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. ADJ4406096 (LAO 0784412)
Regular

JOSE MORFIN vs. WHITE MEMORIAL MEDICAL CENTER

Defendant sought removal from a WCJ's order stipulating to two Agreed Medical Evaluators (AMEs), alleging the WCJ "forced" the agreement. Applicant's attorney and the WCJ countered that defense counsel had agreed to and proposed the AMEs, with the WCJ merely documenting the stipulation. The Appeals Board denied removal as defendant showed no prejudice, but initiated its own removal to address the attorney's alleged false statements and vexatious tactics. Consequently, the Board intends to impose sanctions of up to $2,500 on the defendant and its attorneys for filing a frivolous petition containing misrepresentations.

Workers' Compensation Appeals BoardPetition for RemovalAgreed Medical EvaluatorsWCJSanctionsBad Faith TacticsFrivolousUnnecessary DelayStipulationMisrepresentation of Facts
References
1
Case No. ADJ519728
Regular
Aug 08, 2011

LOWELL BAPTISTE vs. METROPOLITAN TRANSIT AUTHORITY

The Workers' Compensation Appeals Board granted reconsideration of a prior award finding industrial injury and temporary total disability dating back to 2000. The Board found that the medical opinion relied upon by the workers' compensation judge was not substantial evidence due to staleness, lack of complete records, and insufficient specialization. To ensure a fair resolution, the Board ordered new evaluations by independent orthopedic and psychiatric physicians, who will report on all outstanding medical issues.

Workers' Compensation Appeals BoardReconsiderationCompelling Medical EvaluationsTemporary Total DisabilityIndustrial InjuryOrthopedicsPsychiatrySubstantial EvidenceMedical OpinionWCJ
References
2
Case No. ADJ9826556
Regular
Aug 05, 2016

Spencer Bachus vs. John F. Kennedy Memorial Hospital, Hi-Desert Medical Center

The Workers' Compensation Appeals Board (WCAB) granted reconsideration and rescinded a prior decision finding applicant sustained a work-related viral meningitis injury. Defendants argued insufficient medical evidence linked the injury to employment and that the identified virus was not definitively work-acquired. The WCAB determined the existing medical evidence, particularly the Qualified Medical Evaluator's opinions, did not sufficiently establish a special risk of exposure due to the applicant's specific job duties. The case was returned for further development of the record, including a more detailed analysis of the applicant's job tasks and potential exposure risks, and potentially a new medical evaluation by an infectious disease specialist.

Workers' Compensation Appeals BoardViral meningitisIndustrial injuryDual employmentPanel Qualified Medical Evaluator (PQME)Substantial medical evidenceCausationSpecial riskFurther proceedingsRescinded
References
0
Case No. ADJ10077078
Regular
Oct 06, 2016

Francisco Meza Diaz vs. Silvestri Studio, Inc., Travelers Property Casualty Company of America

The Workers' Compensation Appeals Board granted the employer's petition for reconsideration, rescinding the previous order. The Board found that the Qualified Medical Evaluator (QME) should address all contested medical issues, not just compensability and causation, as initially ordered. This aligns with statutory requirements for comprehensive medical evaluations under Labor Code sections 4060, 4062.2, 4062.3, and 4064. Additionally, the Board found no basis for the prior order's findings on earnings, impairment, or further medical treatment, as these were not the stipulated issues for trial.

QMEpanel QMEDr. Hymancompensabilitycausationcumulative traumaLabor Code section 4060Labor Code section 4062comprehensive medical evaluationcontested medical issues
References
0
Case No. ADJ7436407, ADJ1895040 (FRE 0238028)
Regular
Feb 04, 2015

Colleen Newby vs. Fresno Community Medical Center, St. Agnes Medical Center, State Compensation Insurance Fund

The Workers' Compensation Appeals Board denied Colleen Newby's Petition for Removal, upholding the denial of her petition to quash a Qualified Medical Evaluator (QME) request. The Board found that the prior employer, Fresno Community Medical Center, was authorized to file an application for adjudication of claim for Newby's subsequent employment with St. Agnes Medical Center. Crucially, the Board determined that a claim form is not a prerequisite for St. Agnes to request a QME panel in this specific scenario, where a second injury is claimed by a prior employer. Newby's due process claim was rejected as she had an opportunity to present her arguments on removal.

