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Massachusetts Review Board Affirms Award of Workers’ Compensation Benefits to Injured Worker Disabled by Work Accident Years Before, Rejects Successive Insurer Rule as a Defense

In an appeal involving an employee’s award of workers’ compensation benefits for an incapacity due to a work injury, the Board upheld the decision against the insurer’s allegations that the judge had mischaracterized the medical evidence and erred in denying its request to join other insurers toroofing the claim.  In their analysis, the Board focused on the procedural delay committed by the insurer when it attempted to join other insurers. Additionally, the Board found that there had not been supporting medical evidence documenting another cause for the injured worker’s disability.

The employee in this case worked for 42 years as a union sheet-metal worker, installing ductwork and metal roofing. The physical work led to knee injuries, the first occurring in 1981 and requiring arthroscopic surgery.  In 1998, the employee was injured while working and underwent another surgery, eventually returning to work until 2008, when he was diagnosed with arthritis in his left knee.

Working until 2012, the employee filed a claim in 2014 against the workers’ compensation insurance company, based on his 1998 date of injury.  The insurer wanted to join other parties, and the judge found that the insurer did not have sufficient medical documentation of another injury or aggravation and ordered the insurer to pay the employee § 34 benefits. The insurer appealed.

After undergoing an impartial medical exam, the employee was diagnosed as having left knee meniscal tears and osteoarthritis, exacerbated by the work injury in 1998.  The insurer attempted to join other insurers, and the employee had not been paid any benefits for three months.

At the hearing, the judge had found that the employee was credible when relating his years of accidents and issues concerning his knees. Particularly, the judge stated that the employee asserted he did not sustain new injuries or aggravations at work after 1998. The judge also found that the medical examiner had causally related the employee’s diagnoses to the 1998 work injury.  Based on this medical opinion, as well as the testimony of a vocational expert, the judge found that the employee was disabled and entitled to both § 34 total incapacity benefits (until those exhausted) and § 34A permanent and total incapacity benefits continuing forward.

On appeal, the insurer argued that the judge erred by denying its motions to join other insurers for alleged injury dates following 1998.

Here, the insurer had not produced medical evidence supporting its motion but tried to invoke the successive insurer rule as a defense.  It had been over one year after the § 10A conference. The Board stated that, based on the procedural history of the case, the judge had not erred in denying the motion to join.

The Board also rejected the insurer’s claim that the judge had mischaracterized the medical opinion and lack of causation.  According to the Board, the judge had acted within his discretion when he found the employee credible and determined there had been the required causal relationship between the injury and the need for a total knee replacement.  Here, the Board also noted that the evidence supported the judge’s finding.

The Board also stated the rule that an employee may suffer two or more compensable injuries, causally related to a resulting incapacity. This is contemplated by the successive insurer rule, which holds that injuries causally related can lead to a resulting incapacity. But, the Board stated, the successive insurer rule does not apply when there is no successive insurer upon which liability can be shifted.

Noting that the judge had provided the insurer with “ample opportunity” to develop its successive insurer defense, the Board stated it was not an abuse of discretion for the judge to deny the insurer’s motions to join.

The Massachusetts attorneys at Pulgini & Norton offer skilled legal representation to people injured at work and pursuing workers’ compensation benefits. Injured workers may be entitled to compensation for lost wages and for injuries, according to Massachusetts law.  Call our office at (781) 843-2200 or contact us online to learn more about your claim by speaking with one of our professional, dedicated attorneys.  We provide a no-obligation, free consultation.

More Blog Posts:

Gutter Firm Cited by OSHA for Repeat Violations After Massachusetts Worker Falls and Suffers Severe Injuries, Massachusetts Workers’ Compensation Lawyer Blog, February 16, 2017

Workers’ Compensation Insurer did not Meet Burden of Showing Improvement in Employee’s Medical Condition; Massachusetts Reviewing Board Affirms Award of Total and Permanent Incapacity Benefits, Massachusetts Workers’ Compensation Lawyer Blog, January 12, 2017

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