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Case Law Database

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

Case No. MISSING
Regular Panel Decision
Nov 17, 2005

Nikolic v. Regent Wall Street Hotel

The claimant sustained work-related physical injuries and a subsequent psychiatric condition. A Workers’ Compensation Law Judge allowed reports from a Serbian neuropsychiatrist to establish continuing psychiatric disability, despite objections from the employer and carrier concerning the doctor's credentials. The Workers’ Compensation Board, in an amended decision, rejected the objection to the Serbian doctor's report and found no prejudice to the carrier regarding a compensation award made prior to an independent medical examination. The appeals court affirmed the Board's decision, ruling that the carrier waived the right to object by not cross-examining the doctor, and that the Board had continuing jurisdiction to amend its initial decision.

foreign health care provider reportpsychiatric conditionadmissibility of evidenceWorkers’ Compensation Boardcontinuing jurisdictionwaiver of objectionindependent medical examinationappellate reviewNew York Workers' Compensationmedical credentials
References
10
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. MISSING
Regular Panel Decision
Feb 21, 2006

Rivera v. Barnhart

Plaintiff Russell Rivera, Jr. challenged the Commissioner of Social Security's decision denying him Supplemental Security Income (SSI) benefits. The case was referred to Magistrate Judge Frank Maas, who issued a Report and Recommendation to remand the action for further administrative proceedings, citing deficiencies in the plaintiff's hearing. After defendant objected to a time limit, an Amended Report and Recommendation was issued, omitting the disputed time limitation. District Judge Richard J. Holwell, finding no clear error, adopted the Amended Report in its entirety, granting the Commissioner’s motion. The court's decision was based on the Administrative Law Judge's failure to fully develop the administrative record and adequately consider the treating physician’s opinion, Dr. Asbury, whose findings differed from a nonexamining medical consultant.

Social Security BenefitsSupplemental Security IncomeDisability DeterminationAdministrative Law Judge (ALJ) ReviewRemand OrderTreating Physician RuleMedical AssessmentHIV/AIDS ImpairmentHepatitis C DiagnosisProcedural Error
References
15
Case No. MISSING
Regular Panel Decision

Claim of Quail v. Central New York Psychiatric Center

Claimant appealed a Workers' Compensation Board decision that awarded a 10% schedule loss of use of the right hand. The WCB's decision was based on a September 1998 report from the carrier's consultant, which found a 10% loss. The claimant's treating physician had reportedly found a 20% loss in a July 1998 report, but this report was not properly filed. Despite multiple directives to submit a final medical report from the treating physician, claimant failed to do so before the WCLJ's decision. After the WCLJ's ruling, claimant submitted a newly prepared report from his treating physician indicating a 20% loss. The Board declined to consider this new evidence, citing its discretion to refuse evidence that could have been presented earlier. The appellate court affirmed the Board's decision, finding no abuse of discretion in their refusal to consider the late evidence.

Schedule Loss of UseRight Hand InjuryMedical EvidenceAppellate ReviewBoard DiscretionFailure to Submit EvidenceTreating Physician ReportCarrier Consultant ReportProcedural IssuesPermanency Determination
References
2
Case No. SRO 118826
Regular
Apr 01, 2008

PATRICIA M. BAGLEY vs. COUNTY OF SONOMA, BRAGG & ASSOCIATES

This case concerns the application of the correct permanent disability rating schedule for an admitted industrial injury. The defendant sought reconsideration of a finding that the 1997 schedule applied, arguing the treating doctor's reports were insufficient to establish permanent disability prior to January 1, 2005. The majority denied reconsideration, finding Dr. Murphy's reports, along with a QIW finding, constituted substantial evidence of permanent disability under the applicable statute. A dissenting commissioner argued Dr. Murphy's reports lacked sufficient analysis and rationale to be considered substantial evidence.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and AwardPermanent DisabilityRating ScheduleTreating PhysicianSubstantial Medical EvidencePermanent and Stationary StatusLabor Code Section 4660(d)Qualified Injured Worker
References
12
Case No. ADJ6581429
Regular
Feb 28, 2010

ELLIS PARK vs. SCHOOL FIRST FEDERAL CREDIT UNION, TRAVELERS WALNUT CREEK

Here's a summary of the case for a lawyer, in a maximum of four sentences: This Workers' Compensation Appeals Board case concerns an applicant alleging a cervical and upper extremity injury on November 19, 2008, while retrieving an item under a desk. The Administrative Law Judge denied reconsideration, finding the applicant's medical reporting inconsistent with their trial testimony regarding the incident and its reporting to treating physicians. The applicant's failure to mention the specific injury mechanism to doctors shortly after the alleged event was a key factor in the denial. The Board adopted the WCJ's report, denying the petition for reconsideration.

