Massachusetts Appellate Court explains that a Medical End Result does not Mean a Denial of Medical Reimbursements for Continued Treatment

When you suffer an injury on the job, the Massachusetts’ workers’ compensation system is designed to provide you with benefit payments to make up for your lost wages as well as reimbursement for any reasonable and necessary medical bills. Some injuries that happen at work heal over time, but others leave the victim with permanent disabilities and pain. In a workers’ compensation claim, one key determination that the court will make is whether you have reached maximum medical improvement. This has an impact on whether you can receive compensation for additional medical treatment, whether you are able to return to work in the same capacity, and more. At Pulgini & Norton, we provide seasoned guidance to injured workers to ensure that they receive the fair outcome that they deserve.

Recently, the Massachusetts Court of Appeal considered a claim in which the plaintiff, an injured worker, disagreed with the lower court’s conclusion that he had reached maximum medical improvement. The employee had suffered a left shoulder injury in 2013 and a second injury to his back in 2014. The employer’s insurance company initially paid benefits to the worker for both injuries. In 2014, the insurer stopped paying benefits on the basis that it was not liable for the injuries, that the employee had a pre-existing condition, and that something other than his job was to blame for the injuries. After more proceedings, the court also concluded that the employee had reached maximum medical improvement for the shoulder injury. The judge also awarded compensation for the back injury.

On appeal, the employee argued that the lower court was mistaken in concluding that he did not require further medical treatment for his shoulder injury. The judge adopted an opinion from a medical examiner that the end result had been reached. The report also stated, however, that surgery to treat the left shoulder condition would be a reasonable, necessary, and causally related outcome of the shoulder injury. According to the appellate court, the judge mistakenly equated a medical end result with a lack of need for additional treatment.

The appellate court also concluded that the judge made reversible errors regarding the average weekly wage award that it included in its order. More specifically, the appellate court found that the lower court did not support its findings regarding the awarded average weekly wage. Because the judge did not explain how it arrived at the amount of weekly benefits included in the order, the appellate court vacated the award with instructions to provide the methodology and findings used to support the average weekly wage award. The order that the judge issued failed to include findings of fact about how much the employee earned during the prior year and the documentary evidence provided in the record included conflicting information.

If you suffered an injury at work, you may be entitled to benefit payments and medical expenses reimbursements through the Massachusetts workers’ compensation system. We understand how confusing and overwhelming this process may seem, which is why we provide a free consultation to help you learn more about your potential rights and whether we can assist you. Call us now at 781-843-2200 or contact us online.

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