Petition for RemovalPetition to QuashQME RequestQualified Medical EvaluatorClaim FormDue ProcessAgreed Medical EvaluatorApplication for AdjudicationTemporary DisabilityPermanent Disability
References
1
Case No. MISSING
Regular Panel Decision

Ochal v. Television Technology Corp.

David Ochal suffered severe electrocution injuries in a work-related accident in February 1988. His personal injury action was settled by stipulation in November 1999, which included a structured settlement and an agreement by a third-party defendant to pay $50,000, waive a substantial workers' compensation lien, and cover pre-settlement medical bills. In May 2004, Ochal moved to enforce the stipulation, seeking payment for approximately $20,000 in medical bills and a pro rata share of litigation costs from the third-party defendant's workers' compensation carrier. The Supreme Court denied his motion, and Ochal appealed. The appellate court affirmed the denial, ruling that Ochal had breached the implied covenant of good faith and fair dealing by submitting medical bills 4.5 years post-settlement and that his claim for pro rata litigation costs lacked merit due to his failure to reserve this right during the settlement.

Structured SettlementStipulation of SettlementContract InterpretationImplied Covenant of Good Faith and Fair DealingWorkers' Compensation LienMedical BillsPro Rata Share of Litigation CostsAppellate ReviewBreach of ContractWaiver of Rights
References
10
Case No. ADJ10336191
Regular
Jan 18, 2023

JEFFERY BLUM vs. STATE OF CALIFORNIA, CALIFORNIA HIGHWAY PATROL, STATE COMPENSATION INSURANCE FUND, STATE CONTRACT SERVICES

This case involves an employer's petition for reconsideration of a workers' compensation award. The Appeals Board denied the petition, affirming the finding that the applicant sustained new and further permanent disability to his knees. The employer's arguments regarding apportionment for the lumbar spine and bias of the medical evaluator were rejected, as the lumbar spine issue was settled by prior stipulation and bias was not raised timely. The Board found the medical evaluator's opinions on knee impairment constituted substantial evidence, despite a functional capacity evaluation.

New and further disabilityPermanent disabilityApportionmentStipulations with Request for AwardQualified Medical Evaluator (QME)Lumbar spineBilateral knee impairmentSubstantial evidencePetition for ReconsiderationWorkers' Compensation Appeals Board (WCAB)
References
12
Case No. ADJ3752774
Regular
Apr 20, 2010

VICENTE ROMERO vs. FOUR WINDS, INC., STATE COMPENSATION INSURANCE FUND

This case involves a defendant's petition for reconsideration of an award for industrial injury. The defendant challenges the $100\%$ permanent disability rating, lack of apportionment, and award of future medical treatment. The defendant argued that an Agreed Medical Evaluator (AME) found the injury non-industrial, and their petition to reduce the award was timely. The Appeals Board denied reconsideration, adopting the WCJ's report and reasoning, finding the defendant failed to show good cause to be relieved of their stipulations regarding industrial causation and the need for future medical treatment. The Board emphasized that stipulations, once entered by counsel, cannot be set aside merely due to a poor outcome for the party.

WORKERS' COMPENSATION APPEALS BOARDFindings of Fact and Awardpermanent disability awardapportionmentAgreed Medical Evaluator (AME)industrial injurypetition for reconsiderationstipulationsgood causeres judicata
References
2
Case No. MISSING
Regular Panel Decision

Queens Blvd. Medical, P.C. v. Travelers Indemnity Co.

The plaintiff, Queens Blvd. Medical, P.C., sought $950 in first-party no-fault benefits for biofeedback medical services provided to its assignor for lower back and chronic pain syndrome. The central issue at trial was the medical necessity of these services under Insurance Law § 5102 (a) (1). The plaintiff established a prima facie case with expert testimony from a board-certified neurologist affirming the medical appropriateness of biofeedback. The defendant insurance company failed to present admissible evidence to disprove medical necessity, as its expert was deemed incompetent to testify on biofeedback for back pain. Consequently, the court granted the plaintiff's motion for a directed verdict, awarding judgment for $950 along with statutory costs, interest, and attorney's fees.

No-fault benefitsMedical necessityBiofeedback treatmentExpert testimonyDirected verdictInsurance lawChronic pain syndromeBack injuryCPT codesBurden of proof
References
9
Showing 1-10 of 9,960 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