to the unreasonable delay in raising objections.

Workers' Compensation Appeals BoardQualified Medical EvaluatorQME panelindustrial injuryspider bitesecurity guardreplacement paneldepositiondiscovery ordersfinal order
References
4
Case No. ADJ830768
Regular
Apr 09, 2009

MIKE OLSON vs. PACIFIC COAST SERVICES, EMPLOYER COMPENSATION INSURANCE CO.

This case involves a lien claimant, Jennifer Scott, seeking reconsideration after her $\$750.00$ lien for a doctor's report was disallowed. The WCJ found the report not to be an allowable medical-legal cost. The petition for reconsideration was dismissed primarily because it was unverified, a requirement under Labor Code section 5902, and the defect was not cured. Even if considered on the merits, the Board would have denied the petition, adopting the WCJ's reasoning that the report was not a compensable medical-legal expense. The report was procured at the applicant's attorney's request, not by an authorized medical evaluator, and the attorney failed to establish the doctor's qualifications as an expert rater.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and OrderIndustrial cumulative injuryUpper extremitiesTruck mechanicApplicant counsel's lienMedical-legal costLabor Code section 5811Labor Code section 4620(c)
References
1
Case No. MISSING
Regular Panel Decision

In re Carew

The court considered two child abuse petitions filed by the Suffolk County Department of Social Services against a father, based on unsworn statements from his three and five-year-old children. The respondent father moved for psychiatric evaluations of the children and their mother to defend against the allegations, citing the need for expert assessment of the children's credibility. The court balanced the children's welfare against the father's right to a fair trial, noting the unique challenges of corroborating out-of-court statements in Article 10 proceedings. The court granted the father's request to the extent of ordering a validation interview for both children, stipulating a court-designated examiner if parties could not agree. The request for the mother's examination was denied due to insufficient justification.

Child AbuseFamily Court ActPsychiatric EvaluationChild CredibilityHearsay TestimonyCorroboration RequirementDue ProcessParental RightsSuffolk CountyUnsworn Statements
References
5
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