CA - WCAB Says Judge Exceeded Authority in Ordering Replacement QME
05/21/2025 | 0
The California Workers’ Compensation Appeals Board said a trial judge incorrectly ordered a replacement qualified medical evaluator for a represented worker because the first provider selected was not available within 120 days.
The WCAB said in an en banc decision published Monday that judges are not required by law to order a replacement panel in a represented case when the QME isn’t available for an exam within 120 days.
As a result, the WCAB said it has authority only to decide whether a replacement is appropriate.
“In a represented case, the Labor Code expressly allows...
Read More
The Iowa Court of Appeals ruled that a worker was entitled to alternate care for a knee injury, but not for his head injury.
Case: Archer Daniels Midland v. Tuttle, No. 24-0711, 05/07/2025, published.
Facts: Donald Tuttle worked for Archer Daniels Midland as a maintenance mechanic. He injured his left knee at work in January 2018.
ADM chose the University of Iowa Hospitals and Clinics as the authorized treatment provider for Tuttle’s knee injury. UIHC medical providers performed an arthroscopy and partial medial meniscectomy in February 2018.
The UIHC medical providers opined that Tu...
A New York appellate court ruled that the report and testimony of a worker’s expert should not have been kept from evidence even though the expert did not appear for a deposition before the deadline set by the Workers’ Compensation Board.
Case: Matter of Pressimone v. New York City Housing Authority, No. CV-23-1658, 05/01/2025, published.
Facts: Anthony Pressimone worked for the New York City Housing Authority. In 2020, Pressimone established a claim for workers’ compensation benefits for an injury to his left arm.
In 2022, Pressimone submitted a report from Dr. Jeffery Gu...
The Commonwealth Court of Pennsylvania ruled that a claims administrator could not carry its burden of proof to challenge the amounts charged by a medical supply company with evidence that comparable products could be purchased online for less.
Case: Cannon Cochran Management Services Inc. v. Scomed Supply (Bureau of Workers’ Compensation Fee Review Hearing Office), No. 1534 C.D. 2023, 05/07/2025, unpublished.
Facts: Jason Patrick worked for Orkin LLC. He suffered injuries at work in April 2005, and Cannon Cochran Management Services Inc. administered his workers’ compensation cl...
With profound sadness, the Law Offices of David J. Shepard announces the death of David J. Shepard after a very short-term illness at the age of 74. He was the sole practitioner of a workers, compensation practice that was founded in 1986.
Shepard was admitted to the California State Bar in 1978 after getting his juris doctorate from the University of Sa...
The Workers’ Compensation Insurance Rating Bureau voted to ask California’s Insurance Commissioner to increase workers’ comp insurance rates by 11.2%.
That’s not just bold. It’s obscene, especially coming from the WCIRB that gets its funding exclusively from insurers.
According to the 2025 State of the Line report from the National Council on Compensation Insurance, workers’ compensation is already one of the nation's most profitable lines of insurance. Costs are rising only moderately, and insurer...
West Virginia’s Intermediate Court of Appeals upheld a determination that a worker’s doctor visits and X-rays were reasonable and necessary treatment for his compensable injuries.
Case: JP Morgan Chase v. Gwinn, No. 24-ICA-402, 04/29/2025, published.
Facts and procedural history: Donald Gwinn worked for JP Morgan Chase. He suffered multiple injuries in July 2015 when he fell down stairs.
A lumbar spine X-ray was performed a few days after the accident, which showed bilateral pars defects at L5 with grade 1 anterolisthesis of L5 on S1, and no fracture.
A claims adjuster for JP M...
A former officer of the Westminster Police Department was seen drinking and dancing, went on a skiing and snowboarding trip and competed in 5k races despite claiming she was completely disabled from a work-related injury, according to the Orange County District Attorney's Office.
Nicole Brown, 39, of Riverside, is charged with 15 felonies for alleged workers' compensation fraud, and her stepfather, a workers' compensation defense attorney, has also been charged with two felonies for allegedly conspiring and helping to orchestrate the ruse.
Brown's cha...
Six years of underreporting payroll and dodging insurance premiums resulted in criminal penalties for a San Jose security company owner.
The California Department of Insurance said Raul Chavez pleaded guilty to premium fraud and was sentenced to 180 days in Santa Clara County jail, two years of probation and restitution of $225,168 for the scheme.
