Massachusetts Appellate Court Orders Lower Court to Award Reasonable and Necessary Medical Expenses Reimbursement for Shoulder Injury

If you are injured at work, it is important to make sure that you receive wage benefits compensation for your medical bills that are related to your injury. The Massachusetts workers’ can be difficult to navigate, especially if you are also struggling to overcome painful injuries and major disruption in your life. At Pulgini & Norton, our experienced team of Boston work injury lawyers is standing by and ready to help you navigate your right to workers’ compensation benefits.

In a recent claim, the employee claimed that he suffered two injuries. The first was to his left shoulder and the second was to his back. The employer’s insurer accepted liability and paid benefits for the employee’s missed wages. Several months later, the insurer canceled the benefits on a number of grounds including an allegation that the injuries stemmed from a pre-existing injury, that the employee could not prove a causal relationship between his job duties and the injuries, and disability.

The employee then filed a claim seeking maximum benefits for his injuries. The judge awarded benefits for the shoulder injury but not the back injury. Both parties filed appeals. Eventually, the worker sought compensation for the reasonable cost of a shoulder surgery, but the judge stated that the employee sought medical benefits in a general sense. The judge also concluded based on medical opinions admitted in evidence that the employee had reached maximum medical improvement and that the surgery was not necessary. The judge awarded benefits for the worker’s lost wages and the parties appealed again.

On review, the appellate court agreed with the worker that the judge committed an error by concluding that there was no need for the shoulder injury. Reviewing the medical reports submitted in evidence, the appellate court noted that one of the doctors stated that a surgery for the left shoulder would be reasonable and necessary and directly related to the work accident that the employee suffered. The lower court judge mischaracterized the medical report in concluding that the injury had reached maximum improvement and that no additional therapies were necessary.

The appellate court also agreed with the insurer’s allegation that the judge did not conduct an appropriate average weekly wage analysis when determining the benefit payment that the worker was entitled to receive. The judge did not describe the method he used to reach this number in his report. Based on the error regarding the surgery and the lack of explanation regarding the weekly benefit award, the appellate court reversed and remanded the case for further proceedings.

If you were hurt at work, our seasoned team of lawyers is standing by to help you fight for the outcome that you deserve. Work injuries can happen in many different circumstances including sudden accidents and injuries that develop over time resulting from repetitive actions. Our team offers a free consultation so that you can learn more about the workers’ compensation system and whether you have a right to receive benefits and medical expenses reimbursements. Call us at 781-843-2200 or contact us online to schedule your appointment soon.

Contact Information