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

Case No. ADJ9836001; ADJ9836002 ADJ9836004; ADJ9836542 ADJ10301695
Regular
Sep 28, 2016

BEATRIZ HERNANDEZ vs. RAMCO ENTERPRISES

This case concerns whether the applicant is entitled to a new Qualified Medical Evaluator (QME) for a later reported injury. The defendant argued that under *Navarro v. City of Montebello*, the same QME should evaluate all injuries reported prior to an initial evaluation. However, the Board found *Navarro* distinguishable because the applicant's fifth injury was reported *after* the initial QME evaluation, despite occurring earlier. Therefore, the applicant is entitled to a new PQME for the later reported injury, and the defendant's petition for reconsideration was denied.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and OrderQualified Medical Evaluator (QME)Panel QME (PQME)Navarro v. City of MontebelloLabor CodeMedical-Legal EvaluationsApplication for Adjudication of ClaimDeclaration of Readiness to Proceed
References
1
Case No. ADJ8975338
Regular
Jun 21, 2017

Kevin Livingstone vs. ATI, American Insurance Company, ESIS

This case involves a defendant's attempt to strike a Qualified Medical Evaluator's (QME) report and obtain a replacement due to a 7-day delay in a supplemental report. The Appeals Board vacated its prior order granting reconsideration because the initial WCJ's order denying the strike was not a final order subject to reconsideration. The Board further denied the defendant's petition for removal, finding no irreparable harm. The ruling clarifies that only an untimely initial QME evaluation mandates replacement, whereas a late supplemental report is within the WCJ's discretion to address based on good cause.

WCABPetition for ReconsiderationPetition for RemovalQualified Medical EvaluatorQMESupplemental ReportTimelinessFinal OrderInterlocutory OrderAdministrative Director
References
14
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. ADJ7899375
Regular
Apr 06, 2020

AMANDA CULVER vs. INITIATIVE FOODS, UNITED STATES FIRE INSURANCE COMPANY, CRUM AND FORSTER

This case involves Amanda Culver's claim for permanent total disability due to a 2010 industrial injury resulting in a fall down stairs. The defendant, Initiative Foods, contested the finding of 100% permanent disability, arguing the Administrative Law Judge (ALJ) improperly relied on an Independent Vocational Evaluator (IVE) and overlooked their own vocational expert. The Workers' Compensation Appeals Board affirmed the ALJ's decision, finding the IVE's report constituted substantial evidence supporting the applicant's permanent total disability. The Board found the defendant's arguments regarding the IVE's methodology and reliance on medical reports unconvincing.

Independent Vocational Evaluatorvocational rehabilitationpermanent total disabilityorthopedic injurypsychiatric injuryapportionmentAgreed Medical Examinerwork restrictionsvocational testingsubstantial evidence
References
3
Case No. TI11710087
Regular
Nov 20, 2018

Theodore Davis vs. CITY OF MODESTO, YORK INSURANCE SERVICES, GROUP, INC.

This case involves applicant Theodore Davis's prostate cancer claim against the City of Modesto. The core dispute centers on the admissibility and review of a medical report by Dr. Besses. The Appeals Board initially denied review of Dr. Besses' report but, following a court of appeal remittitur, is now granting removal. The matter is returned to the trial level for the WCJ to re-evaluate the admissibility of Dr. Besses' report under Labor Code section 4605 and related rules, and whether it can be provided to the QME. This decision clarifies that while QME evaluations are required for compensability disputes, privately obtained medical reports may still be admissible.

RemittiturPetition for RemovalPetition for ReconsiderationQualified Medical EvaluatorLabor Code Section 4060Labor Code Section 4605Admissibility of Medical ReportsEx Parte CommunicationCumulative TraumaSpecific Injury
References
9
Case No. ADJ9 636706; ADJ9636707 ADJ9447837
Regular
Aug 09, 2016

RICK PARKER vs. DSC LOGISTICS, ZURICH NORTH AMERICA

This case concerns whether a Qualified Medical Evaluator (QME) must address all claimed industrial injuries filed prior to their initial evaluation. The Workers' Compensation Appeals Board (WCAB) rescinded a prior order that denied the defendant's petition to vacate new QME panels. The WCAB held that Labor Code section 4062.3(j) requires a QME to evaluate all contested medical issues arising from injuries reported on one or more claim forms prior to the employee's initial appointment. Therefore, the applicant must return to the original QME, Dr. Steinmann, to evaluate the disputed medical issues in all relevant case numbers.

