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

Case No. ADJ10800397
Regular
May 20, 2019

MARILYN RAMIREZ GALVEZ vs. NIAGARA BOTTLING LLC, SAFETY NATIONAL INSURANCE CO.

The applicant sought a QME panel in psychology for a claimed psychiatric injury after orthopedic and internal medicine evaluations. The WCJ denied the request, finding no substantial medical evidence for a psychological QME. The Appeals Board granted removal, rescinded the WCJ's order, and found good cause for a psychological QME panel. This decision allows the applicant to pursue necessary medical-legal discovery regarding her disputed psychological injury claim.

Petition for RemovalFindings and OrderQualified Medical EvaluatorQME panelpsychologypsychiatric injurydiscoveryinternal medicineorthopedic QMEhypertension
References
1
Case No. MISSING
Regular Panel Decision

Clear Water Psychological Services PC v. American Transit Insurance Co.

Plaintiff Clear Water Psychological Services PC sought no-fault benefits from defendant American Transit Insurance Company. The plaintiff moved for summary judgment, while the defendant cross-moved for a 90-day stay, arguing that the assignor, Oshane Crooks, was acting as an employee at the time of the November 10, 2014 automobile accident, falling under Workers’ Compensation Board jurisdiction. A key issue was the admissibility of an uncertified police accident report (MV-104AN) which suggested the assignor was driving a taxi. The court ruled the uncertified report inadmissible under CPLR 4518 (c) for authentication reasons, despite the officer's personal observations. However, acknowledging the unresolved factual question of the assignor’s employment status and the Workers’ Compensation Board's primary jurisdiction, the court granted the defendant’s motion, staying the action for 90 days for a Workers’ Compensation Law applicability determination.

No-fault benefitsSummary judgmentStay of actionWorkers' CompensationPolice accident reportAdmissibility of evidenceCPLR 4518Vehicle and Traffic LawPrimary jurisdictionEmployment status
References
12
Case No. 2015-455 K C
Regular Panel Decision
Dec 19, 2017

Metro Psychological Servs., P.C. v. Travelers Prop. & Cas. Ins. Co.

This case involves Metro Psychological Services, P.C., as an assignee, seeking first-party no-fault benefits from Travelers Property & Casualty Insurance Company. The defendant moved for summary judgment, arguing the assignor's injuries occurred during employment, which would make workers' compensation benefits applicable. The Civil Court denied the defendant's motion and granted the plaintiff's cross-motion for summary judgment. The Appellate Term reversed this order, concluding there was an unresolved issue as to whether the plaintiff's assignor was acting in the course of employment at the time of the accident. Consequently, the matter was remitted to the Civil Court to be held in abeyance, pending a determination by the Workers' Compensation Board regarding the parties' rights under the Workers' Compensation Law, underscoring the Board's primary jurisdiction in such matters.

No-Fault BenefitsWorkers' Compensation LawPrimary JurisdictionAbeyanceSummary JudgmentAppellate ReviewInsurance DisputeMedical ProviderAssigneeCourse of Employment
References
9
Case No. 2021 NY Slip Op 04626 [197 AD3d 518]
Regular Panel Decision
Aug 04, 2021

D. S. v. Positive Behavior Support Consulting & Psychological Resources, P.C.

This case involves an appeal by the Port Jefferson School District from an order denying its motion to dismiss a personal injury complaint. The infant plaintiff, a special education student, was allegedly injured by a therapist, Vito Silecchia, during a behavioral therapy session. The plaintiffs sued the School District, among others, alleging Silecchia was an employee or agent. The District contended Silecchia was an independent contractor retained through Positive Behavior Support Consulting and Psychological Resources, P.C. The Appellate Division affirmed the Supreme Court's denial of the dismissal motion, stating that the complaint adequately stated a cause of action and that documentary evidence did not conclusively establish an independent contractor relationship, given provisions in the agreement suggesting the District maintained some control over the services.

Personal InjuryRespondeat SuperiorIndependent ContractorMotion to DismissAppellate ReviewVicarious LiabilitySchool District LiabilitySpecial EducationTherapist NegligenceCPLR 3211 (a) (1)
References
25
Case No. ADJ9368263, ADJ9380293
Regular
Sep 15, 2015

JOSE MELCHOR vs. BRUTOCAO VINEYARDS, STAR INSURANCE COMPANY

This case involves a defendant's petition for removal regarding an order for a second Qualified Medical Examiner (QME) panel concerning the applicant's head injury. The Workers' Compensation Appeals Board (WCAB) granted removal to correct a clerical error in the original order. The WCAB affirmed the necessity of a second QME to further develop the medical record on the head injury claim, specifically in the specialty of Psychology-Clinical Neuro Psychology.

