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Mass. Appellate Court Upholds Denial of Extended Benefits Based on Finding that the Claimant Misrepresented the Scope and Severity of his Symptoms

Medical expert testimony and evidence play a significant role in a workers’ compensation claim. As seasoned Boston work injury lawyers, we have assisted many injured workers throughout the area with understanding the claims process and ensuring that they receive the best outcome possible. Although you may be tempted to navigate the claims process on your own, having an experienced and knowledgeable attorney on your side can help you ensure that you present the right medical evidence and that your injury is assessed correctly.

In a recent claim, the employee appealed from a decision awarding benefits to compensate him for his medical expenses and total incapacity benefits. He suffered a work-related back injury in 2003 and his employer provided weekly incapacity benefits for several months. The employer’s insurer later denied the worker’s application for ongoing benefits and a workers’ compensation judge affirmed the denial.

The worker filed an appeal and underwent an independent medical examination prior to the hearing. The report prepared as a result of the examination concluded that the worker endured a back strain related to his occupation and that the injury would have resulted in a disability lasting five to eight weeks. The doctor also noted that because the worker underwent what he characterized as excessive treatment and did not work for four years, the employee should start with sedentary work as he re-entered the workforce. The doctor also noted that the employee’s medical records were unremarkable.

The employer’s insurer asserted the defense of liability at the hearing as well as pre-existing injury. The judge permitted each side to offer additional medical evidence to address the period before the independent medical examination. The doctor was deposed at the hearing and testified that at most the employee would have been disabled by his work injury for up to sixteen weeks, which was a different conclusion from the report that he prepared. He indicated that the opinion was based on his review of the medical records and the examination of the employee.

In his decision, the judge relied on multiple sources of evidence including the employee’s tax documents to conclude that the employee’s testimony and recitation of the accident giving rise to the injury and the years that followed was not credible. Instead, the judge concluded that the employee engaged in a variety of jobs after the injury and worked for construction companies and contractors during times that he reported to doctors that he was unable to work or that he had not worked at all. Based on this, the judge awarded a limited period of benefit payments.

The plaintiff appealed, alleging that by issuing a finite period of benefits for the period immediately following the injury the judge misconstrued one of the doctor’s opinions. The judge wrote in his decision that the doctor concluded that the employee’s condition was not entirely inconsistent with degenerative disc disease as the sole cause of his symptoms when in fact the doctor actually wrote that the results were not entirely consistent with degenerative disc disease as the sole cause of the worker’s symptoms. Based on this, the employee argued that it was incorrect to discontinue his benefits.

The appellate court rejected this argument and pointed to another doctor’s report indicating that the worker suffered a back strain. Therefore, whether the worker was entitled to ongoing benefits depended on whether the judge found his testimony regarding his disability and work-related limitations credible. The judge made it clear in his decision that he did not credit the employee and that the employee had misrepresented the level of activity that he engaged in following the injury. Based on this lack of credibility, the judge was free to reject or accept any medical opinions that were based on the employee’s subjective complaints.

Moreover, the appellate court concluded that the doctor’s opinion that the worker’s injury was not entirely consistent with degenerative disc disease as the sole cause of his injury was not sufficient to carry the worker’s burden of proof that he had been incapacitated as the result of a work injury.

Work injuries can be life-altering and incredibly stressful. We have served a broad range of Massachusetts’ workers with a variety of injuries, including medically complex matters. To set up your free consultation, call us at 781-843-2200 or contact us online.

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