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Massachusetts Appellate Court Upholds Denial of Compensation for Total Left Hip Replacement in Workers’ Compensation Claim

Big Revolving DoorEnsuring that your medical expenses will be covered in a workers’ compensation claim is one of the biggest concerns that injured workers face. There are many rules and procedures that govern this process, which is why having a seasoned Boston work injury lawyer on your side can improve your chance of being treated fairly and receiving the compensation that you deserve.

In a recent claim, an employee was seeking compensation for a total left hip replacement. The man was an employee with an appliance company beginning in 1980. He worked as a machine operator and then as an x-ray technician, which was the position he held when he was injured. A revolving door struck his left knee, causing him to fall down and injure his left side as a result. He received treatment from two doctors. One addressed his knee injury, while the other addressed his hip. He required surgery on both knees and received benefits during the surgery and recovery periods.

The employee filed a workers’ compensation claim, but the employer rejected it, stating that a proposed left total hip replacement was not a direct cause of the work injury. The administrative judge presiding over the claim denied the request for benefits, and the employee appealed. He underwent an additional medical examination with an impartial physician, who provided a report and testimony at a hearing for the appeal. The issue in dispute at the hearing was whether the employer was required to compensate the man for the left total hip replacement.

The employee filed a motion seeking to provide additional medical testimony on the basis that the medical issues were complex. He highlighted his pre-existing hip arthritis and the disagreement among several doctors in the case as the reason. The judge denied this motion, finding the matter not complex. In the judge’s ruling, he concluded that the employer was not required to pay for the total hip replacement.

The employee appealed again, stating that the judge erred by rejecting his motion to provide additional testimony based on the medical complexity of the case. The reviewing court agreed with the lower judge’s decision and affirmed it. The lower court had stated that a disagreement among doctors does not serve as a basis for medical complexity, and the appellate court agreed with this statement. It also noted that a determination of whether medical complexity is involved in a case involves a subjective approach and that case law clearly states that an objective approach to determining medical complexity is inappropriate. Medical complexity can arise from many different factors, such as the combination of two unrelated medical specialties or a case that involves a novel and unsettled area of medicine.

If you were injured on the job, we are standing by and ready to assist you with pursuing the workers’ compensation benefits that you deserve. Ensuring that you are treated fairly and that you are reimbursed for all of your medical expenses can be complicated. We proudly serve victims and their families throughout Massachusetts. Call us now at 781-843-2200 or contact us online to set up your free consultation today.

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