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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

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. MISSING
Regular Panel Decision
Apr 21, 2004

Zenteno v. Geils

The defendants appealed an order from the Supreme Court, Westchester County, which granted the plaintiff's motion to restore a personal injury action to the trial calendar and for leave to serve a supplemental bill of particulars. The Appellate Division affirmed the order, finding that the plaintiff demonstrated a meritorious cause of action and a reasonable excuse for delay, citing extensive medical evaluations and difficulties obtaining authorization from the Workers’ Compensation Board. The court also determined that the defendants were not prejudiced by the restoration. Furthermore, an alleged agreement to proceed to arbitration was deemed unenforceable due to non-compliance with CPLR 2104 "open court" requirements. Finally, the Supreme Court's decision to grant leave for a supplemental bill of particulars was upheld, as it pertained to continuing consequences of existing injuries rather than new ones, aligning with CPLR 3043 [b].

Personal InjuryTrial Calendar RestorationSupplemental Bill of ParticularsArbitration Agreement EnforcementCPLR 2104CPLR 3043Medical ExaminationsWorkers' Compensation IssuesAppellate ReviewProcedural Motion
References
20
Case No. ADJ8836050
Regular
Jan 26, 2016

EDUARDO CASTILLO vs. GENERAL MOTORS; permissibly self-insured, administered by SEDGWICK CLAIMS MANAGEMENT SERVICES, INC.

The Appeals Board granted the defendant's petition for removal, rescinding the WCJ's orders appointing new orthopedic and psychiatric evaluators. The Board found the WCJ erred by directly appointing new physicians without first attempting to supplement existing medical reports or deposing prior evaluators, as per the *McDuffie* precedent. The Board determined the existing medical reports were not "fatally flawed" and directed the parties to pursue supplemental opinions or depositions before appointing new evaluators.

WCABPetition for RemovalOrdersMedical Record DevelopmentPanel Qualified Medical EvaluatorAgreed Medical EvaluatorSupplemental ReportsDepositionsPrejudiceDelay
References
3
Case No. ADJ2182506 (SFO 0470932)
Regular
Jun 08, 2010

LARRY CHIAPPELLONE vs. NORCAL/GOLDEN GATE DISPOSAL and RECYCLING COMPANY, JT2 INTEGRATED SERVICES

This case involved a defendant's petition for removal seeking a new Qualified Medical Evaluator (QME) due to alleged delays. The Appeals Board denied the petition, adopting the WCJ's reasoning that Labor Code section 4062.5 and related regulations do not mandate a new QME for untimely supplemental reports. Specifically, regulations address timeframes for initial evaluations, not supplemental ones, and the failure to meet supplemental report deadlines does not necessitate a new QME. Therefore, the WCJ's denial of the defendant's motion was not an abuse of discretion.

Petition for RemovalQualified Medical EvaluatorSupplemental ReportRegulatory TimeframesLabor Code Section 4062.5Administrative Director Rule 38(h)WCJ DiscretionNew Panel QMEMedical Evaluation ProcessReappointment Grounds
References
0
Case No. MISSING
Regular Panel Decision

55th Management Corp. v. Goldman

This case addresses whether an out-of-court statement made to a court evaluator in an Article 81 guardianship proceeding is protected by absolute privilege, thereby defeating a defamation claim. The defendant, a tenant, made allegedly defamatory remarks about a landlord to a court evaluator during the evaluator's investigation for a guardianship proceeding. The court considered if the remarks were pertinent, if a statement to a court evaluator is considered part of a judicial proceeding, and if the speaker had standing. The court found the remarks pertinent, extended the absolute privilege to statements made to court evaluators given their role as court agents, and affirmed the defendant's standing as a potential witness. Consequently, the defendant's motion to dismiss the defamation complaint was granted.

DefamationAbsolute PrivilegeJudicial ProceedingsCourt EvaluatorGuardianshipMental Hygiene Law Article 81Tenant-Landlord DisputeMotion to DismissCPLR 3211 (a) (7)Scope of Privilege
References
44
Case No. ADJ6640151
Regular
May 12, 2011

CHERYL CIENFUEGOS vs. FOUNTAIN VALLEY SCHOOL DISTRICT, KEENAN & ASSOCIATES

The Workers' Compensation Appeals Board granted the defendant's Petition for Removal, rescinding an order compelling the applicant to see a second Qualified Medical Evaluator (QME), Dr. Dao. The Board found that the applicant was not entitled to a second QME solely due to a delay in scheduling a supplemental examination with the first QME, Dr. Chiu. The Board reasoned that administrative rules regarding QME availability do not apply to supplemental evaluations. Consequently, the applicant must attend the rescheduled examination with Dr. Chiu.

Petition for RemovalQualified Medical EvaluatorPanel QMELabor Code sections 4060 and 4062.2Industrial injuryNeckShouldersUpper extremitiesPsycheAgreed Medical Evaluator
References
1
Case No. ADJ8975338
Regular
Jun 21, 2017

Kevin Livingstone vs. ATI, American Insurance Company, ESIS

This case involves a defendant's attempt to strike a Qualified Medical Evaluator's (QME) report and obtain a replacement due to a 7-day delay in a supplemental report. The Appeals Board vacated its prior order granting reconsideration because the initial WCJ's order denying the strike was not a final order subject to reconsideration. The Board further denied the defendant's petition for removal, finding no irreparable harm. The ruling clarifies that only an untimely initial QME evaluation mandates replacement, whereas a late supplemental report is within the WCJ's discretion to address based on good cause.

WCABPetition for ReconsiderationPetition for RemovalQualified Medical EvaluatorQMESupplemental ReportTimelinessFinal OrderInterlocutory OrderAdministrative Director
References
14
Case No. ADJ4155359 (OXN 0143340)
Regular
May 23, 2014

LISA SMITH vs. AGOURA WESTLAKE ANIMAL HOSPITAL, FIREMAN'S FUND INSURANCE COMPANY

Defendant Agoura Westlake Animal Hospital sought removal from an order continuing the case to trial on psychiatric injury and sleeplessness, arguing they should have obtained a supplemental QME report first. The Appeals Board denied this petition, agreeing with the WCJ that the psychiatric injury issue was ready for trial as both parties had QME evaluations. The Board found no abuse of discretion in the WCJ treating the hearing as a Mandatory Settlement Conference rather than a status conference. One Commissioner dissented, believing removal should be granted to allow the supplemental QME evaluation due to applicant's refusal to attend and the lack of trial readiness for psychiatric injury.

Petition for RemovalQualified Medical Evaluator (QME)Injury to PsycheSleeplessnessMandatory Settlement Conference (MSC)Declaration of Readiness to Proceed (DOR)Petition to CompelWCJ (Workers' Compensation Judge)Appeals BoardIndustrial Injury
References
0
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. ADJ9755370
Regular
Aug 10, 2017

BERNARDINO GARDEA vs. CITY OF PASADENA

This case concerns the City of Pasadena's request for reconsideration of a Workers' Compensation Appeals Board (WCAB) decision regarding the applicant's occupational group number. The WCJ initially recommended dismissal of the reconsideration petition as untimely. However, the defendant has now requested leave to file a supplemental petition to address issues raised in the WCJ's report. The WCAB has granted the defendant's request to file this supplemental petition. The defendant is ordered to file the supplemental petition within 20 days, either by mail or via EAMS, to avoid rejection.

Workers' Compensation Appeals BoardSupplemental PetitionReconsiderationOccupational Group NumberAdministrative Law JudgePetition for ReconsiderationWCAB Rule 10848Electronic Adjudication Management SystemEAMSCity of Pasadena
References
0
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