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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

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

Claim of Clark v. Siara Management, Inc.

Claimant, a custodian, sustained two work-related injuries in 2000, and his workers' compensation benefits were approved. In 2003, the employer's workers' compensation carrier requested an independent medical examination (IME) by Charles Totero. Claimant moved to preclude Totero's report, arguing it was improperly mailed by UMC Medical Consultants, EC., an IME services company, instead of Totero himself, in violation of Workers' Compensation Law § 137. Both a Workers' Compensation Law Judge and the Board denied the motion, finding UMC, as Totero's direct employer and a registered IME company, was authorized to perform administrative services like mailing reports under 12 NYCRR 300.2 (e) (1). The appellate court affirmed the decision, concluding that the submission substantially complied with statutory requirements.

IME Report AdmissibilityWorkers' Compensation Law § 137Procedural ComplianceMedical Report MailingIME Services CompanyAppellate AffirmationStatutory InterpretationIndependent Medical Examiner12 NYCRR 300.2
References
1
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
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
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
Aug 10, 2012

Williams v. Woodhull Medical & Mental Health Center

Valerie E. Williams filed an action against Woodhull Medical and Mental Health Center and other defendants, alleging discrimination and retaliation under federal and state laws, including Title VII and 42 U.S.C. §§ 1981, 1983, 1985, and 1986. Magistrate Judge Lois Bloom issued a Report and Recommendation, advising to grant the defendants' motion for summary judgment on all claims. Plaintiff Williams filed objections to the R&R, particularly contesting the recommendation on her Title VII retaliation claim. District Judge Nicholas G. Garaufis, upon de novo review of the contested portions and clear error review of the uncontested, adopted the R&R in its entirety. The court granted summary judgment to the defendants, finding no genuine dispute of material fact regarding Williams's claims, specifically noting a lack of causal connection for retaliation and insufficient evidence for a hostile work environment or due process violations.

Employment DiscriminationTitle VII RetaliationSummary JudgmentProcedural Due ProcessHostile Work EnvironmentMedical Negligence AllegationsPublic Health LawHospital EmploymentMagistrate Judge ReviewFederal Rules of Civil Procedure 56
References
80
Case No. 07-CV-6149L
Regular Panel Decision
Feb 18, 2010

Johnson v. THE UNIVERSITY OF ROCHESTER MEDICAL CENTER

Plaintiffs Keith Johnson, M.D., and Laura Schmidt, R.N., filed a qui tam action under the False Claims Act against the University of Rochester Medical Center and Strong Memorial Hospital. They alleged defendants defrauded the government by submitting false claims for anesthesiology services under Medicare/Medicaid, claiming physician supervision when it was absent. Johnson also alleged retaliatory discharge for reporting violations, and Schmidt claimed retaliation for refusing to alter medical records. The defendants moved to dismiss, arguing failure to plead fraud with particularity under Fed. R. Civ. P. 9(b) and failure to state a claim under Rule 12(b)(6). Johnson cross-moved to amend the complaint to add claims of libel per se and prima facie tort against Dr. Lustik. The court granted the defendants' motion to dismiss, finding that the plaintiffs failed to allege that any fraudulent bills were actually presented to Medicare/Medicaid. The retaliation claims were also dismissed because the complaints were not made in furtherance of a qui tam action. Johnson's motion to amend was denied as frivolous and in bad faith. Defendants' request for sanctions was denied without prejudice.

False Claims ActQui TamMedicare FraudMedicaid FraudRetaliatory DischargePleading StandardsRule 9(b)Motion to DismissLeave to AmendLibel
References
28
Case No. SAL SJO 252436 (MF); SJO 246192
Regular
Jul 02, 2007

NIHAL HORDAGODA vs. State Compensation Insurance Fund

This case involves an employer's petition for reconsideration of an order authorizing medical treatment and admitting the Qualified Medical Examiner's (QME) reports. The employer argued the QME reports were inadmissible due to an alleged ex parte communication between the applicant and the QME, and that the awarded treatments were improper. The report recommends denying the petition, finding the communication was permissible under LC § 4062.3(h) and that the QME's opinions and awarded treatments for chronic pain were reasonable and not governed by ACOEM guidelines.

Workers' Compensation Appeals BoardPetition for ReconsiderationQualified Medical EvaluatorLabor Code Section 4062.3Ophthalmological evaluationFunctional capacity evaluationUtilization ReviewACOEM GuidelinesChronic spinal conditionTreating physician
References
0
Case No. MISSING
Regular Panel Decision

Rothe v. United Medical Associates

The claimant, a physician, sought workers’ compensation benefits for a work-related left foot and ankle injury. After an initial award, the employer and carrier requested a suspension of payments, arguing insufficient medical evidence of continued disability. The Workers’ Compensation Board subsequently rescinded benefits for the period of March 10, 2002, through September 18, 2002. This was due to the claimant's failure to submit timely and physician-signed medical progress reports, as required by law. The appellate court affirmed the Board's decision, emphasizing that physician's assistant reports do not constitute competent medical evidence of continuing disability and that the Board was not obliged to consider late submissions.

Workers' CompensationMedical EvidenceDisability BenefitsProgress ReportsPhysician's Assistant ReportCompetent Medical EvidenceC-4 ReportsAppellate ReviewUntimely SubmissionContinuing Disability
References
5
Case No. ADJ9556841
Regular
Aug 15, 2016

SOFIA RIOS vs. TULARE REGIONAL MEDICAL CENTER, ALPHA FUND

The Workers' Compensation Appeals Board denied the employer's petition for reconsideration of an award to Sofia Rios. The Board found that the Qualified Medical Evaluator did not engage in ex parte communication by sending a questionnaire and that his reports constituted substantial medical evidence. The employer's arguments that the doctor relied on personal anecdotes and an inaccurate assessment of lift team availability were rejected. The Board affirmed the original award based on the substantial evidence in the medical reports.

Workers' Compensation Appeals BoardPetition for ReconsiderationPanel Qualified Medical EvaluatorEx Parte CommunicationSubstantial Medical EvidenceLabor Code Section 5909TollingReasonable Medical ProbabilityInadequate Medical HistoriesCausation Analysis
References
5
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