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

Case No. ADJ1700793 (SAC 0307437) ADJ3714832 (SAC 0307399)
Regular
Jun 13, 2011

JUANITA BRADLEY (Deceased) vs. COUNTY OF PLACER

This case involves a dispute over liability for a medical-legal report cost. The defendant seeks reconsideration of a prior award holding them responsible for Dr. Adelberg's $4,237.50 report. The defendant argues the judge ignored a prior order for an Agreed Medical Evaluation (AME) and that the applicant's attorney improperly proceeded with Dr. Adelberg's exam. The Board granted reconsideration, preliminarily finding it may be inequitable to place the full cost on the defendant, and intends to split the expense between the defendant and applicant's attorney. A dissenting opinion argues the defendant's own correspondence shows an ongoing dispute regarding the AME, supporting the original award of liability.

Workers' Compensation Appeals BoardReconsiderationMedical-Legal ReportAgreed Medical EvaluationQualified Medical EvaluatorJoint Findings and AwardLabor Code Section 4062(a)Stipulation and OrderEquitable PowersLien Claimant
References
1
Case No. MISSING
Regular Panel Decision

Colindres v. Carpenito

Plaintiff Rochelle Colindres sought a protective order to deny defendants' demand for a medical report from her former treating psychologist, Diane Henry, or alternatively, relief from compliance with Uniform Rules for Trial Courts § 202.17(b)(1). Colindres argued that the defendants waived their right to the report as the independent medical examination (IME) already occurred, and that obtaining the report would be an undue hardship since Henry ceased treatment due to Colindres' attendance issues. Defendants Mario Carpenito, Jr., City of White Plains, and White Plains Parking Department opposed, asserting that the report was necessary to clarify alleged injuries, prepare for cross-examination, and facilitate settlement, highlighting Colindres' complex medical history predating the incident. The court denied both branches of Colindres' motion, finding that the rule applies broadly to personal injury actions, defendants did not waive their entitlement, and Colindres failed to prove it was impossible to obtain the report. The court ordered Colindres to exchange a compliant medical report from Diane Henry by March 27, 2017.

protective ordermedical report disclosurediscovery disputepsychological treatmentindependent medical examinationCPLR 310322 NYCRR 202.17waiver of discoveryundue hardshippersonal injury damages
References
12
Case No. MISSING
Regular Panel Decision

Goldberg v. Edson

The plaintiffs appealed two orders from the Supreme Court, Rockland County. The first order, dated January 5, 2006, granted summary judgment to defendants Page Edson and the County of Rockland, dismissing the complaint against them regarding claims of legal and medical malpractice. The second order, dated January 23, 2006, granted summary judgment to defendant Elizabeth O’Connor, dismissing the complaint against her for legal malpractice. The appellate court affirmed both orders, finding that Edson and the County were immune from liability under Social Services Law § 419 for reporting suspected child abuse and removing a child, and that O’Connor was not negligent in her legal services.

Legal MalpracticeMedical MalpracticeSummary JudgmentChild Abuse ReportingSocial Services LawImmunityMandated ReportersAppellate ReviewGood FaithNegligence
References
6
Case No. ADJ2337190 (LAO 0829672) ADJ3193895 (LAO 0829673) ADJ187762 (LAO 0829674)
Regular
Apr 21, 2009

OLIVIA HUERTA vs. GMP LABORATORIES, STATE COMPENSATION INSURANCE FUND

This case involves a lien claimant, Dr. Elena Konstat, seeking reconsideration of a Workers' Compensation Appeals Board decision that limited reimbursement for her medical-legal reports. The Board found that the original decision erred in disallowing two of Dr. Konstat's three medical-legal reports. The Board clarified that the Official Medical Fee Schedule for treatment rates does not apply to medical-legal expenses, and the testimony of the defendant's lien negotiator was not substantial evidence. Consequently, the Board granted reconsideration, rescinded the original finding, and substituted a new finding allowing reimbursement for all three of Dr. Konstat's medical-legal reports, with the exact amounts, penalties, and interest to be determined.

Medical-legal lienReconsiderationFindings and AwardIndustrial injuryNervous system injuryPsycheLicensed clinical psychologistMedical-legal expensesOfficial Medical Fee Schedule (OMFS)Compromise and Release (C&R)
References
1
Case No. ADJ9725603
Regular
Nov 23, 2020

LUZ LOZA vs. GOLDBLATT GOLDBLATT/BAY AREA RESTAURANT MANAGEMENT, ARCH INSURANCE COMPANY, administered by YORK RISK SERVICES GROUP, INC.