Workers' Compensation Appeals BoardPetition for ReconsiderationIndustrial InjuryCourse of EmploymentCervical SpineUpper ExtremitiesMedical EvidenceTrier of FactTerminationKaiser Report
References
1
Case No. ADJ4503675 (MON 0306061)
Regular
Apr 18, 2011

ARTHUR WILSON vs. CAPISTRANO UNIFIED SCHOOL DISTRICT; Permissibly Self-Insured, Administered By CORVEL CORPORATION

The Workers' Compensation Appeals Board granted reconsideration to rescind an award for dental treatment. The Board found the administrative law judge erred by admitting and relying on the reports of Dr. Esagoff, a non-treating dentist, as they were not obtained in compliance with relevant Labor Code sections regarding medical-legal procedures and treating physician reports. The case is returned to the trial level for applicant to obtain a proper report from a designated treating physician, with Dr. Esagoff's reports to be stricken. Issues of industrial causation for dental treatment must follow former Labor Code section 4062 procedures.

Workers' Compensation Appeals BoardCapistrano Unified School DistrictCORVEL CORPORATIONInjury to teethCompensable consequenceAdmitted industrial injuryRight kneeCustodianDr. Jacob EsagoffD.D.S.
References
5
Case No. ADJ6948621 ADJ7946738
Regular
Apr 22, 2013

STEFANO MUSETTI vs. GOLDEN GATE DISPOSAL & RECYCLING dba RECOLOGY, permissibly self-insured, administered by CORVEL CORP.

In this workers' compensation case, the employer sought reconsideration of an award ordering a total knee replacement. The applicant's treating physician recommended the surgery, but the employer argued the award was premature as a panel qualified medical evaluator's report was pending and the treating physician's report lacked proper authorization markings. The Appeals Board denied reconsideration, finding the employer had sufficient time to obtain the PQME report and that the treating physician's report constituted substantial medical evidence supporting the surgery. The Board also noted that the employer failed to initiate utilization review despite being aware of the treatment request.

Workers' Compensation Appeals Boardindustrial injuryright kneegarbage collectortotal knee replacementsupplemental reportpanel qualified medical evaluator (PQME)treating physiciansubstantial medical evidencePetition for Reconsideration
References
7
Case No. ADJ133550 (LAO 0865174)
Regular
Mar 04, 2011

DAVID MENDEZ vs. COAST HEAT TREATING CO., ZENITH WOODLAND HILLS

The Applicant sought reconsideration and removal of an order denying his petition to strike a doctor's report, arguing a certified interpreter was required for a Spanish-speaking claimant during a medical examination. The Appeals Board dismissed the petition for reconsideration because the order was not final. The Board denied the petition for removal, finding no substantial prejudice or irreparable harm and noting the issue of the report's admissibility is reserved for trial. The Applicant failed to provide proof of allegations or file a Declaration of Readiness regarding discovery issues.

Workers' Compensation Appeals BoardPetition for ReconsiderationPetition for RemovalWCJcertified interpretermedical examinationnon-English speaking workersubstantial evidencediscovery issuesevidentiary issues
References
7
Case No. ADJ9834159 (MF) ADJ9834161
Regular
Jul 30, 2018

ESAU HERNANDEZ vs. D.L. BONE AND SONS PAINTING, ICW GROUP/EXPLORER INSURANCE COMPANY, STATE COMPENSATION INSURANCE FUND

This case concerns a defendant's attempt to obtain a replacement Qualified Medical Evaluator (QME) panel after the applicant initially objected to the timeliness of the original QME's report. The Appeals Board treated the defendant's petition as one for removal and denied it. The Board found that the defendant, having failed to timely object to the QME's report itself, could not rely on the applicant's subsequent objection to request a new panel. The Board concluded that the defendant's failure to act promptly meant they were not entitled to a replacement QME panel, and no substantial prejudice or irreparable harm warranting removal was demonstrated.

Workers' Compensation Appeals BoardReconsiderationRemovalQualified Medical EvaluatorQME panelAdministrative Director RuleTimeliness objectionReplacement QME panelLabor CodeFindings of Fact
References
1
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