Although injured workers are entitled to benefits for injuries that happen on the job, there are some procedural rules and defenses that employers and insurance companies can use to avoid paying benefits. One of these rules is called the serious and willful conduct rule. As experienced Boston workers’ compensation lawyers, we have handled numerous cases that involve this issue.
The Massachusetts appellate court recently considered a claim involving the serious and willful conduct rule. The employee was 48 at the time the injury occurred and was an immigrant from Albania. He did not speak or write English and provided testimony in the proceedings through an interpreter. He worked as a truck driver starting in 2006 and was involved in a rollover accident while on the job in 2012. He underwent a spinal surgery following this accident and settled the associated workers’ compensation claim in 2014. The settlement agreement excluded the disc herniation procedure and only encompassed liability for soft tissue injuries in his lumbar region.
The man started working for another employee in 2015 and was shortly involved in another accident while driving a truck on the job that resulted in injury to his lower back. He was driving with a suspended license at the time of this accident. The administrative law judge assigned to the claim initially denied his request for benefits. The employee appealed seeking payment of benefits along with reimbursement for medical expenses. The Workers’ Compensation Trust Fund defended against the appeal asserting many different arguments, including an argument that the employee acted serious and willfully and was therefore barred from seeking benefits.
The employee underwent an independent medical examination which concluded that the man suffered a myofascial strain of his lumbar spine and exacerbation of his existing injury. It also concluded that his symptoms had increased significantly. The judge deemed the matter medically complex and additional records were introduced. During a hearing on the matter, the judge adopted the employee’s testimony that he had no knowledge that his license had been suspended. The judge also concluded that the suspended license had no bearing or impact on the accident. The court, therefore, denied the Trust Fund’s serious and willful conduct-based defense. Ultimately, the judge ordered the employer to pay the employee benefits for a specific period as well as to provide medical expenses reimbursement. Both parties appealed.
On review, the appellate court upheld the lower court’s application of the serious and willful rule, which bars an employee’s ability to receive benefits where he or she was engaged in serious and willful conduct of a quasi-criminal nature at the time of the accident. Serious refers to the conduct itself while willful implies that the employee was intentional or reckless. It bars compensation where the serious and willful conduct is the cause of the injury. Because the man’s operation of a vehicle with a suspended license was not determined to be the cause of the accident, the serious and willful defense did not apply. Regarding the award of benefits, the appellate court remanded the matter after finding that the judge improperly determined the cause of the employee’s injuries and as a result selected an improper period of time for benefit payments.
If you were injured at work, you probably have countless questions about your legal rights and whether you are entitled to compensation. Our seasoned team of workers compensation professionals is prepared to help you fight for the outcome that you deserve while ensuring that you receive compassionate and responsive legal counsel. We offer a free consultation so call us now at 781-843-2200 or contact us online.