Recently, an employee appealed a decision to the Massachusetts Department of Industrial Accidents Review Board after a judge denied his § 30 claim for reimbursement of costs for a total left hip replacement. While the Board upheld the decision, they noted that the judge had set forth a standard for assessing medical complexity that had been rejected. The rule, stated by the Board, is that a subjective approach must be used to determine medical complexity.
In this case, the employee had worked for his employer for over 30 years, as a machine operator and an x-ray technician. He suffered injuries in an accident at work, when a revolving door struck his knee, and he fell onto his side. After receiving medical treatment from two doctors, the employee underwent surgery on both knees, and during the recovery period, he received weekly indemnity benefits.
Next, the employee filed a workers’ compensation claim for a proposed total left hip replacement, on the ground that it was causally related to the work accident. The insurer rejected the claim, and an administrative judge denied it at a conference. The employee appealed and underwent an examination by an impartial physician.
At a hearing on whether the workers’ compensation insurer was responsible for paying for the hip replacement, the employee moved to allow additional medical testimony, based on the complexity of the medical issues. He argued that several doctors disagreed when consulting on the case, and he had pre-existing arthritis in his hip. The judge denied the employee’s motion, ruling that the medical issues were not complex. The employee’s claim for payment was also denied and dismissed.
On appeal, the employee argued that the judge abused his discretion in finding that the medical issues were not complex. The Board, in their analysis, stated that a judge is not required to set forth the grounds for his ruling on any motion – including one for additional medical evidence. In this case, the judge had expanded on his analysis, stating that an objective standard applied. The Board stated that this analysis “runs afoul” of the rule that a subjective approach applies to medical complexity. In their opinion, the Board quoted case law that makes clear that defining “complex” requires individual knowledge, experience, and education.
While the judge misstated the medical complexity standard, the Board stated it did not require recommittal. The remaining comments revealed a rational analysis, and there was no abuse of discretion. The decision was affirmed.
After suffering injuries in a workplace accident or facing the consequences of a work-related medical condition, you may be eligible for medical benefits and missed wages from work. At the Massachusetts law firm of Pulgini & Norton, our workers’ compensation attorneys represent individuals in their claims for workers’ compensation benefits. To further understand your legal rights and how to further your benefits claim, contact a skilled lawyer by calling (781) 843-2200 or filling out our online form.
More Blog Posts:
Massachusetts Reviewing Board Holds Judge Properly Continued Injured Employee’s Benefits, Despite Having Inappropriately Commented on Her Physical State at a Hearing, Massachusetts Workers’ Compensation Lawyer Blog, April 13, 2017
Reduction in Injured Worker’s Benefits Upheld by Massachusetts Court Because Judge’s Decision “Rectified” Omission in Earlier Order, Massachusetts Workers’ Compensation Lawyer Blog, March 2, 2017