Massachusetts Court Awards Injured Worker Maximum Penalties Against Insurer for Failure to Reimburse Medical Prescription Expenses

The workers’ compensation claims process can be a major headache, especially if this is your first time seeking benefits for a work injury. Knowing which documents to file and the right process for ensuring that you receive the benefits that you deserve is not something you should have to stress about when you are also focusing on healing and getting back to work. Our seasoned team of Boston workers’ compensation lawyers is ready to help you assert your rights and to receive the fair outcome that you deserve.

Recently, a Massachusetts court considered a claim in which the injured employee alleged that the insurer failed to reimburse him for prescription medications in violation of an order. Initially, the employee argued that the employer’s insurance company did not make all of the payments due to him under a prior conference order. The insurer filed an appeal regarding the original order and before the hearing on the appeal, the employee filed a claim seeking penalties and a request that the claim for penalties be heard at the appeal. The employee later admitted that the request for penalties did not comply with the statutory requirements because it failed to include an affidavit stating when the payment was due when a payment was made, and the amount of payments still owed.

Before the judge could issue an order on the request for penalties, the insurer paid the outstanding balance for the prescription medications. Because the employee failed to follow the appropriate requirements in seeking penalties, however, the judge denied the request for penalties for failure to pay.

On appeal, the employee argued that he essentially complied with the requirements based on a number of things including testimony he provided regarding the prescriptions and the amounts owed. The appellate court agreed, finding that the insurer never disputed that more money was owed to the employee or that it failed to make a timely payment. The insurer’s only defense was that the employee did not comply with the affidavit required pursuant to the statute.

Relying on the claimant’s testimony about the prescriptions and outstanding reimbursements, the appellate court concluded that the affidavit requirement was satisfied. It also noted that the statute did not prohibit a claimant from proving that he or she was entitled to additional payments at the hearing before the judge or a jury.

Based on these findings, the appellate court reversed the lower court’s denial of the claim for penalties and awarded the statutory maximum of $10,000 to be paid to the employee.

If you were hurt at work, we are ready to help you fight for the fair treatment and benefits that you deserve. Our team of Massachusetts workers’ compensation lawyers has provided compassionate and responsive legal guidance to injured workers and their families throughout the state, including Boston. We provide a free consultation so that you can learn more about our law firm and so that we can discuss your situation. To schedule, call us at 781-843-2200 or contact us online to get started.

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