Massachusetts Appeals Court Rules Against Injured Worker, Discontinues Temporary Total Incapacity Benefits

In an opinion from the Appeals Court of Massachusetts released earlier this year, In re Hollow’s Case, the Appeals Court discussed the seemingly inconsistent decision of an administrative judge in granting an employee’s medical services claim while discontinuing his workers’ compensation benefits under § 34.

The employee was injured while working at a grocery store, when a 30-pound box fell from a shelf approximately 15 feet high and struck him on the head. The insurer accepted liability, and he began receiving temporary total incapacity benefits under § 34. A year later, the employee filed a medical services claim under G.L. c. 152 §§ 13 and 30 for Botox injections to treat his headaches, which he suffered as a result of the accident. An administrative judge granted the employee’s medical services claim. The insurer appealed that decision and also moved to discontinue his § 34 benefits. After a hearing at which the employee testified, the administrative judge ordered the employee’s § 34 benefits to be discontinued but required the insurer to pay for the employee’s Botox injections. The employee appealed to the reviewing board of the Department of Industrial Accidents, which affirmed the administrative judge’s order.

On appeal, the employee argued that the administrative judge’s decision was inconsistent in allowing him to claim medical services while discontinuing his § 34 benefits. However, the Appeals Court explained the difference between the two legal standards. In determining whether to discontinue medical benefits, the judge must decide whether the employee is so incapacitated as to render him unable to return to work. Recognizing that the employee’s headaches are a valid medical condition, then, is not the same as finding that the condition is so incapacitating that the employee cannot work.

The employee also argued that the administrative judge failed to give prima facie effect to the impartial medical examiner (IME) report, in which the examiner provided his opinion regarding the employee’s ability to return to work. While an IME report under § 11A is sufficient to establish such a matter, it is only regarded as prima facie evidence if it is based on medical evidence and facts that are found to be complete and accurate. The facts supporting the medical examiner’s opinion were based solely on statements from the employee, since medical testing showed no signs of abnormalities. Findings of fact, assessments of credibility, and the weight of the evidence are exclusively decided by the administrative judge. Since the administrative judge did not find the employee’s testimony credible, the Appeals Court held that the IME report need not be considered prima facie evidence, since it was not based on credible evidence.

If you have been injured on the job, you may be entitled to workers’ compensation benefits for your injuries and lost wages. The Massachusetts attorneys at Pulgini & Norton offer comprehensive guidance and individualized representation to clients seeking workers’ compensation benefits.   To discuss your claim with one of our experienced attorneys, contact our office at (781) 843-2200 or online and schedule a consultation.

More Blog Posts:

Massachusetts Appeals Court Sides with Injured Correctional Officer in Workers’ Compensation Case, Massachusetts Workers’ Compensation Lawyer Blog, published June 26, 2015

Massachusetts Appeals Court Denies Psychiatric Workers’ Compensation Claim, Massachusetts Workers’ Compensation Lawyer Blog, published June 5, 2015

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