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Massachusetts Appellate Court Remands Award of Reasonable and Necessary Medical Expenses Based on Lower Court’s Lack of Specificity in Ruling

There are some instances of work-related injuries where the employee is able to recover to full capacity. In other instances, the employee faces a lifetime of pain and physical limitations. Ensuring that you receive the compensation and medical expenses reimbursement that you deserve is a key aspect of navigating the Massachusetts workers’ compensation system. As seasoned Boston work injury lawyers, we are committed to helping injured workers and their families to secure the outcome that they deserve.

A recent claim explores a situation where an injured worker suffered permanent injuries. The worker was a delivery driver who claimed that she suffered an injury to her leg when she was stepping out of her large delivery truck and into a pothole. She received temporary incapacity benefits and filed a claim for additional benefits. The employer, a self-insurer, accepted liability for the accident but challenged the extent of the disability and the employee’s earning capacity.

The worker underwent an independent medical examination and the parties submitted additional medical evidence. The judge ultimately adopted the opinion of the medical examiner stating that the worker suffered from a series of serious complications including complex regional pain syndrome. The doctor who authored the report also reported that there was no doubt that the work accident caused the injury. The judge also adopted the employee’s testimony that she experienced chronic pain that caused her to wake up multiple times during the night and that although she took serious medications like Valium and Tramadol it did not provide her with meaningful pain relief.

The lower court ultimately ordered the insurer to pay reasonable and related medical expenses and concluded that the worker was unable to perform even sedentary work. The insurance company appealed.

The appellate court first agreed that the lower court erred by allowing the parties to submit additional medical evidence despite finding the report from the independent medical examiner to be accurate. The judge made unclear findings about whether the parties should have been allowed to submit additional medical evidence, which involves finding that there are complex medical issues or that the independent medical examination was inadequate.

As a result of this finding, the appellate court remanded the action with instructions to make a clearer finding regarding whether the impartial medical opinion was adequate or whether the case warranted additional medical evidence. The appellate court also agreed with the insurer that the court was not clear regarding the award of necessary and reasonable medical expenses, finding that the court needed to designate which parts of the workers’ body were encompassed within the order awarding reasonable and necessary medical expenses.

If you were hurt at work, it is critical that you seek advice from a seasoned and compassionate Boston work injury lawyer. The workers’ compensation system can be incredibly complex and it’s hard for most injured workers to know whether they are receiving the fair treatment that they deserve. We provide a free consultation to help you learn more about the workers’ compensation system and to discuss your situation. To set up your appointment call us at 781-843-2200 or contact us online.

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