The Massachusetts Department of Industrial Accidents Reviewing Board recently decided an appeal involving medical benefits and mileage reimbursement under the workers’ compensation laws. In Frances Margraf v. Central Berkshire Regional School District, the employer’s insurer appealed a decision of an administrative judge awarding benefits pursuant to G.L.c. 152 § 13 and § 30. On appeal, the Reviewing Board ultimately affirmed the decision, ordering the insurer to pay for all but one of the claimed prescriptions.
The employee was a paraprofessional who worked with special needs students. In March 2005, she suffered an injury to her lower back and right lower extremity, including her hip, thigh, hamstring, and ankle. As a result, the employee underwent reconstructive surgeries on her right ankle. The insurer accepted liability for the diagnoses of chronic lower extremity weakness, right ankle injury, and intervertebral displacement. The employee subsequently filed a claim for § 13 and § 30 benefits for prescription medications for chronic pain, as well as mileage reimbursement for medical appointments.
The employee was examined by an independent medical examiner pursuant to § 11A. The insurer offered additional medical reports from another doctor in order to support its contention that the work injury was no longer a major cause of the employee’s disability or need for treatment under § 1(7A). Finding that the matter was not medically complex, the judge denied the insurer’s motion to allow the additional reports. The judge also found that the employee’s testimony was credible and adopted the opinion of the independent medical examiner that the requested prescriptions were reasonable, necessary, and related to the injury. As a result, the judge ordered payment for those prescriptions, monitoring of those medications, and payment of the mileage request.