Workers' Compensation Appeals BoardReconsiderationPetition to Vacate QME PanelsLabor Code section 4062.3Qualified Medical EvaluatorPanel QMEDuplicative Medical EvaluationsDoctor ShoppingNavarro v. City of MontebelloContested Medical Issues
References
1
Case No. MISSING
Regular Panel Decision
Nov 03, 1967

Holloway v. Board of Examiners

The petitioner, a school social worker, initiated an Article 78 proceeding to compel the respondent to provide copies of medical and other reports that led to an unsatisfactory rating in an examination for a Supervisor of School Social Workers license. The Supreme Court, Kings County, initially dismissed the petition. However, the appellate court reversed this judgment, granting the petition to the extent of directing the respondent to furnish the reports to a physician designated by the petitioner, rather than directly to the petitioner. The case was remanded to the Special Term for further proceedings, including a determination on allowing the petitioner more time to appeal the unsatisfactory rating.

Article 78 CPLRLicense ExaminationSchool Social WorkerMedical ReportsDisclosureAdministrative AppealUnsatisfactory RatingAppellate ReversalRemandPhysician Disclosure
References
3
Case No. ADJ6632043 ADJ6580510
Regular
Jul 01, 2010

DARRYL PILLORS vs. PENSKE TRUCK LEASING CO., OLD REPUBLIC INSURANCE COMPANY

The Appeals Board granted removal, rescinded the WCJ's order, and returned the case to the trial level. This was because the WCJ improperly ordered a second QME panel before adjudicating the admissibility of the first panel's report. Defendant argued prejudice from incurring costs for two evaluations, and the Appeals Board agreed this raised irreparable harm. The WCJ must now determine the admissibility of the initial QME report and any subsequent orthopedic evaluations.

RemovalQualified Medical EvaluatorQME panelAdmissibility of reportTimeliness of objectionPetition for RemovalWCJ decisionMedical UnitIndustrial injuryBack injury
References
1
Case No. ADJ7762389
Regular
Jan 22, 2014

ANA RAMIREZ vs. HENROSE CORPORATION, dba MCDONALDS RESTAURANT, CALIFORNIA RESTAURANT MUTUAL BENEFIT CORPORATION, AMERICAN CLAIMS MANAGEMENT

The Workers' Compensation Appeals Board denied Henrose Corporation's Petition for Removal. Petitioner sought to have the applicant re-evaluated by Agreed Medical Examiners (AMEs) to potentially extend temporary disability beyond the statutory limit, arguing their initial reports were insufficient. The Board found that Petitioner failed to demonstrate significant prejudice or irreparable harm to justify removal. The denial was based on the judge's report, which concluded the matter was set for trial appropriately and the requested re-evaluations were not warranted under the circumstances.

Petition for RemovalWorkers' Compensation Appeals BoardPermanent and Stationary DateTemporary DisabilityMedical ReportsOrthopedic InjuryPsychiatric InjuryAdministrative Law JudgeLabor Code Section 4656(c)(1)Agreed Medical Examiner
References
0
Case No. ADJ7399938 ADJ7068967
Regular
Jun 23, 2015

OLENA GARCIA vs. RESIDENCE INN, NATIONAL UNION FIRE INSURANCE COMPANY OF PITTSBURGH, PENNSYLVANIA

The Appeals Board granted reconsideration, rescinded the prior award, and returned the case for further development of the record. The initial award found permanent total disability based on a vocational expert's opinion, but the Board found this opinion lacked substantial medical evidence. Specifically, the medical expert's supplemental report was not based on a current evaluation, and the vocational expert's conclusions, relying on that report, were therefore also flawed. The matter is remanded to allow for a current medical evaluation and reassessment of vocational rehabilitation and diminished earning capacity.

Workers' Compensation Appeals BoardPermanent Total DisabilityJoint Findings and AwardVocational ExpertSubstantial EvidenceScheduled RatingFunctional Capacity EvaluationAgreed Medical ExaminerApportionmentModified Work
References
0
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