Petition for RemovalSecond QME PanelHead InjuryMedical Record DevelopmentWCJ Duty to Develop RecordPQME SpecialtyPSNPsychology-Clinical Neuro PsychologyMandatory Settlement ConferenceLack of Diligence
References
0
Case No. ADJ7787692, ADJ7787693
Regular
Jan 14, 2016

Elizabeth Sauseda vs. The Permanente Medical Group, Inc.

This case involves the defendant's petition for removal, seeking to replace a Qualified Medical Evaluator (QME) in psychology due to alleged reporting delays. The Workers' Compensation Appeals Board (WCAB) denied the petition, upholding the administrative law judge's (WCJ) decision. The WCAB adopted the WCJ's recommendation, finding that a new QME examination would not proceed and the existing QME would remain. The issue of the defendant's personnel actions as a good faith defense remains for the trial judge's determination.

Petition for RemovalQualified Medical EvaluatorPanel QMEAdministrative Law JudgeSupplemental ReportReplacement QME PanelMandatory Settlement ConferenceGood Faith Personnel DefenseWCJ ReportMedical Unit
References
0
Case No. ADJ7087574
Regular
Nov 22, 2010

VJERA STARK vs. COUNTY OF BUTTE, Permissibly Self-Insured, YORK INSURANCE SERVICES GROUP, INC.

This case involves a workers' compensation claim for psychological and digestive injuries. The Board dismissed the employer's petition for reconsideration of an order for a replacement Qualified Medical Examiner (QME) as the order was not final. However, the Board granted removal and rescinded the order, finding the employer prejudiced by the determination that the original QME's report was irrevocably flawed. The matter was returned to the trial level for further development of the record regarding the adequacy of the QME's report and the compensability of psychiatric injury under Labor Code § 3208.3.

Workers' Compensation Appeals BoardReconsiderationRemovalQualified Medical ExaminerPQMESubstantial EvidenceIrrevocably FlawedLabor Code Section 3208.3Predominant CauseGood Faith Personnel Action
References
21
Case No. ADJ6627019
Regular
May 06, 2013

SANDRA BERKENSTOCK vs. AGILENT TECHNOLOGIES

The defendant sought reconsideration of an order denying their request for a replacement Qualified Medical Evaluator (QME) panel in psychiatry/psychology. The applicant sustained industrial injuries including to her psyche. The administrative law judge denied the replacement panel because the QME's report was eventually received. However, the Workers' Compensation Appeals Board dismissed the defendant's petition. The Board ruled that the denial of a replacement QME panel is an interim, procedural order not subject to reconsideration under Labor Code section 5900(a).

WCABAgilent TechnologiesADJ6627019Petition for ReconsiderationQualified Medical EvaluatorQME panelpsychiatrypsychologyFlorence Thomas-RiddleLabor Code section 139.2(j)(1)(A)
References
7
Case No. ADJ10015666, ADJ12280547
Regular
Oct 31, 2025

YGNACIO PONCE vs. TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICA, EARTHBOUND FARMS

Applicant Ygnacio Ponce sought reconsideration of Findings and Orders issued on July 19, 2021, which found that he did not sustain injury to several body parts and was not entitled to additional QME panels for internal medicine and psychology. Ponce specifically contended the workers' compensation administrative law judge (WCJ) erred in denying a QME to determine if he sustained a psyche injury. The Workers' Compensation Appeals Board affirmed the F&O, concluding there was no substantial evidence to support causation for the alleged psyche injury and that the applicant failed to demonstrate due diligence in seeking a QME panel within the mandated discovery period.

Workers' Compensation Appeals BoardReconsiderationFindings and OrdersMaterial HandlerRight Shoulder InjuryPermanent StationaryNew and Further DisabilityQualified Medical Evaluator (QME)Petition to ReopenPsyche Injury
References
2
Case No. ADJ94 70576
Regular
Jun 26, 2017

CARLOS CAMARGO vs. COX PETROLEUM TRANSPORT, EM OIL TRANSPORT, INC., STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board (WCAB) granted the applicant's Petition for Reconsideration, rescinded the original Finding and Order, and returned the case for further proceedings. The WCAB found that the primary medical evaluator's (QME) reports were not substantial evidence because they were based on incomplete and inaccurate history, and failed to consider the impact of industrial stress on the applicant's internal medicine conditions. Additionally, the WCAB determined that a separate evaluation by a psychology or psychiatry QME was warranted to address the applicant's psychiatric injury claim, as the internal medicine QME deferred to mental health specialists. Therefore, the record requires further development regarding both the physical and psychiatric aspects of the applicant's claimed industrial injuries.

AOE/COEQMEhypertrophic obstructive cardiomyopathyindustrial stresspsychiatric injuryDSM-IVLabor Code section 3208.3preponderance of the evidenceaggravated conditionsupplementation of the record
References
12
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