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Massachusetts Court Rules Employee Must Provide Evidence to Distinguish Workers’ Compensation Benefits Claim from Prior Claim

A Massachusetts court recently reviewed a decision of the Department of Industrial Accidents regarding workers’ compensation benefits in the case of Giraldo v. Dep’t of Indus. Accidents (Mass. Super. Jan. 12, 2016). In Giraldo, the primary issue for the court was whether the Department erred by dismissing the employee’s claim for disfigurement benefits based on its finding that the claim had been previously filed and denied.paperwork-1538658-639x426

In 2004, the employee was injured in a workplace accident and awarded workers’ compensation benefits, which he received for the next five years. In December 2008, a Department administrative judge denied the employee’s claim for permanent incapacity benefits and ordered that his benefits end entirely. In 2009, the employee filed a new claim for disfigurement benefits based on the same injury. His claim was denied, and the appeal was dismissed after the employee failed to pay the filing fee. The employee filed another claim in 2011 for disfigurement benefits, which was denied because he had failed to perfect his appeal in the prior claim.

In the current case, the court addressed yet another claim filed by the employee for disfigurement. The claim was denied by the administrative judge, who found that the employee was unable to submit any evidence distinguishing the new claim from his previously filed and dismissed claims. On appeal to the court, the employee invoked G.L. c. 152, section 14(1) against his employer’s insurer, contending that it wrongfully failed to pay benefits on his previous claims. The employee also argued that he had the right to proceed with his claim, despite the lack of evidence to distinguish the present claim from his previous benefits claims.

Pursuant to Massachusetts law, the Department conciliator may administratively withdraw an employee’s claim if he fails to produce requested material. In Giraldo, the conciliator requested evidence from the employee that would distinguish his most recent claim from his previous claims. The court found that the employee did not provide the requested information. The court also noted that the originating injury was the 2004 injury that involved the same employer and the same body parts, and that had already been the subject of the employee’s previous claims.

The court went on to state that proceeding against the employer’s insurer by invoking a new statute does not change its finding. In addition, the failure of the employee to perfect his 2009 appeal conflicted with the relief sought under G.L. c. 152, section 152, since the law only applies when an insurer has unreasonably defended its case. As a result, the court held that the Department’s decision to allow the administrative withdrawal of a claim when the employee has not provided any evidence to distinguish the claim from a prior claim was reasonable.

Individuals who have sustained work-related injuries may be entitled to compensation for medical treatment and lost income. Seeking an experienced workers’ compensation attorney to represent you in your benefits proceedings may be advantageous in seeking a favorable outcome. The Massachusetts attorneys at Pulgini & Norton provide knowledgeable legal guidance to clients pursuing workers’ compensation benefits. To consult with one of our skilled attorneys regarding your benefits claim, contact our office at (781) 843-2200 or online and schedule a consultation.

More Blog Posts:

Massachusetts Appeals Court Finds for Worker Claiming Partial Incapacity Benefits, Massachusetts Workers’ Compensation Lawyer Blog, published August 12, 2015

Massachusetts Reviewing Board Affirms Decision Awarding Injured Employee Workers’ Compensation Benefits, Massachusetts Workers’ Compensation Lawyer Blog, published October 13, 2015

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