Massachusetts Appellate Court Reverses Termination of Benefits for Worker Injured in Car Crash Based on Lack of Factual Findings in the Record

Workers’ compensation cases involving pre-existing medical or health conditions can be complicated. The law entitles an employee to receive compensation to the extent a work-related injury exacerbates the pre-existing injury. Ensuring that your pre-existing injury is diagnosed correctly and that you receive the full amount of benefits you deserve for the exacerbating work injury is critical. At Pulgini & Norton, our Boston workers’ compensation attorneys proudly help injured workers negotiate with insurance companies and fight for their rights.

The Massachusetts appellate court recently considered whether an award of benefits to an injured employee with a history of back conditions should be terminated based on a medical finding that he reached maximum medical improvement. The employee was hurt while working as a glass installer during a motor vehicle accident in August 2015. The insurer for the employer paid temporary total incapacity benefits. During November 2016, it filed a complaint to discontinue payment of benefits or modify those payments base don a report from an independent medical examiner. A judge reviewing the request ordered a modification of the benefit payments to partial incapacity benefits and determined that the employee’s earning capacity was $250 per week. Both parties filed an appeal and the employee underwent another independent medical examination.

Another hearing was held at which the judge concluded that the matter was medically complex and deemed the examiner’s report inadequate. The parties submitted additional medical evidence and the judge concluded that the employee had a history of lower back pain that’s not related to his occupation, including a spinal fusion that happened when he was eight. In addition to listing other back-related injuries that the employee suffered, the judge adopted medical opinions concluding that the employee experienced a flare-up of an existing back condition and that he returned to his pre-accident level of capacity. The judge also adopted an opinion finding that the employee reached maximum medical improvement and that any impairment was based on pre-existing conditions and not the work-related accident. The judge also concluded that any additional medical treatment would not be related to the accident and would be related to his pre-existing conditions.

On appeal, the insurance company argued that termination of benefits was appropriate from the date that the doctor concluded that the employee reached maximum medical improvement. In reversing the judge’s termination of benefits, the appellate court noted that the judge took inconsistent positions regarding the medical opinions adopted in the order. The judge adopted two medical experts’ opinions in determining when to terminate benefits but failed to explain which aspect of which report supported the date of termination. Based on the content of the reports, the decision to terminate may have been based on a mischaracterization of one of the expert’s opinions. Without additional findings in the order, the appellate court could not determine whether the lower court applied Massachusetts workers’ compensation rules correctly in determining that the injured employee’s benefits should be terminated.

If you were hurt at work, our seasoned team of Boston work injury lawyers are prepared to assist you in navigating the workers’ compensation system. We understand how stressful this process can be, particularly if you are concerned about your future health and financial situation. We offer a free consultation to help you learn more about the process and how we can represent you. Contact us today at 781-843-2200 or contact us online.

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