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Case Law Database

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

Case No. ADJ11629114
Regular
Sep 16, 2022

KATHLEEN PHILLIPS vs. SHORENSTEIN HAYS-NEDERLANDER THEATRES, LLC, STATE NATIONAL INSURANCE COMPANY, INC., MEADOWBROOK INSURANCE

The Workers' Compensation Appeals Board (WCAB) granted reconsideration and modified a prior decision concerning applicant Kathleen Phillips' industrial hip injury. While affirming the finding that the Qualified Medical Examiner's (PQME) reports lacked substantial medical evidence, the WCAB rescinded the striking of those reports and the PQME's disqualification. The WCAB reasoned that striking reports and disqualifying a PQME requires specific legal grounds not present here, and the determination of substantiality relates to the weight of evidence, not admissibility. The WCAB emphasized that the PQME's reports remain part of the record, with the judge retaining discretion to assign them appropriate weight.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and OrderQualified Medical Examiner (PQME)Substantial Medical EvidenceRemoval StandardThreshold IssueInterlocutory FindingAdmissibility of EvidencePrejudiced
References
5
Case No. ADJ7741851
Regular
Apr 22, 2013

SANDRA GALINDO vs. WARNER BROTHERS, INC.

Here's a summary of the case in four sentences for a lawyer: The defendant, Warner Brothers, seeks reconsideration of an order compelling payment for a panel Qualified Medical Evaluator's (PQME) second report, arguing it lacked substantial medical evidence. The Appeals Board denied reconsideration, adopting the WCJ's report which found no legal basis for the defendant's refusal to pay. The defendant's claims of inaccurate medical history in the PQME's report were unsubstantiated despite multiple opportunities to present evidence. The Board affirmed the obligation to pay the PQME's fees, penalties, and interest.

Panel QMEPetition for ReconsiderationOrder to PayMedical-legal costsSubstantial medical evidenceLabor Code Section 462260-day payment periodPenalty and interestFrivolous actionsDue process
References
6
Case No. ADJ10298073 (MF) ADJ10298213
Regular
May 10, 2019

MARIA DE LA LUZ LOPEZ vs. KARMAN STAFFING, SOUTHEAST PERSONNEL LEASING, INC., STATE NATIONAL INSURANCE COMPANY Administered By PACKARD CLAIMS ADMINISTRATION

The Workers' Compensation Appeals Board granted the applicant's petition for reconsideration. The Board rescinded the prior Findings and Award, which found no compensable injury based on a PQME's report deemed more convincing than the applicant's treating physicians. The Board found the PQME's report may not have constituted substantial evidence and the applicant's treating physician reports were insufficient. The case is returned to the trial level for further proceedings, including obtaining new medical reports, to fully adjudicate the alleged injury.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and AwardPanel Qualified Medical EvaluatorPrimary Treating Physiciancompensable specific injurycumulative traumasubstantial evidencemedical reportingdevelop the record
References
5
Case No. ADJ8040191
Regular
Sep 18, 2013

JOEL GOODEN vs. HILLS PET NUTRITION, INC., ACE AMERICAN INSURANCE COMPANY

The defendant petitioned for removal, seeking to overturn an order vacating submission of the case for further medical record development. The administrative law judge (WCJ) had vacated submission to review PQME reports from Dr. Georgis and Dr. Francisco. The WCJ subsequently took the matter off calendar to allow parties to obtain a supplemental report from the PQME reviewing Dr. Francisco's report. As the issue raised by the defendant's petition is now moot due to the subsequent order, the Appeals Board dismissed the Petition for Removal.

