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Case Law Database

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

Case No. ADJ9581070; ADJ10207290
Regular
Sep 12, 2016

LETICIA ORNELAS vs. NORTHSTAR GROUP SERVICES, INC., NEW HAMPSHIRE INSURANCE COMPANY

The Workers' Compensation Appeals Board (WCAB) denied the defendant's petition for reconsideration or removal of a prior order. The WCAB affirmed the finding that Dr. David Teicheira was the properly designated Qualified Medical Evaluator (QME) for the applicant's cumulative trauma claim. This decision was based on the understanding that a new QME panel is validly obtained for a subsequent claim, even if an Agreed Medical Evaluator (AME) was previously used for a different injury. The prior AME agreement did not preclude the use of a QME for the distinct cumulative trauma claim.

WCABPetition for ReconsiderationQME PanelAgreed Medical EvaluatorCumulative TraumaSpecific InjuryFindings and OrderWCJLabor CodeNavarro v. City of Montebello
References
6
Case No. ADJ8214888
Regular
Sep 10, 2012

OLGA VALENCIA vs. YESSICA MARTINEZ, MEADOWBROOK INSURANCE

The Workers' Compensation Appeals Board (WCAB) dismissed the applicant's petition for reconsideration of a mandatory settlement conference order. However, the WCAB granted the applicant's request for removal, finding substantial prejudice and irreparable harm. The WCAB clarified the prior order to state that it does not preclude future panel Qualified Medical Examiner (QME) evaluations for the left foot/ankle, provided legal requirements are met. While the applicant's objection letters were deemed non-compliant with QME procedures at that time, the door remains open for future QME evaluations.

Workers' Compensation Appeals BoardRemovalReconsiderationMandatory Settlement ConferenceQualified Medical ExaminationTreating Physician's ReportLabor Code section 4062.2Substantial PrejudiceIrreparable HarmInterlocutory Orders
References
5
Case No. ADJ10237267
Regular
Jan 31, 2018

KENNETH ANGEL vs. ABLE ENGINEERING, ZURICH NORTH AMERICA

This Workers' Compensation Appeals Board case concerns applicant Kenneth Angel's request for a replacement Qualified Medical Evaluator (QME) in dentistry. Angel argued that the assigned QME, Dr. David Polushkin, was not licensed to practice at the West Covina location where the evaluation occurred. The Board denied reconsideration, finding insufficient evidence that Dr. Polushkin was ineligible to practice at that location, as "address of record" does not necessarily preclude other authorized practice sites. Furthermore, the Board noted that issues of QME eligibility are within the purview of the Administrative Director, not the Appeals Board.

QME panelreplacement QMEdental QMEWCJPetition for ReconsiderationAmended Findings of FactverificationwaivereligibilityAdministrative Director
References
0
Case No. ADJ4423159 (SAL 0118926)
Regular
Sep 20, 2016

ISIDRO CERVANTES vs. QUALITY FARMS LABOR, LIBERTY MUTUAL INSURANCE COMPANY

The Workers' Compensation Appeals Board granted removal to review an administrative law judge's order precluding applicant from submitting non-medical records to the Qualified Medical Evaluator (QME). The Board determined that certain medical study abstracts and specific AMA Guides pages were relevant and permissible for submission to the QME, particularly concerning the disputed application of the Combined Values Chart. However, other submitted non-medical documents, such as panel decisions and index pages for abstracts, were deemed not sufficiently relevant or their authenticity was unclear, thus their submission was not permitted. Ultimately, the Board amended the original order to allow the applicant to provide only the specifically identified relevant medical abstracts and AMA Guides pages to the QME.

Petition for RemovalDecision After RemovalQualified Medical EvaluatorNon-medical recordsMedical study abstractsAMA GuidesCombined Values ChartLabor Code section 4062.3PrejudiceIrreparable harm
References
9
Case No. ADJ6698865
Regular
Aug 12, 2010

VALENTINO VILLALPANDO vs. CINTAS CORPORATION, INC., XL SPECIALTY INSURANCE Administered By CAMBRIDGE/XCHANGING

The Workers' Compensation Appeals Board denied Cintas Corporation's Petition for Reconsideration and Removal. The Board affirmed the finding that the applicant needs further medical treatment but clarified that this does not preclude future challenges to specific treatment. The Board also upheld the striking of the QME report due to procedural violations by the defendant, including failure to provide a log of records and a Spanish interpreter. Consequently, the defendant's challenges to the QME report and orders regarding Dr. Bogerty's evaluation were also denied.

