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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. ADJ3057272 (RDG 0125821)
Regular
Dec 03, 2010

FIDEL NAZARENO vs. OLD DURHAM WOOD COMPANY, STATE COMPENSATION INSURANCE FUND

This case involves a defendant's petition for reconsideration of a permanent disability award, arguing the Agreed Medical Evaluator's (AME) impairment rating was inconsistent with AMA Guides. The Appeals Board granted reconsideration, rescinded the award, and returned the matter for further development of the record. Issues include the DEU rater improperly separating AME's combined whole person impairment and the AME needing to clarify his reasoning on grip loss and potential overlap with other impairments. The AME will also re-evaluate impairment without referencing prior DEU ratings.

WORKERS' COMPENSATION APPEALS BOARDAgreed Medical EvaluatorAMEpermanent disabilityAMA GuidesDEU raterrating instructionswhole person impairmentFindings and AwardPetition for Reconsideration
References
1
Case No. ADJ6976775
Regular
Jul 20, 2015

STEPHANIE HOBBS vs. COUNTY OF LOS ANGELES

This case involves an applicant whose permanent disability rating was challenged. The administrative law judge (WCJ) found a combined permanent disability of 61%, but the applicant argued the WCJ erred by not adopting an agreed medical evaluator's "alternative manner" of calculating cervical spine impairment. While the WCJ correctly rejected the evaluator's method as lacking substantial evidence under *Guzman*, the Appeals Board granted reconsideration. The Board rescinded the award to allow the medical evaluator to provide a revised opinion that fully complies with *Guzman* standards for establishing cervical spine impairment.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and AwardIndustrial InjuryCumulative TraumaCustody AssistantPermanent DisabilityApportionmentNeck InjuryPsyche Injury
References
9
Case No. ADJ10091553
Regular
May 06, 2019

DWIGHT STILLWELL vs. WYLATTI RESOURCE MANAGEMENT, INC., STATE COMPENSATION INSURANCE FUND

In this workers' compensation case, the applicant challenged the administrative law judge's (WCJ) permanent disability rating of $76\%$. The applicant argued that the WCJ improperly combined medical impairments when an agreed medical evaluator suggested adding them for a higher rating of $88\%$. The WCJ acknowledged misinterpreting the medical evidence in their report, admitting that the agreed medical evaluator did indicate adding impairments was more appropriate. Consequently, the Workers' Compensation Appeals Board granted reconsideration to allow the WCJ to re-evaluate the permanent disability rating based on the correct understanding of the medical evidence.

Agreed Medical EvaluatorAMA GuidesPermanent Disability RatingPetition for ReconsiderationWorkers' Compensation Appeals BoardFindings and AwardCVCSchedule for Rating Permanent DisabilitiesOrthopedistIndustrial Injury
References
0
Case No. ADJ8550681
Regular
May 14, 2015

NANCY TOM vs. PARAMOUNT PICTURES

Applicant Nancy Tom sought reconsideration of a workers' compensation award, arguing her 9% permanent disability rating was too low. She contended for further medical evaluation regarding worsening symptoms and a claimed 40% grip loss in her right hand, plus additional impairment ratings for her thumb and knee. The Board denied reconsideration, adopting the WCJ's reasoning that Dr. Angerman's conclusory deposition testimony regarding increased impairment lacked substantial medical evidence and conflicted with AMA Guides to the Evaluation of Permanent Impairment. The Board found that Applicant failed to meet her burden of proof for a higher disability rating.

Workers' Compensation Appeals BoardParamount PicturesPermissibly Self-InsuredPetition for ReconsiderationFindings of Fact and AwardExecutive AssistantIndustrial InjuryPermanent DisabilityAgreed Medical EvaluatorOrthopedist
References
4
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. ADJ12305682
Regular
Apr 14, 2023

DAVID REED vs. CSR MANAGEMENT SERVICES, STATE COMPENSATION INSURANCE FUND

This case involves CSR Management Services and their insurer seeking reconsideration of a $71\%$ permanent disability award for David Reed. The defendants argued that the qualified medical evaluator, Dr. Brophy, did not sufficiently explain the applicant's scarring impairment. The Workers' Compensation Appeals Board denied the petition, finding Dr. Brophy adequately explained the scarring impairments as Class 1 under the AMA Guides. The Board noted that defendants could have sought further clarification from the evaluator.

CSR Management ServicesState Compensation Insurance FundADJ12305682Petition for ReconsiderationAmended Findings of FactAward and Orderconstruction laborerindustrial injuryupper extremitiesback
References
2
Case No. ADJ2453188 (LBO 0391424)
Regular
Jul 20, 2009

WILLIAM GILBERT vs. CITY OF LOS ANGELES

The Workers' Compensation Appeals Board granted reconsideration and rescinded the prior award, finding the medical evidence insufficient. The applicant sought a higher permanent disability rating than the $12\%$ awarded, arguing the judge erred in calculating impairment and omitting pain and grip strength adjustments recommended by the Agreed Medical Evaluator. The Board returned the case to the trial level for further development of the medical record, requiring the evaluator to fully explain their findings on impairment, pain, and grip strength, and to consider *Almaraz* principles regarding equitable permanent disability awards.

Workers' Compensation Appeals BoardCumulative InjuryPermanent DisabilityLeft Median Sensory NeuropathyLeft Ulnar Motor NeuropathyAgreed Medical EvaluatorOrthopedistAMA GuidesImpairment RatingGrip Strength
References
9
Case No. ADJ8181938; ADJ8702275
Regular
Apr 10, 2023

KAREN MILLER vs. STATE OF CALIFORNIA, VENTURA YOUTH CORRECTIONAL FACILITY, STATE COMPENSATION INSURANCE FUND, STATE CONTRACT SERVICES

The Workers' Compensation Appeals Board denied the defendant's petition for reconsideration. The defendant argued against the statutory 15% increase, the method of evaluating spine impairment, and the inclusion of a sleep disorder. The Board adopted the WCJ's report, finding no error in the application of the 15% increase or the evaluation of the spine impairment using the ROM method as deemed appropriate by the agreed medical examiner. Furthermore, the Board upheld the finding of an industrially caused sleep disorder, noting that formal sleep studies are not always required for diagnosis and that the physician's rating falls within the AMA Guides.

WCABPetition for ReconsiderationDeniedVentura Youth Correctional FacilityAdjudication NumbersOccupational Group 214Cervical SpineLumbar SpineBilateral ShouldersGastrointestinal System
References
1
Case No. ADJ9311285
Regular
Jan 12, 2018

Herbert Schmitz vs. Westlands Water District, Liberty Mutual Insurance Company/Wausau

The Workers' Compensation Appeals Board (WCAB) reconsidered a decision awarding 74% permanent disability. The defendant argued the Qualified Medical Evaluator (QME), Dr. Deshmukh, improperly used the hernia chapter of the AMA Guides for impairment rating, violating *Almaraz-Guzman* principles. The WCAB agreed that Dr. Deshmukh's rating lacked sufficient explanation for deviating from standard orthopedic evaluations. Consequently, the WCAB rescinded the permanent disability and attorney's fees findings, returning the case for further proceedings, potentially including a supplemental report or deposition from Dr. Deshmukh, to properly address impairment rating.

Workers Compensation Appeals BoardPermanent DisabilityQualified Medical EvaluatorWhole Person ImpairmentAMA GuidesAlmaraz-GuzmanIndustrial InjuryMedical TreatmentLabor CodeFindings and Award
References
6
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