An Administrative Law Judge (ALJ) who hears and decides a claim for workers’ compensation benefits must consider a detailed technical record before rendering a decision. Sometimes a crucial piece of information is overlooked or ignored in the course of the judge’s decision-making process. When this happens, and the claim for benefits is denied, the claimant’s attorney brings the omission to the court’s attention through the review process.
In a case decided on appeal in May 2014, the Reviewing Board found that the ALJ’s findings omitted a significant diagnosis made by an examining physician. The omission was significant enough that the Reviewing Board at Board Nos. 019900-92 and 064092-92 sent the case back to the ALJ for a new hearing and decision.
At the time of the two injuries for which the employee first submitted a claim, in 1992, he was working as a Cable and Conduit Installer. He slipped and fell while working inside a manhole, injuring his left leg, hip, and low back. Following that injury, he was out of work for approximately six weeks and was paid workers’ compensation benefits.
The employee then returned to limited duty for two weeks and then full duty. A short time later, he felt a twinge in his back and stabbing pain between his shoulder blades and neck when he was pulling a wet plank from a manhole. He was off for a few days on full benefits and then returned to work.
He was promoted several years later to Construction Inspector and worked as an Inspector up until filing the current claim in 2010. His claim was denied at conference. He appealed and a hearing was held.
The ALJ observed that the 20 years of evidence was extensive, varied, sometimes vague, and sometimes contradictory.
The ALJ denied the employee’s claim, finding no dispositive medical evidence that the employee’s chronic pain and degenerative disc disease were causally related to the injuries in 1992, which the judge described as “thigh and back contusions, hamstring pull, and lumbar strain.”
On appeal to the Reviewing Board, the employee claimed that the ALJ made five erroneous findings. The Reviewing Board disagreed about all but the fifth.
The employee’s fifth claim of erroneous findings concerned the records of Dr. William Shea. The ALJ had found in his decision that there was no record or report from Dr. Shea indicating the employee was suffering from left hip sciatica after the first 1992 injury.
The employee, via his attorney, brought to the Reviewing Board’s attention a billing slip dated just after the first 1992 injury, signed by Dr. Shea, stating the date of the injury and that the employee’s diagnosis was “sciatica L hip.”
The ALJ had based his decision denying the employee’s claim on a foundation that his work-related injury consisted of a “left thigh/back contusion and acute hamstring pull” and that the diagnosis of left sciatica was not associated with that injury.
Since this mistake was the basis for other findings and rulings regarding causation and disability, the Reviewing Board sent the matter back to the ALJ for further findings of fact and rulings of law.
The employee’s claim was maintained and saved from peremptory denial, all because of a billing slip discovered and brought to the attention of the Reviewing Board.
For more information about the workers’ compensation process, contact a Boston workers’ compensation attorney from Pulgini & Norton to schedule a free consultation to find out more about what our lawyers can accomplish for you. Contact us with a brief description of your situation or reach us by phone at our Downtown Boston, Hyde Park, or Braintree, Massachusetts office locations.
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