The Workers' Compensation Appeals Board granted reconsideration of an administrative law judge's order finding the applicant entitled to pre-authorization for their treating physician to issue a PR-4 report at the medical-legal billing rate. While affirming the applicant's right to obtain the report, the Board clarified that the defendant retains the right to object to or raise defenses regarding the physician's billing. The Board reasoned that treating physicians are permitted to provide comprehensive medical-legal evaluations, and such reports are governed by specific medical-legal fee schedules, not the Official Medical Fee Schedule.

PR-4 reportmedical-legal billing ratepre-authorizationprimary treating physician (PTP)Qualified Medical Evaluator (QME)comprehensive medical evaluationOfficial Medical Fee SchedulePetition for ReconsiderationFindings of Fact and Order (F&O)Labor Code
References
3
Case No. ADJ15742808
Regular
Apr 03, 2023

DENISE RICO vs. STARCREST PRODUCTS OF CALIFORNIA, INC., ZENITH INSURANCE COMPANY

The Workers' Compensation Appeals Board denied reconsideration of the Findings and Orders regarding a lien trial. The defendant, Zenith Insurance Company, contested the compensability of a medical-legal report from Dr. Haghighinia, arguing it was not from a qualified medical evaluator. The Board adopted the WCJ's report, which found that a report from a treating physician addressing disputed issues like causation in a denied claim is compensable as a medical-legal expense under Labor Code 4620(a). The petition for reconsideration was denied as no new evidence or compelling legal arguments were presented.

WCABPetition for ReconsiderationDeniedMedical-Legal ReportPrimary Treating PhysicianPanel QMELabor Code 4060Labor Code 4062.2Labor Code 4064Contested Claim
References
2
Case No. ADJ6484208
Regular
Aug 21, 2018

ERIK LOPEZ vs. SERFIN CONSTRUCTION, INC., STATE COMPENSATION INSURANCE FUND

The WCAB granted reconsideration and rescinded the prior order, finding that lien claimant South Bay Neurological Diagnostic Center was not entitled to reimbursement for a sleep study. The Board determined the sleep study and associated reports were not valid medical-legal expenses because they were not requested by a medical-legal evaluator and were not incidental to the production of a medical-legal report capable of proving or disproving a disputed medical fact. Therefore, the lien claim was denied.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and OrderAdministrative Law Judgeindustrial injurysleep disorderlien claimantmedical-legal expenseAgreed Medical Evaluator (AME)Report and Recommendation
References
1
Case No. ADJ10230241
Regular
Jul 19, 2019

SAUL ROMERO vs. CARNICERIA NUEVA VALLARTAS, INC.

The WCAB granted reconsideration and rescinded the WCJ's findings, remanding the case for further development of the medical record. The defendant argued the applicant failed to prove an industrial injury, citing a lack of substantial medical evidence. The Board found that no comprehensive medical-legal report from an agreed or panel QME, nor a complete report from the applicant's primary treating physician addressing causation, was present. The case is returned to the trial level for a new decision after a comprehensive medical-legal report is obtained, likely through an agreed or panel QME.

Workers' Compensation Appeals Boardindustrial injuryherniauninsuredsubstantial medical evidencereconsiderationmedical-legal reportprimary treating physiciancausationreasonable medical probability
References
5
Case No. MISSING
Regular Panel Decision

People v. Barto

The defendant was convicted after a jury trial in Seneca County Court for insurance fraud in the third degree, falsifying business records in the first degree, defrauding the government, and falsely reporting an incident in the third degree. The charges arose from the defendant, an acting Village Justice, falsely reporting an assault to police, allegedly to obtain prescription pain medication. Medical evidence presented by the prosecution, including the absence of injuries despite extensive testing, contradicted the defendant's account of being strangled and struck. The appellate court unanimously affirmed the judgment, rejecting the defendant's contentions regarding the legal sufficiency and weight of the evidence. The court found that the jury could reasonably conclude the defendant falsely reported the incident and caused a false workers' compensation form to be filed. The appellate court also found no reason to modify the sentence despite improper prosecutorial statements.

Insurance FraudFalsifying Business RecordsDefrauding GovernmentFalse ReportingAssault ClaimMedical EvidenceLegal SufficiencyWeight of EvidenceWorkers' CompensationJury Trial
References
8
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
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