CompFox Logo
AboutWorkflowFeaturesPricingCase LawInsights

Updated Daily

Case Law Database

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

Case No. MISSING
Regular Panel Decision

Main Evaluations, Inc. v. State

The claimant, Main Medical Evaluations, entered into contracts with the New York State Office of Temporary and Disability Assistance (OTDA) to perform consultative medical evaluations. OTDA terminated these contracts, alleging the claimant failed to disclose professional disciplinary proceedings against its chief medical officer, Arvinder Sachdev, and submitted false information during the bidding process. Following the dismissal of its claim in the Court of Claims, the claimant appealed. The appellate court affirmed the lower court's judgment, concluding that OTDA had legitimate grounds for termination due to the claimant's misrepresentations and failure to report substantial contract-related issues concerning Sachdev's integral role. Additionally, the court rejected the claimant's equal protection argument, finding no evidence of selective enforcement based on impermissible considerations.

Contract TerminationProfessional MisconductFalse RepresentationEqual ProtectionGovernment ContractsAppellate ReviewBreach of ContractMedical LicensingAdministrative ProceedingsDue Diligence
References
5
Case No. ADJ9011624
Regular
Dec 13, 2019

ELISHA HARDEN vs. COUNTY OF SACRAMENTO

This case concerns whether specific medical reports obtained for a disability retirement claim are admissible in a workers' compensation proceeding. The Appeals Board rescinded the prior ruling, holding these reports are relevant and may be provided to the orthopedic Agreed Medical Evaluator (AME) and psychiatric Qualified Medical Evaluator (QME). The Board found the reports relevant to the medical issues, even though they were not obtained through the standard workers' compensation medical-legal evaluation process. Consequently, the applicant's objection to providing these reports to the evaluators was overruled.

RemovalReconsiderationAgreed Medical Evaluator (AME)Qualified Medical Evaluator (QME)Medical-legal evaluatorsMedical recordsLabor CodeFindings and Orders (F&O)Disability retirementPermanent impairment
References
9
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
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. ADJ10223818
Regular
Sep 14, 2018

Irene Malagon vs. Larsen Supply Company, Inc.; Samsung Fire and Marine Insurance Company, Administered by Broadspire

This case involves a workers' compensation applicant claiming injury to her shoulders, neck, and back. The defendant sought reconsideration of the WCJ's finding of industrial causation, arguing the medical evidence was insufficient. The Board affirmed the WCJ's decision, finding the applicant's treating physician's report to be substantial evidence despite some historical inconsistencies. The Board also found the Qualified Medical Evaluator's reports problematic, particularly regarding causation for wrist and hand injuries due to contradictory opinions and insufficient analysis. A dissenting commissioner believed both medical reports had significant flaws, necessitating further evaluation.

AOE/COEProduction workerCumulative injuryMedical opinionSubstantial evidenceTreating physicianQualified Medical Evaluator (QME)CausationReconsiderationCredibility determination
References
0
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. ADJ10474797
Regular
Nov 13, 2017

Hernan Fuentes vs. STAFFMARK INVESTMENT, LLC, ACE AMERICAN INSURANCE COMPANY, CANNON COCHRAN

The Workers' Compensation Appeals Board granted reconsideration, rescinded the prior Findings and Order, and returned the case for further medical record development. The Board found the Qualified Medical Evaluator's (QME) report lacked substantial evidence due to the physician's apparent misunderstanding of workers' compensation principles and conflicting dates of maximum medical improvement. The applicant's primary treating physician's reports were also insufficient as they did not address a significant MRI finding of a re-tear. Therefore, a new medical evaluation from an Agreed Medical Examiner or a WCJ-selected physician is required to determine the applicant's entitlement to temporary disability indemnity.

Workers' Compensation Appeals BoardHernan FuentesStaffmark Investment LLCACE AMERICAN INSURANCE COMPANYCannon CochranADJ10474797San BernardinoPetition for ReconsiderationTemporary Disability IndemnityPrimary Treating Physician
References
0
Case No. ADJ7212946
Regular
Dec 13, 2012

JOSE QUINTERO vs. CORPORATE PERSONNEL NETWORK, NEW HAMPSHIRE INSURANCE CO., administered by CHARTIS

The Appeals Board granted reconsideration to address the admissibility of Dr. Konstat's psychiatric evaluation. The Board found Dr. Konstat's report inadmissible because it was a medical-legal evaluation obtained in violation of statutory procedures for represented employees, bypassing the requirement for an Agreed Medical Evaluator or Qualified Medical Evaluator. Consequently, the Board amended the prior award to exclude industrial injury to the psyche due to lack of substantial medical evidence. The applicant's award for orthopedic injuries and medical treatment was affirmed.

Workers' Compensation Appeals BoardJose QuinteroCorporate Personnel NetworkNew Hampshire Insurance Co.ChartisAmended Findings and Awardindustrial injuryleft shoulderneckback
References
1
Case No. ADJ8109233
Regular
Oct 07, 2013

JOSE CARMONA HERNANDEZ vs. DAVID CARLUCCI, SECURITY NATIONAL INSURANCE COMPANY

The Workers' Compensation Appeals Board granted the defendant's Petition for Removal, reversing the WCJ's order for a new Agreed Medical Evaluator (AME) or Qualified Medical Evaluator (QME). The Board found Dr. Allems' supplemental report was not untimely because the applicant did not properly pursue administrative remedies for an untimely report. Furthermore, the Board determined the ex parte communication was insufficient to warrant a new evaluation, as the applicant failed to provide evidence of its nature and the aggrieved party did not elect to terminate the evaluation. Consequently, the applicant is not entitled to a new AME or QME.

Petition for RemovalAgreed Medical EvaluatorQualified Medical Evaluatoruntimely reportex parte communicationLabor Code section 4062.5Administrative Director Rule 31.5Medical Directorsupplemental reportreplacement QME panel
References
2
Case No. ADJ4070560
Regular
Mar 11, 2010

Lawrence Ware vs. Abrazo Del Sol, Inc., Zenith Insurance Company

The WCAB affirmed the judge's award of $2,625.00 to lien claimant Dr. Gabriel for a medical-legal report, reducing his billed amount by $875.00. The Board found that the doctor's report did not qualify as a Qualified Medical Evaluation and that the lien claimant failed to meet his burden of proving the reasonableness of the full billed amount, particularly regarding the time spent on report preparation. While defendants did not strictly follow objection procedures, their challenge to the report's reasonableness was considered, and the WCJ's discretionary reduction was upheld. Consequently, the lien claimant's petition for reconsideration was denied.

Medical-legal expensesLien claimantReconsiderationWCJOfficial Medical Fee ScheduleLabor Code Section 4622(a)Compromise and ReleaseConsequential injuryDental reportingQualified Medical Evaluator
References
7
Showing 1-10 of 12,262 results

Ready to streamline your practice?

Apply these legal strategies instantly. CompFox helps you find decisions, analyze reports, and draft pleadings in minutes.

CompFox Logo

The AI standard for workers' compensation professionals. Faster research, deeper analysis, better outcomes.

Product

  • Platform
  • Workflow
  • Features
  • Pricing

Solutions

  • Defense Firms
  • Applicants' Attorneys
  • Insurance carriers
  • Medical Providers

Company

  • About
  • Insights
  • Case Law

Legal

  • Privacy
  • Terms
  • Trust
  • Cookies
  • Subscription

© 2026 CompFox Inc. All rights reserved.

Systems Operational