Chavez, 40, was the owner of Tactical Operations Protective Services, which provided security, staffing and patrol. A referral in 2023 about suspected fraud prompted CDI to investigate Chavez, uncovering a worker's inj...
The federal Occupational Safety and Health Administration said it updated the inspection program that focuses on businesses with high rates of injuries.
OSHA’s Site-Specific Targeting program directs agency enforcement resources to non-construction businesses with 20 or more employees and that have the highest rates of injuries and illnesses based on injury and illness data submitted in accordance with the agency’s recordkeeping requirements.
The agency said it will start selecting businesses for inspection based on high injury and illness rates from 2023, as well as injury and i...
The New Mexico Workers' Compensation Administration is holding informational sessions throughout the state on June 10.
The series of free events is intended to provide information about workers’ compensation claims, coverage and returning to work after an injury.
“Our goal is to empower workers and employers with the resources they need to navigate workers’ compensation with confidence,” said WCA Director Heather Jordan. “This is about providing clarity, not confusion.”
The free event series, “Fast Facts, Real Help: Understanding Workers’ ...
The Workers’ Compensation Appeals Board erred when it held that the failure to list in a pretrial conference the statement reports from a qualified medical evaluator was harmless, a California appellate court ruled.
The 3rd District Court of Appeal said longstanding precedent requires it to annul a split Workers’ Compensation Appeals Board decision affirming a workers’ compensation judge’s finding that an injury was compensable because the judge relied on two medical reports that weren’t identified as exhibits on the pretrial statement.
Two WCAB commissioners fo...
A New York appellate court upheld the termination of a volunteer firefighter’s operational privileges due to his failure to disclose his disabled designation by the Workers' Compensation Board, among other misconduct.
Case: Matter of Correra v. Millwood Fire District, No. 2022-06969, 04/30/2025, published.
Facts: Robert Correra volunteered as a firefighter for the Millwood Fire District. Following a physical examination in 2020, the district suspended Correra’s operational privileges and charged him with misconduct.
The district alleged that Correra had provided false inform...
West Virginia’s Intermediate Court of Appeals ruled that a worker’s widow failed to link his dementia and death to his occupational hearing loss.
Case: Clark v. U.S. Steel Mining Co. Inc., No. 24-ICA-429, 04/29/2025, published.
Facts: Clifton Clark Sr. worked for U.S. Steel Mining Co. Inc. He established two occupational hearing loss claims against U.S. Steel and received a total of 3.66% permanent partial disability awards.
Clark saw audiologists Cheryl Rhodes and William Larsen between July 2020 and March 2023. Both said he reported a decrease in hearing acuity over time, and ...
The Delaware Superior Court ruled that a sole proprietor’s election of coverage was sufficient to cover him under the policy issued to his business and that his petition to determine compensation after he was attacked by an employee should have been granted.
Case: Bayly v. Red House Motors, No. S24A-05-002 CAK, 05/06/2025, published.
Facts: Robert Bayly is the sole proprietor of Red House Motors. While he was at work in June 2021, he was attacked by a temporary employee.
At the time, Red House had a workers’ compensation policy from Federated Reserve Insurance Co., part of ...
AL - Commission Partially Dismisses Citation for 'Hearsay' in Scaffolding Incident
A scaffolding company must pay a $7,000 fine after an employee was seriously injured from a scaffold component that rolled off an upper level and struck his arm as he worked on a project in Mobile, Alabama.
In what became the final order of the Occupational Safety and Health Commission on Thursday, Baytown, Texas-based Precision Refractory Services LLC saw part of its citation dismissed over what the ruling called “hearsay” regarding the incident, reducing the original proposed fine of $8,702, according to Secretary of Labor v. Precision Refractory Services.
I...
A Texas appellate court ruled that an injured worker forfeited any issues on her appeal due to inadequate briefing.
Case: Jones v. Mansfield Independent School District, No. 02-24-00355-CV, 05/15/2025, published.
Facts and procedural history: Joyce Jones worked for the Mansfield Independent School District as a teacher’s assistant. She suffered injuries from a fall at work in May 2021.
Jones filed a workers’ compensation claim, and the district accepted liability for a cervical strain, a lumbar strain and bilateral shoulder strains.
Jones objected, contending that she...