Massachusetts Appellate Court Reverses Order Awarding Benefits for Back Injury Upon Finding that the Record Lacked Sufficient Supporting Medical Evidence

Knowing which medical treatments you can receive after suffering a work-related injury and whether it will be covered by workers’ compensation benefits can be difficult to determine, especially if you are dealing with painful symptoms. At Pulgini & Norton, our dedicated team of Massachusetts workers’ compensation lawyers has guided many Boston residents and their families through the claims process. As a recent opinion illustrates, having a seasoned attorney on your side can help you ensure that your right to compensation and reimbursement is protected.

In the case, the employee suffered a back injury during his employment at a supermarket in 1991. He underwent a surgical procedure to address the injury in 1992 and returned to work in 1993 for an electric company. He was laid off in 2009 and rehired in August 2011 to work on a large job. He was laid off again in March 2012, at which time he filed a claim seeking workers’ compensation benefits. He alleged that while no specific injury or event had caused his pain, he suffered injuries as a result of repetitive tasks like lifting and carrying.

After an initial hearing, the judge awarded the employee temporary total incapacity benefits. They did not require the employer to provide compensation for back surgery, however. The employee underwent a medical examination that the judge deemed sufficient. Neither party requested a chance to depose the expert or to offer additional medical evidence. Based on the medical report, the judge concluded that the employee suffered a work-related injury between August 2011 and March 2012. He also found that the work-related injury was the major and predominant cause of his disability despite his pre-existing back injury. The judge awarded temporary total and partial incapacity benefits and required the employer to provide reimbursement for all medical expenses. This included a November 2013 back surgery.

The employer’s insurer appealed on a number of grounds. One of the grounds alleged that the physician’s conclusion that the new injury was the major cause of the employee’s injury was based on assumed work conditions that the judge did not approve. The appellate court agreed with the insurer, finding that the administrative judge had noted that the employee’s description of his job duties was not consistent with testimony he provided during a hearing, particularly regarding the number of times per day that he was required to carry heavy objects. The appellate court concluded that the lower court erred when it failed to make a specific finding regarding the nature and scope of the employee’s job duties, particularly regarding how often he was required to carry heavy objects. Instead, the administrative judge only noted that the employee “exaggerated somewhat” the nature and scope of his carrying.

The appellate court also agreed with the insurer’s contention that the administrative judge’s order requiring the insurer to pay for the November 2013 surgery lacked a medical opinion foundation. The appellate court noted that the employee’s testimony regarding his injury and the surgery was insufficient to show that the surgery was adequate, reasonable, and causally related to the accident. The judge did not cite anything in the medical opinion to support the ruling requiring the insurer to pay for the surgery. As a result of the foregoing findings, the appellate court vacated the original order and remanded the case for additional proceedings.

If you have been injured on the job, you may be entitled to workers’ compensation benefits. At Pulgini & Norton, we pride ourselves on providing Boston residents with compassionate, knowledgeable, and diligent legal counsel. We know just how stressful this situation is for you and your family and the immense financial pressure that it can cause. We offer a free consultation to help you learn more about workers’ compensation benefits and how we can assist you in asserting your rights. Call us now at 781-843-2200 or contact us online to schedule your appointment.

Related Posts:

Massachusetts Appellate Court Reverses Trial Court Award of Benefits Based on Failure to Examine Claimant’s Alleged Pre-Existing Condition

Massachusetts Appellate Court Upholds Denial of Reimbursement for Pain Medication Based on “Major Cause” Doctrine

Massachusetts Appellate Court Remands Award of Total Incapacity Benefits Based on Lack of Evidence

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