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Case Law Database

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

Case No. TI11710087
Regular
Nov 20, 2018

Theodore Davis vs. CITY OF MODESTO, YORK INSURANCE SERVICES, GROUP, INC.

This case involves applicant Theodore Davis's prostate cancer claim against the City of Modesto. The core dispute centers on the admissibility and review of a medical report by Dr. Besses. The Appeals Board initially denied review of Dr. Besses' report but, following a court of appeal remittitur, is now granting removal. The matter is returned to the trial level for the WCJ to re-evaluate the admissibility of Dr. Besses' report under Labor Code section 4605 and related rules, and whether it can be provided to the QME. This decision clarifies that while QME evaluations are required for compensability disputes, privately obtained medical reports may still be admissible.

RemittiturPetition for RemovalPetition for ReconsiderationQualified Medical EvaluatorLabor Code Section 4060Labor Code Section 4605Admissibility of Medical ReportsEx Parte CommunicationCumulative TraumaSpecific Injury
References
9
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. ADJ2522892 (ANA 0394094)
Regular
Mar 03, 2009

DONNA SMITH vs. MASTER FINANCIAL, INC., MIDCENTURY INSURANCE COMPANY

This case involves an admitted industrial injury to the applicant's upper extremities, with the Workers' Compensation Appeals Board (WCAB) granting reconsideration of a previous award. The WCAB rescinded the original award due to the trial judge's failure to rule on the defendant's objection to the admissibility of a key medical report. The admissibility of this report, which reviewed an inadmissible prior opinion, is central to determining permanent disability and related benefits like a supplemental job displacement voucher. The case is returned to the trial level for an express ruling on the report's admissibility and further proceedings on the remaining issues.

Workers' Compensation Appeals BoardReconsiderationFindings of Fact and AwardIndustrial InjuryUpper ExtremitiesBankruptcy ManagerMaster FinancialMid-Century Insurance CompanyPermanent DisabilitySupplemental Job Displacement Voucher
References
4
Case No. ADJ1471935 (LAO 0872244)
Regular
Mar 26, 2014

JESUS RIOS vs. BRYAN JONES dba THE K GROUP, TOKIO MARINE, UNISURED EMPLOYERS BENEFITS TRUST FUND

The Workers' Compensation Appeals Board (WCAB) granted reconsideration to determine the admissibility of evidence obtained after the Mandatory Settlement Conference (MSC). The applicant sought to introduce supplemental medical reports from previously seen physicians and reports from new medical and vocational experts, arguing his condition worsened and the existing record was inadequate. The WCAB held that supplemental reports from the applicant's original physicians were admissible under Labor Code section 5502(d)(3) due to a changed condition, but reports from newly disclosed physicians and vocational experts were not. The majority affirmed the WCJ's decision to exclude the latter evidence, finding the applicant failed to demonstrate good cause or due diligence in obtaining it prior to the MSC.

Mandatory Settlement Conferencediscovery closurereopen recordsupplemental medical reportsvocational expertdue diligencegood causepermanent and stationaryAMA Guidesloss of earnings capacity
References
7
Case No. ADJ9919365, ADJ9919392, ADJ10564628
Regular
Aug 25, 2017

ALFREDO JORDAN RAMOS vs. BEN'S ROOFING, INC., REDWOOD FIRE AND CASUALTY COMPANY, BERKSHIRE HATHAWAY HOMESTATE COMPANIES, STATE COMPENSATION INSURANCE FUND

The Appeals Board granted reconsideration and rescinded the WCJ's decision due to improperly identified exhibits and a lack of specific record citations in the opinion. The WCJ improperly admitted grouped medical reports and failed to cite which specific reports formed the basis of the Findings and Award. While the Appeals Board acknowledges the potential admissibility of the applicant's treating physician's later report, the WCJ retains discretion over its admission. The case is returned for further proceedings to allow for proper development of the record and a clearer articulation of the WCJ's reasoning.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and AwardQualified Medical EvaluatorTreating Physician ReportLabor Code Section 5703Develop the RecordAdmissibility of EvidencePermanent DisabilityPanel QME
References
5
Case No. AD.J9467074, AD.J9468922
Regular
Oct 03, 2016

THEODORE DAVIS vs. CITY OF MODESTO, YORK INSURANCE SERVICES GROUP, INC.

This case concerns the admissibility of a medical report by Dr. Besses and whether it can be reviewed by a panel qualified medical examiner (QME). The applicant sought reconsideration and removal of a prior decision that found the report inadmissible due to improper procedure under Labor Code section 4060. The Appeals Board treated the applicant's filing as a Petition for Reconsideration, finding that the admissibility of the report presented a critical issue in the case. Ultimately, the Board denied the Petition for Reconsideration and dismissed the Petition for Removal, upholding the prior decision.

