Massachusetts Appellate Court Issues Opinion Regarding Medical Expert Evidence Adoption in Toxic Mold Exposure Case

Work-related accidents take many different shapes and forms, including environmental exposure cases. When your on-the-job injury is complex, it is important to have a seasoned Boston workers’ compensation lawyer on your side to ensure that you receive the outcome that you deserve. In a recent case, the employee worked for a City municipality where he was in charge of recapping landfills. Later, he was in charge of overseeing the City’s composting operations, which took place on a fifteen-acre, open-air space. The immediate neighbors made complaints about the poor condition and odors coming from the composting location.

The employee took note of these issues and made changes to the operation that made it more efficient. This included checking the temperature of the compost piles with a long stick, picking up the material with his hands, and walking around the compost facility to check for odors. In January 2008, he began experiencing cramping and fatigue. When he started coughing up blood, he went to the emergency room and was diagnosed with a pulmonary embolism. He suffered another episode six days after he was discharged. Several years later in 2013, he was diagnosed with another pulmonary embolism.

The employee then saw several medical professionals, including doctors at the Mayo Clinic in Florida. He testified that most of the evaluations were self-referred because he suspected that his condition was caused by aspergillum mold. The employer allowed him to manage the facility offsite out of concern for possible mold exposure. The insurer refused to pay for the medical treatment that the employee underwent and an administrative law judge affirmed the denial.

The parties submitted medical evidence and testimony from environmental experts. The judge concluded based on the evidence that the employee suffered at best an allergic asthmatic reaction, or occupational asthma, that had resolved because he was no longer working at the facility. The judge also concluded that the pulmonary embolisms could not be attributed to his workplace exposure. Regarding the medical expenses, the judge concluded that most of the expenditures were the result of the employee’s own diagnosis and that not all of them were reasonable and necessary expenses. The judge ordered the insurer to pay for the medical treatments deemed reasonable and necessary for the employee’s temporary asthmatic reaction.

The employee appealed alleging that the judge erred by adopting a truncated version of the medical diagnosis for occupational asthma and that the opinion contained a more complete diagnosis of allergic asthma with fungal hypersensitization. He also argued that the judge erred by finding some of the medical treatments non-compensable.

The reviewing court agreed with the plaintiff regarding the ambiguity surrounding which diagnosis was adopted in the final opinion. The reports referred to occupational asthma as well as occupational asthma with fungal hypersensitivity. The appellate court concluded that these diagnoses might be different in meaning and that the court needed to clarify which diagnosis he adopts and the reasoning for doing so. The appellate court rejected the employee’s second argument regarding medical expenses reimbursement finding that the employee failed to satisfy his burden of proving that every medical treatment was reasonable and necessary.

If you experienced a work-related injury, we are standing by and ready to help you understand your legal rights when it comes to workers’ compensation benefits. The claim process can be incredibly stressful and confusing, especially if your condition is medically complex or involves pre-existing conditions. We provide a free consultation to help you learn more about our services and whether you have a viable claim. Call us now at 781-843-2200 or contact us online.

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