Mass. Appellate Court Reverses Benefits Decision Based on Medical Evidence Regarding Causation

Pre-existing injuries are one of the most complex issues that can arise in a Massachusetts workers’ compensation claim. Even if you suffered the injury over a decade ago, it may have implications for your ability to obtain benefits now. In a recent case, the worker suffered a back injury while working in a supermarket in 1991. The following year, the worker required a laminectomy and he returned to work the next year employed in a variety of capacities until he was laid off several years later for a two-year period. Then, he was ultimately rehired by the same employer. He was tasked with operating a device called a 4-slide machine. Some years later, he was laid off again. Throughout this time period, the employee alleged that he suffered an ongoing, repetitive, work-related injury that was sustained as a result of lifting and carrying motions.

The worker filed a workers’ compensation claim and the judge initially awarded temporary benefits but did not require the insurer to pay for the lumbar surgery. Both the worker and the insurer appealed. The worker underwent a medical examination by a board-certified orthopedic surgeon. The doctor’s report was deemed adequate and neither party asked for an opportunity to take the deposition of the doctor or to provide additional medical documentation. Based on this report, the reviewing judge concluded that the back injury constituted a pre-existing injury and that the employee suffered an industrial injury during his later years of employment. The judge also concluded that the newer injury was a primary but not predominant cause of his disability and ordered the insurer to pay section 34 and 35 benefits, as well as reimbursement for medical expenses.

The insurer appealed on several grounds, including an argument alleging that the medical evidence regarding the major cause of the injury was based on assumed work conditions that the judge did not credit and that therefore it did not constitute sufficient evidence to satisfy the worker’s burden of proof. The appellate court agreed with this argument, finding an inconsistency in the testimony provided at the hearing and the doctor’s report regarding how often the worker performed lifting-related tasks. Ultimately, the appellate court vacated the lower court’s conclusion that the back injury was related to the new injury and remanded the matter for additional proceedings to determine the worker’s job-related conditions.

If you were injured on the job, you may be entitled to compensation for your medical expenses. The insurance system and claims process are incredibly daunting and it can be easy to get confused about the best way to protect your rights. At Pulgini & Norton, we focus specifically on employee-side workers’ compensation claims. Let us put our experience and dedication to use for you. Call us at 781-843-2200 or contact us online.

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