Petition for ReconsiderationPetition for RemovalLabor Code section 4060Batten v. Workers' Comp. Appeals Bd.Qualified Medical Examiner (QME)Panel QMEAdmissibility of Medical ReportInterim OrdersFinal OrderThreshold Issues
References
7
Case No. ADJ18027061
Regular
Sep 10, 2025

HEATHER TILLER KELLEY vs. SACRAMENTO CITY UNIFIED SCHOOL DISTRICT

Defendant Sacramento City Unified School District sought reconsideration of a WCAB decision that found applicant Heather Tiller Kelley sustained industrial injuries and that reports from her treating physicians (Mark Zuber, D.C., Adrienne Pasek, Psy.D., and Kasra Maasumi, M.D.) were admissible. Defendant argued these physicians lacked a proper treatment relationship and that the reports were improperly obtained. The Workers' Compensation Appeals Board denied the petition for reconsideration, affirming that defendant relinquished medical control by denying liability, allowing applicant to self-procure treatment, and thus the treating physician reports were admissible in proceedings.

WCABPetition for ReconsiderationOpinion and Order Granting PetitionAdmissible EvidenceTreating PhysiciansMedical-Legal ReportsLabor Code Section 4062.2Self-Procured TreatmentRemoval StandardPermanent and Stationary Status
References
15
Case No. ADJ13157138
Regular
Sep 15, 2025

EDDY PUTMAN vs. BALTIMORE ORIOLES, USF&G, TRAVELERS INDEMNITY COMPANY

Defendant sought reconsideration of a WCJ's Findings of Fact, Award, and Order issued on June 12, 2025, which awarded applicant temporary and permanent disability. The defendant contested the retroactive disability awards, the calculation of the average weekly wage, and the admissibility of medical reports by Dr. Michael Einbund, given a later date of injury finding. The Workers' Compensation Appeals Board, adopting the WCJ's report, denied the petition for reconsideration. The Board affirmed the WCJ's findings regarding the disability awards, the applicant's average weekly wage, and the admissibility of Dr. Einbund's reports, reasoning that the claim's injury period predated January 1, 2005, making the old procedural rules applicable.

Permanent DisabilityTemporary Total DisabilityDate of InjuryLabor Code Section 5412PQMEPetition for ReconsiderationAverage Weekly WageAdmissibility of Medical ReportsLabor Code Section 4062.2Substantial Medical Evidence
References
11
Case No. MISSING
Regular Panel Decision
Aug 12, 1998

Quispe v. Lemle & Wolff, Inc.

The Supreme Court, New York County, affirmed a lower court's denial of the defendants' motion for a new trial on liability. The central issue on appeal was the trial court's refusal to admit a hospital triage report into evidence. The report contained conflicting accounts of how the plaintiff sustained injuries, specifically whether she fell from a fire escape or jumped from a window to escape a fire, both from a height of eight feet. The court found the report inadmissible under both the business entry exception to the hearsay rule and as an admission against interest. This was due to the defendants' failure to prove that the plaintiff was the direct source of the recorded information, as the plaintiff spoke only Spanish and the nurse relied on unidentified EMS workers and a hospital translator. Furthermore, the court noted that the cause of the injury was not pertinent to the plaintiff's diagnosis or treatment, which further precluded its admission under the business records exception. The defendants' argument that the translator acted as the plaintiff's agent was also rejected as lacking factual support.

Hearsay RuleBusiness Entry ExceptionAdmission Against InterestHospital Triage ReportMedical Records AdmissibilityTranslation AccuracyInterpreter CompetencyCause of InjuryNew Trial MotionAppellate Review
References
3
Case No. MISSING
Regular Panel Decision
Jan 27, 1965

Rivera v. Hellman

This case involves a motion to confirm a Special Referee's report concerning the amounts and priorities of various liens. The Special Referee conducted a hearing and reported on claims from an attorney for the plaintiff ($793.50), Roosevelt Hospital ($846.53), and the Millinery Health Fund ($641.00, later adjusted to $528). The report established the amounts of each lien and recommended priorities, placing the attorney's lien first, followed by the hospital lien (except for a $12 outpatient service), and then the compensation lien. The court concurred with the Special Referee's report and recommendations, granting the motion to confirm.

Lien PriorityAttorney's LienHospital LienDisability BenefitsWorkmen's Compensation LawSpecial Referee ReportMotion GrantedNew York Supreme CourtLien LawMotion Practice
References
2
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