Massachusetts Appellate Court Discusses Causation Standard in Work Injury Cases Involving Pre-Existing Conditions

There is quite a bit of evidence that is collected during a Massachusetts workers’ compensation claim. From doctors’ exams to hearing testimony, these documents become part of the record and help inform the judge about the appropriate ruling in your case. There can be many issues involving which pieces of evidence the just should consider and whether there is enough evidence in the record to support the outcome that the judge delivers. At Pulgini & Norton, we are ready to help you ensure that you are being treated fairly during a work injury claim proceeding and that you get the outcome that you deserve.

Recently, a Massachusetts appellate court considered an appeal involving a woman who worked as a flight attendant when she allegedly suffered a work injury to her elbow resulting in surgery. She returned to work 18 months after the injury in a full-time capacity until she left work as the result of continuing pain. The employee sought reimbursement for medical expenses, but the insurer denied it raising a question of causation. In other words, the insurer was not convinced that the injury and resulting medical treatment were directly related to her job duties. A conference order was held, and the presiding judge ordered the insurer to pay the medical expenses. The insurer appealed the award.

The employee was next required to undergo a medical examination with an independent doctor who provided a report to the court. After this, the insurer revoked its rejection of the medical expenses claim and accepted liability for the injury. In the report, the doctor indicated that there was aggravation of underlying degenerative arthritis and disk disease as well as other symptoms and injuries. The doctor also said that the repetitive tasks that she performed at work were the sole cause of some of the medical issues.

Nearly a year later, the insurer filed a complaint for discontinuance alleging that the disability was no longer causally related to her work. Another physician examined the employee and concluded that her injuries were not related to her work. The court denied the request, however, relying on the original medical report. The insurer appealed, arguing that the court could not permissibly rely on the medical report that predated its complaint for a discontinuance of benefit payments.

The reviewing court ultimately vacated the award of benefits finding that the court did not make an appropriate evidentiary finding regarding the cause of the employee’s injury and whether it was primarily attributable to a pre-existing condition or her occupation. When there is a question of causation involving a pre-existing condition, the party seeking benefits must meet a heightened standard of proof. A medical opinion must provide the relative degree to which different causes have contributed to the injury.

If you were involved in a work-related accident, you may be entitled to compensation. Our competent and compassionate Massachusetts workers’ compensation team provides a free consultation to discuss your potential claim and how we may be able to assist you. We know that the workers’ compensation claim process can be incredibly overwhelming and confusing, especially if you are coping with a lack of income and being unable to work. Contact us today at 781-843-2200 or contact us online to get started.

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