Massachusetts Appellate Court Considers Workers’ Compensation Claim Involving Multiple Insurers and Dispute Regarding Coverage for Nursing Fall Injury

As seasoned Boston workers’ compensation lawyers, we know how important it is for injured workers to receive the medical treatment and reimbursements that they deserve in a timely fashion. Unfortunately, many workers’ compensation claims involve disputes with or among insurance companies regarding whether a treatment should be compensable, or which insurer should pay. One of the best things you can do when seeking workers’ compensation benefits is seeking experienced legal counsel to help avoid any delays or complications in your claim.Recently, a Massachusetts court considered a conflict regarding which insurer was required to pay for an injured worker’s medical treatments. The worker was employed as a certified nursing assistant when she fell down a flight of stairs, suffering injuries to her knee and shoulder. The first insurer for the employer paid weekly total incapacity benefits to the employee. She received treatment for the injuries and reported experiencing pain. After 2008, she was unemployed and then secured a job with another nursing company. She was then required to leave work to undergo surgery on her shoulder. During this employment, she also performed some private assistance through a senior care service for an elderly gentleman who required minimal assistance.

After the surgery, the woman reported not experiencing any significant improvements. She filed a claim against the first insurer, seeking benefit payments and partial incapacity benefits. Initially, the judge assigned to the claim denied the request for benefits. The worker appealed and underwent an independent medical examination. Eventually, the judge approved a lump sum settlement between the first insurer and the worker, stating that the case was settled and liability for the shoulder injury was accepted by the insurer.

The employee then filed a second claim against the first insurer, requesting payment for medical treatments for her injuries. She later filed additional claims against the second employer’s insurer and the private elder nursing service. The judge awarded her benefits for some of her injuries in the claim against her first insurer but denied her claims against the second insurer. The employee appealed all three orders.

At an appeal hearing, the parties submitted additional medical evidence due to the complexity of the medical issues. The appellate court upheld the judge’s conclusion that the second and third employers were not required to pay for the employee’s injuries, and it concluded that the first insurer was required to provide benefits for the new and additional injuries that the worker was reporting, stemming from her original fall.

The worker and the first insurer appealed, and the reviewing court concluded that evidence in the record suggested that the employee experienced an injury while working for the second employer and that the lower court failed to consider a number of defenses that the insurers raised. As a result, the appellate court reversed the decision and remanded the matter for additional proceedings.

If you were injured at work, you deserve a dedicated Boston workers’ compensation lawyer to help you pursue the benefits and compensation that you deserve. Although it may seem like the claims process is easy to navigate, there are many rules and strategies to consider. To schedule a free consultation with our legal team, call us at 781-843-2200 or contact us online.

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