Petition for RemovalVacating SubmissionPQMESupplemental ReportWCJOff CalendarMootAppeals BoardWorkers' CompensationCase Development
References
0
Case No. ADJ10084731, ADJ10084732
Regular
Nov 27, 2017

TIMOTHY BEECHAM vs. SWIFT TRANSPORTATION SERVICES, LLC

This case involved the striking of a Qualified Medical Evaluator's (PQME) report due to concerns of racial or ethnic bias. The WCJ found the PQME's deposition testimony, where she referred to the applicant's "Negro blood" and linked it to her assessment of his muscle tone and strength, indicated bias. The Workers' Compensation Appeals Board (WCAB) affirmed this decision, agreeing that such statements suggested reliance on stereotypes and improper medical conclusions. Consequently, the PQME's report was deemed not substantial evidence and was struck, with a new medical evaluation ordered.

Workers' Compensation Appeals BoardReconsiderationPanel Qualified Medical EvaluatorRacial BiasEthnic BiasSubstantial EvidenceStriking ReportNew PanelNeurologyIndustrial Injury
References
0
Case No. MISSING
Regular Panel Decision
Jan 27, 1965

Rivera v. Hellman

This case involves a motion to confirm a Special Referee's report concerning the amounts and priorities of various liens. The Special Referee conducted a hearing and reported on claims from an attorney for the plaintiff ($793.50), Roosevelt Hospital ($846.53), and the Millinery Health Fund ($641.00, later adjusted to $528). The report established the amounts of each lien and recommended priorities, placing the attorney's lien first, followed by the hospital lien (except for a $12 outpatient service), and then the compensation lien. The court concurred with the Special Referee's report and recommendations, granting the motion to confirm.

Lien PriorityAttorney's LienHospital LienDisability BenefitsWorkmen's Compensation LawSpecial Referee ReportMotion GrantedNew York Supreme CourtLien LawMotion Practice
References
2
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. ADJ7587936
Regular
Oct 16, 2012

KAREN GODDARD vs. MARIE CALLENDER'S, ESIS, INC. C/O ACE INSURANCE COMPANY

The Appeals Board dismissed the applicant's petition for reconsideration. They granted removal on their own motion, rescinded the WCJ's order striking the PQME's report, and returned the matter for further development of the record. This action was taken because the record was unclear as to who performed diagnostic testing, potentially violating Labor Code section 4628. The Board directed parties to first obtain a supplemental report from the PQME to clarify this issue.

WCABPQMEAMEIMELabor Code 4628Nerve Conduction StudyMedical Record DevelopmentPetition for ReconsiderationRemovalFindings Order Opinion
References
7
Case No. MISSING
Regular Panel Decision

Chaplin v. Pathmark Supermarkets

This case addresses a motion by defendants, including Supermarkets General Corp., for a protective order to vacate the plaintiff Mimi Chaplin's notice for discovery and inspection of accident reports. Mimi Chaplin sought these reports after sustaining personal injuries from a fall at the defendant's premises. The court, presided over by Justice James F. Niehoff, analyzed the newly enacted CPLR 3101 (g), which mandates full disclosure of accident reports prepared in the regular course of business. The court found that the accident report in question was prepared in Supermarkets General Corp.'s regular course of business, rendering it discoverable regardless of its potential use in litigation, thus denying the defendants' motion.

DiscoveryProtective OrderAccident ReportsCPLR 3101(g)Litigation PreparationRegular Course of BusinessPersonal InjuryNegligenceDisclosureEvidence
References
10
Case No. ADJ9467074; ADJ9468922
Regular
Jul 15, 2018

THEODORE DAVIS vs. CITY OF MODESTO, Permissibly Self-Insured, administered by YORK INSURANCE SERVICES GROUP, INC.

This case involves applicant Theodore Davis's claims of industrial injury to his prostate. The Workers' Compensation Appeals Board (WCAB) granted the defendant's petition for removal and dismissed their petition for reconsideration. The WCAB rescinded the judge's finding that Dr. Besses' inadmissible report could be reviewed by the PQME, citing Labor Code section 4061(i) and Regulation 35(e). The Board affirmed that inadmissible medical-legal reports, obtained outside statutory procedures, cannot be reviewed by the PQME.

WCABRemovalReconsiderationPetitionAdmissibilityMedical-legal reportPQMELabor CodeBattenQualified Medical Evaluator
References
9
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