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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

Claim of Estanluards v. American Museum of Natural History

Claimant appealed a Workers' Compensation Board decision that precluded reports from physician Douglas Schwartz regarding schedule loss of use. Claimant argued Schwartz was an attending physician, not subject to Independent Medical Examination (IME) regulations, or that his reports substantially complied. The Board affirmed, finding Schwartz's examinations were IMEs as he did not treat the claimant. The court affirmed the Board's decision, noting Schwartz's reports lacked proper distribution and certification, failing to meet Workers' Compensation Law § 137 requirements for IME reports. The court also rejected the argument that the statute only applies to employer-initiated IMEs, emphasizing its intent to prevent fraudulent alterations regardless of who initiated the IME.

IME reportsSchedule Loss of UseWorkers' Compensation Law § 137Attending PhysicianIndependent Medical ExaminationReport PreclusionCertificationStatutory ComplianceAppellate ReviewPermanent Partial Disability
References
3
Case No. CV-22-2040
Regular Panel Decision
Mar 14, 2024

In the Matter of the Claim of George Mina

Claimant George Mina appealed a Workers' Compensation Board decision that found his failure to attend independent medical examinations (IMEs) unreasonable. Mina, who injured his back in December 2020, missed two scheduled IMEs in Manhattan, citing the unreasonableness of travel from his New Jersey residence. A Workers' Compensation Law Judge initially found no good cause for his absence but directed the employer to schedule an IME within 30 miles of his home. The Board affirmed this decision, which was subsequently upheld by the Appellate Division, Third Judicial Department, citing that the IME location in Manhattan (22.3 miles from claimant's residence) was within a "reasonable distance" as per Workers' Compensation Law § 137 (4).

Workers' CompensationIndependent Medical ExaminationIMETravel DistanceUnreasonable RefusalSuspension of PaymentsBack InjuryNew Jersey ResidenceManhattan IMEAppellate Division
References
4
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. MISSING
Regular Panel Decision

Claim of Gabak v. New Venture Gear

The claimant sustained a left knee injury, and an independent medical examination (IME) in August 2003 concluded no ongoing work-related disability. Subsequently, a Workers’ Compensation Law Judge (WCLJ) suspended benefits and later precluded the IME report due to untimely filing. The WCLJ also granted the employer's request to cross-examine the treating physician and ordered continued payments. The Workers’ Compensation Board affirmed the WCLJ's decision, which the appellate court further affirmed. The appellate court found that the faxed IME report on August 11, 2003, did not substantially comply with filing requirements, and the official report with IME-4 form was received untimely on August 21, 2003. It also ruled that the doctrine of laches did not apply, upholding the order for continued payments.

Independent Medical ExaminationTimely FilingWorkers' Compensation BoardAppellate ReviewMedical Evidence PreclusionLaches DoctrineCausalityContinuing DisabilityWorkers' Compensation Law § 137NYCRR 300.2 Filing Requirements
References
2
Case No. 534963
Regular Panel Decision
Jun 01, 2023

Matter of Harris v. Department of Envtl. Protection

The claimant, Kevin Harris, a construction worker, filed a workers' compensation claim for work-related injuries to his right shoulder, wrist, and elbow. An orthopedic surgeon, Louis Rose, determined Harris had reached maximum medical improvement and assessed a schedule loss of use (SLU) for these injuries. The self-insured employer challenged Rose's report, arguing his examination was an independent medical examination (IME) and his report failed to comply with statutory and regulatory provisions for IME reports. The Workers' Compensation Board sua sponte agreed that Rose's examination was an IME and precluded his report and testimony due to untimely filing and failure to furnish it to required parties. Consequently, the Board found insufficient evidence for an SLU award. The Appellate Division affirmed the Board's decision, concluding that substantial evidence supported the IME classification and the preclusion of Rose's report due to non-compliance.

Workers' CompensationSchedule Loss of Use (SLU)Independent Medical Examination (IME)Medical Report PreclusionTimely FilingComplianceAppellate ReviewOrthopedic InjuryEmployer Self-InsuredRight Shoulder Injury
References
8
Case No. MISSING
Regular Panel Decision

Claim of Pugliese v. Remington Arms, Inc.

The claimant, employed by Remington Arms, Inc. for over three decades, sought workers' compensation benefits, citing severe depression and anxiety stemming from alleged harassment and falsification of attendance records by a supervisor. Initially, a Workers' Compensation Law Judge denied further adjournments for an independent medical examination (IME) report and cross-examination of the treating psychologist, determining the depression to be an occupational disease. The Workers' Compensation Board subsequently modified this, reclassifying it as a compensable accidental injury. The employer and its carrier appealed, challenging the use of hearsay evidence, the preclusion of their IME report, and the denial of their right to cross-examine the claimant's treating psychologist. The appellate court found sufficient corroboration for the hearsay evidence and upheld the IME report's preclusion due to the carrier's delays. However, the court reversed the denial of cross-examination, stating that the absence of the IME report did not negate the carrier's right, especially given their dispute on causal relationship. Consequently, the case was reversed and remitted to the Workers' Compensation Board for further proceedings.

