Massachusetts Appellate Court Reverses Cancellation of Benefits in Pre-Existing Lower Back Injury Case

One of the most complicated aspects of any workers’ compensation claim is determining how your pre-existing injuries may be involved. If you have a pre-existing injury and it is exacerbated by a work-related accident, you may still be entitled to benefits and medical expenses reimbursements but proving that your work-related duties caused the exacerbation can be tricky. At Pulgini & Norton, we proudly provide diligent and experienced legal representation to injured workers throughout Boston and are prepared to help you fight for your rights.

A recent case discussed a situation where a worker had a pre-existing lower back condition and suffered an injury to that same area. Insurance companies will often try to use pre-existing injuries to have benefit awards modified or terminated on the basis that the injury was not to blame for the exacerbation. In the case, the worker was a glass installer for a vehicle repair company. He was reportedly injured in a motor vehicle accident while on the job in November 2016. The insurer filed a motion seeking to discontinue the benefits that it paid to the employee as a result of the crash. The judge ruling on the petition modified the award to partial benefits and both parties filed an appeal.

After an independent medical examination, the judge concluded that the worker had a history of non-work-related lower back problems and that he had a spinal fusion procedure when he was eight-years-old. The judge only gave partial credit to the employee’s testimony about his history of back illnesses and did not entirely believe the employee that he was pain-free prior to the accident. Based on these findings, the judge set a date terminating benefits for the employee.

On review once again, the appellate court concluded that the judge did not make sufficient findings of fact in her opinion to support her assignment of a date of termination for the benefit payments. The judge adopted multiple medical opinions regarding whether the employee’s pre-existing lower back condition and was not clear in which aspects of each opinion supported the decision to terminate. Specifically, the judge did not provide an evidentiary basis for setting a date to terminate the injured worker’s benefit payments. According to the appellate court, it was possible that the judge may have mis-characterized the expert medical testimony from one of these reports.

The appellate court also rejected the insurer’s assertion that the employee’s right to medical reimbursements should be terminated. The medical reports merely referred to the worker’s ability to function and did not address whether the worker would need continued medical treatment. The court stated the longstanding rule that even though an employee may have his or her benefits terminated, the employee may still be entitled to receive reimbursement payments for medical expenses associated with the work-related injury.

If you were injured at work and you have pre-existing medical conditions, it is essential that you have a seasoned and knowledgeable attorney helping you to protect your rights. Insurance companies do not have your best interests in mind and there are countless procedural and substantive rules that govern cases involving pre-existing injuries. Our diligent team of Boston workers’ compensation lawyers will ensure that you receive the outcome that you deserve. Call us now at 781-843-2200 or contact us online to schedule your free consultation.

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