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Massachusetts Reviewing Board Reverses Award of Benefits, Based on Judge’s Failure to Consider Insurer’s Medical Evidence

Empty Hospital RoomIn a workers’ compensation claim, there are many rules regarding the types of evidence that the administrative law judge can consider when determining whether an award of benefits is proper. As seasoned Boston workers’ compensation lawyers, we are well-versed in these laws and fight vigorously to make sure that our clients receive the fair treatment they deserve during the claims process. If you were hurt at work, contact us today to learn more about whether you are entitled to workers’ compensation benefits.

A recent claim discussed the evidence that a judge may consider during administrative hearings. The employee in the action worked as a mental health care provider for patients suffering from psychiatric injuries. During May 2015, he was attacked by a patient and suffered serious trauma to his neck and the back of his head. He also sustained an injury to his left ear.

The employee filed a claim for workers’ compensation benefits with his employer’s insurance carrier. Pursuant to Massachusetts law, the employee underwent a medical examination by an impartial physician who assessed the nature and extent of his injury. The physician who performed this assessment testified at a hearing about the claim, and the judge concluded that the case involved medically complex issues. In instances in which there are medical complexities involved, a judge can allow the parties to provide additional medical evidence to assist with finding clarity. After this holding, the insurance company provided additional medical reports. These reports were not listed in the judge’s final decision or included in the list of evidence used in reaching the final decision.

The employee was awarded workers’ compensation benefits from November 2015 and continuing. The insurance company appealed, arguing that the omission of the reports was a reversible error. The employee responded by arguing that the omission of the reports would constitute a reversible error only in the event that the information addressed the issue of whether or not the attack caused the injuries and the extent to which the employee was incapacitated as a result of the injuries.

On review, the reviewing board first noted that the judge has the duty to consider and to evaluate evidence. The failure to list the evidence or to indicate that it was considered in reaching the final ruling deprived the insurance carrier of its due process rights. Since the decision did not include any indication that the judge considered or reviewed the reports, the reviewing board reversed the award of benefits and remanded the case for further proceedings to address the error.

If you suffered injuries on the job, you probably have questions about whether you are entitled to workers’ compensation benefits and the way to go about protecting those rights. At Pulgini & Norton, our experienced and compassionate team of Boston work injury lawyers is ready to stand by you and to ensure that you receive the maximum amount of compensation that you deserve. Time may be running out on your claim, so contact us soon. To schedule your free consultation, call us now at 781-843-2200 or contact us online.

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