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Reviewing Board Holds Judge Gave Inconsistent Findings in Judgment Denying Massachusetts Employee Medical Benefits and Dental Care

In this appeal before the Massachusetts Department of Industrial Accidents, the Reviewing Board recommitted a case in which the judge made inconsistent and contradictory findings. Specifically, the judge ruled on whether the employee stated a valid claim for benefits and medical treatment after suffering a compensable injury.  The issue was whether the treatment, a dental bridge, directly related to the work-related incident or was due to a pre-existing dental condition.

dental care

At the time of the hearing, the employee was 57 years old, a paraprofessional who worked with autistic children. An industrial accident took place when the employee had been holding a child in her lap, and he hit her in the face with his head. After a conference, the judge denied the employee’s claim for medical benefits.

The insurer then raised § 1(7A) as an affirmative defense at the hearing, which states that when a compensable injury combines with a pre-existing condition, which had resulted from a disease that is not compensable, the condition is compensable to the extent the compensable injury was a major cause of the disability or treatment need. At the hearing, the issue was the extent to which the work incident damaged the employee’s teeth, which led to the medical need for a bridge.

The employee had been diagnosed, before the accident, with chronic adult periodontitis, and she had undergone root canals and was missing 10 teeth. On the day of the work-related incident, she went to her employer’s Occupational Medicine Services, completed an accident report, and had x-rays. Next, the employee visited Occupational Medicine and saw a dentist, Dr. J. Patrick Carsell, complaining that she suffered pain in her mouth and jaw, and she was concerned her teeth were loose.  

The judge had determined that the employee had been credible regarding the accident and her follow-up care.  However, the judge stated that the employee had not been a credible historian regarding her dental history and care, as well as her attempt to secure treatment earlier.

Since the Department did not maintain a dentist on the roster of impartial physicians, the parties agreed to allow medical records to be submitted from the employee’s treating dentist and doctors after the accident. Dr. Carsell was deposed. Dr. Carsell’s testimony included his opinion that the damage to the employee’s teeth was “the major cause” of the need to replace her initial bridge with an expanded prosthesis.

While the judge first credited and adopted Dr. Carsell’s opinion, she then stated that the doctor had been unclear whether the broken tooth number 9 “could” be related to the head butt.

The issue before the judge was whether the employee’s damage to her teeth and need for treatment was caused by the head-butting incident. Specifically, the question was whether this need included an expanded eighth-tooth bridge.  Since this was a medical question, it required expert medical testimony.

The employee argued the decision should be reversed because the judge found that Dr. Carsell’s opinion that the work injury was “a major cause” of the employee’s disability conflicted with her finding that there was no competent medical evidence supporting the claim.  The insurer also argued that the decision was inconsistent and agreed that it should be remanded for clarification.

The Reviewing Board stated that the judge was required to perform a § 1(7A) analysis. First, the insurer has to meet its burden of producing evidence that the employee had a pre-existing condition that combined with the compensable injury to prolong either the employee’s disability or her treatment needs. Here, the Board made clear that while the employee “clearly” had pre-existing dental issues, the judge did not cite medical evidence that indicated which pre-existing condition combined with the work-related injury to cause the need for the expanded bridge.

The Board vacated the decision and recommitted the case to the judge in order that she reconsider the evidence to make further findings consistent with the opinion.

If you or a loved one has suffered injuries while working on a job site, you may be entitled to receive compensation for your injuries and lost wages. The Massachusetts attorneys at Pulgini & Norton offer experienced legal representation for injured clients pursuing workers’ compensation benefits. To discuss your claim with one of our hardworking attorneys, contact our office at (781) 843-2200 or online and schedule a consultation.

More Blog Posts:

Massachusetts Reviewing Board Recommits Case Involving Entitlement of Spouse of Deceased Worker to Survivor Benefits, Massachusetts Workers’ Compensation Lawyer Blog, August 4, 2015

Massachusetts Reviewing Board Holds Employee Has Right to Compensation, Even When Employer Files for Bankruptcy, Massachusetts Workers’ Compensation Lawyer Blog, July 7, 2016

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