DepressionAnxietyWorkplace HarassmentAttendance Records FalsificationIndependent Medical ExaminationIME Report PreclusionRight to Cross-ExaminationHearsay EvidenceCorroborating EvidenceOccupational Disease
References
11
Case No. ADJ4478194 (ANA 0379216)
Regular
Nov 25, 2008

MILTON T. WYNN vs. BALTIMORE RAVENS, ATLANTA FALCONS, HOUSTON TEXANS, TAMPA BAY BUCCANEERS, ST. LOUIS RAMS, GULF INSURANCE COMPANY; WARD NORTH AMERICA, INC., Permissibly SelfInsured;, TRAVELERS INSURANCE COMPANY Successor in interest by merger GULF INSURANCE COMPANY

The Workers' Compensation Appeals Board granted reconsideration to allow an Independent Medical Examiner (IME) to review newly obtained medical records related to the applicant's pre-existing hip condition. The defendant argued these records were crucial for proper apportionment of permanent disability and that the IME lacked a complete history. The Board rescinded the prior award to develop the medical record further, allowing the IME to provide a supplemental report.

Workers' Compensation Appeals BoardIndependent Medical Examinersubstantial medical evidencebilateral slipped capital femoral epiphysisapportionmentpermanent disabilitycumulative traumaagreed medical examinersupplemental reportnewly discovered evidence
References
4
Case No. ADJ4442180 (MON 0225200)
Regular
Nov 18, 2010

ERMA LESTER vs. STATE OF CALIFORNIA, BOARD OF EQUALIZATION, STATE COMPENSATION INSURANCE FUND, et al

The Workers' Compensation Appeals Board granted reconsideration, reversing a prior award. The Board found that the Independent Medical Evaluator's (IME) April 2010 deposition testimony, which suggested that the applicant's fibromyalgia could not be medically apportioned between two distinct industrial injuries, was not substantial evidence. Consequently, the Board reinstated two separate 50% permanent disability awards for each injury, relying on earlier IME opinions that allowed for apportionment. The Board reasoned that the IME's later opinion lacked a medical basis and appeared to be influenced by legal considerations rather than medical findings.

FibromyalgiaCumulative TraumaApportionmentMedical-Legal OpinionsIndependent Medical EvaluatorPermanent DisabilityCausationSubstantial EvidenceReconsiderationBoard En Banc
References
4
Case No. ADJ4211516 (LBO 0340807)
Regular
Oct 19, 2012

LISA SIMMONS vs. STATE OF CALIFORNIA, DEPARTMENT OF MENTAL HEALTH, Legally Uninsured, STATE COMPENSATION INSURANCE FUND/STATE CONTRACT SERVICES, Adjusting Agency

The WCAB dismissed the defendant's petition for reconsideration, finding the appointment of an IME was not a final order. However, they granted removal, finding the WCJ’s reason for appointing an IME (alleged bias of the prior QME, Dr. Kanter) unsupported by evidence. The Board rescinded the IME appointment and returned the case to the trial level, directing the WCJ to obtain a supplemental report from Dr. Kanter. This action aims to resolve the dispute over home health care services efficiently, emphasizing that supplemental reports from existing medical experts are preferred over new evaluations unless bias is proven.

Workers' Compensation Appeals BoardPetition for ReconsiderationPetition for RemovalIndependent Medical ExaminerQualified Medical EvaluatorFurther Medical TreatmentHome Health CareNursing ServicesMaid and Cleaning ServicesIndustrial Injury
References
10
Case No. MISSING
Regular Panel Decision

Claim of Coratti v. Jon Josef Hair & Colour Group

The Workers' Compensation Board denied a claimant's motion to preclude a workers’ compensation carrier’s consultant report, which was based solely on a review of medical records, not an independent medical examination (IME). The claimant argued non-compliance with Workers’ Compensation Law § 137 (1) (b), a provision requiring notice if an IME is performed. The Board concluded the statute does not apply to records-review-only reports. An appellate court affirmed, holding that the plain language of § 137 (1) (b) explicitly refers to practitioners who have performed or will perform an IME, thereby excluding those who solely review records. The court emphasized that statutory interpretation must adhere to plain language, leaving policy arguments to the Legislature.

IME reportsrecords reviewWorkers' Compensation Lawstatutory interpretationpreclusion motioncausationoccupational illnessdue processlegislative intent
References
3
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