Massachusetts Appeals Court Denies Psychiatric Workers’ Compensation Claim

The Appeals Court of Massachusetts recently had before it an appeal from the decision of an administrative judge regarding a workers’ compensation benefit claim.

In the case, In Re Hines’s Case, Mass. App. Ct. (2015), the plaintiff, an employee who had been working as a personal care attendant, slipped and broke his right ankle. The injury required surgeries to put in place and later remove orthodontic hardware.

The employee applied for and received temporary total incapacity workers’ compensation benefits. Two years later, after conducting surveillance regarding the case, the insurer moved to terminate the employee’s benefits. At that time, the employee attempted to include a psychiatric claim.

The administrative judge reviewed the surveillance videos from the incident, in addition to other evidence, and decided to discontinue the employee’s benefits on the basis that, due to the nature of the injury, there was no reason that the employee could not return to work in the same sort of position where he was working when he got injured. The board subsequently affirmed the decision.

The court stated that the relevant standard in the case was that the employee demonstrate that his condition had changed from the time between the prior evidentiary hearing and the appeal. The court did not agree with the employee’s argument that the administrative judge’s decision was arbitrary and capricious.

The court found that the administrative judge’s decision was based on the evidence that the employee’s current condition was not causally related to the initial accident. The decision was based upon various medical expert opinions, so it was reasonable, and therefore the decision would not be overturned due to a lack of evidentiary support.

Thus, the decision of the reviewing board was affirmed.

Regarding psychiatric claims, one potential facet of the equation that was not addressed is that psychiatric claims are typically not compensated by the workers’ compensation system unless the psychiatric harm occurs contemporaneously with the injury itself. In other words, if mental anguish develops over a period of time following the injury, that is not likely to be compensable by workers’ compensation benefits. If, however, the employee suffers a head injury that immediately leads to mental impairment, that is likely to be a compensable psychiatric affliction. It is interesting to note that the opinion states that the judge’s opinion was based in large part on surveillance footage. It is difficult to imagine how a psychiatric affliction could be witnessed visually.

If you get injured on the job, you may be entitled to workers’ compensation benefits for your injuries and lost wages. The experienced Massachusetts workers’ compensation lawyers at Pulgini & Norton offer comprehensive guidance and representation in these matters. We can assist you throughout the entire workers’ compensation claim process. Call our office today at (781) 843-2200, or you can contact us online in order to schedule an initial consultation.

More Blog Posts:

Massachusetts Legislature Considers Change to Workers’ Compensation, Massachusetts Workers’ Compensation Lawyer Blog, published May 27, 2015

Massachusetts Appeals Court Issues Ruling in Third-Party Lawsuit Following Workers’ Compensation Injury, Massachusetts Workers’ Compensation Lawyer Blog, published May 21, 2015

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