Workers' Compensation Appeals BoardPetition for ReconsiderationRemovalFurther Medical Treatment (FMT)Utilization ReviewMedical Provider Network (MPN)Qualified Medical Evaluator (QME)Medical UnitDr. SoongDr. Bogarty
References
0
Case No. ADJ18724961; ADJ15255319
Regular
Nov 03, 2025

Tina Garza vs. County of Kern

Defendant County of Kern sought reconsideration of a WCJ's Findings of Fact and Discovery Order which determined that Dr. Scott Graham was the Agreed Medical Evaluator (AME) for both claims and that defendant waived its right to a Qualified Medical Evaluator (QME) examination. The defendant argued that the waiver finding was improper and they were entitled to a new medical-legal evaluation panel. The Appeals Board granted reconsideration, rescinded the WCJ's decision, and returned the matter for further proceedings, primarily due to an inadequate record and deficiencies in the minutes of hearing. The Board also noted that based on current Labor Code interpretations, the parties' agreement to an AME once initiated, generally precludes subsequent QME panel requests for submitted issues.

Workers' Compensation Appeals BoardPetition for ReconsiderationAgreed Medical Evaluator (AME)Qualified Medical Evaluator (QME)Panel QMEMedical-Legal ExaminationWaiver of RightLabor Code Section 4062.2Labor Code Section 4062.3Navarro v. City of Montebello
References
9
Case No. MISSING
Regular Panel Decision

People v. Ackerson

In a felony driving while intoxicated trial, defendant Scott Ackerson moved to preclude the testimony of an emergency medical technician (EMT), Diane Wood, citing the physician-patient privilege under CPLR 4504(a). The court denied the motion, stating that evidentiary privileges, being in derogation of common law, must be strictly construed. The Legislature has not explicitly extended this privilege to EMTs, despite creating other specific privileges. The court found no evidence that the EMT acted as an agent for a physician. The opinion emphasized that an EMT's role is to stabilize patients, distinct from a physician's role of diagnosis and treatment, thus not falling within the purpose of the CPLR 4504 privilege.

PrivilegeEmergency Medical TechnicianEMTPhysician-Patient PrivilegeCPLR 4504Statutory InterpretationEvidentiary PrivilegeFelony DWITestimony PreclusionAgency
References
6
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. ADJ7899192, ADJ7902366
Regular
Oct 21, 2019

VALERIE DAILEY vs. SCRIPPS HEALTH

The applicant sought reconsideration of a finding that her psychiatric injury was not a compensable consequence of her industrial neck and elbow injuries. The Board found that the prior QME's report, which applicant sought to admit, should have been considered as it was not properly excluded. The Board also noted that the subsequent QME's report did not review the prior QME's findings, potentially rendering it incomplete. Consequently, the Board rescinded the award and returned the matter for further proceedings to admit the prior QME's report and allow the subsequent QME to review it.

Workers Compensation Appeals BoardPsychiatric InjuryCompensable ConsequenceQualified Medical EvaluatorQME ReportAdmissibility of EvidenceMedical EvaluationFurther ProceedingsFindings and AwardReconsideration
References
9
Case No. ADJ6470549
Regular
Feb 27, 2012

KATHRYN BENSON vs. CITY OF SAN DIEGO

The Workers' Compensation Appeals Board granted reconsideration and reversed a prior decision, allowing a Qualified Medical Examiner's (QME) report into evidence. The original decision excluded the QME report, finding no ratable permanent disability based on the treating physician's opinion. The Appeals Board found the QME report should have been admitted, as there are no explicit time limits for objecting to a treating physician's report or obtaining a QME evaluation for permanent disability. The case is remanded for further proceedings on permanent disability and attorney's fees with the QME report now part of the record.

Workers Compensation Appeals BoardFindings and AwardPetition for ReconsiderationQualified Medical Examiner (QME)Permanent DisabilityFuture Medical TreatmentTreating PhysicianAgreed Medical Examiner (AME)Labor Code Section 4061Strawn v. Golden Eagle Insurance Co.
References
1
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