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

When it comes to receiving workers’ compensation benefits, there are many different considerations that go into determining the amount of wage compensation an injured employee is entitled to receive. One of the biggest determinations involves assessing whether the injured worker has any pre-existing conditions affecting the same part of their body or health as the claimed work injury. To be compensable, a work injury affecting a pre-existing condition must be deemed the major cause of the claimed injury. At Pulgini & Norton, our experienced Massachusetts work injury lawyers have assisted employees with handling claims involving pre-existing conditions and ensuring that they receive the maximum amount of compensation that they deserve.

In a recent appellate opinion, the court discussed the difference between total incapacity benefits and partial incapacity benefits. The plaintiff worked as a certified nursing assistant (CNA) since 1994. In July 2013, the employee reported suffering an injury after she and another CNA transferred a patient to another hospital bed. She did not pursue treatment for her injury until August 2013. The evidentiary record contained conflicting information regarding the date that the injury occurred, but the employee filed her claim for workers’ compensation benefits on July 23 and stated that date as the date of the accident.

The lower court reviewed the employee’s claim and credited her testimony regarding how the injury happened as well as the relative events associated with the purported date of the injury. The employer’s insurance company challenged this determination, arguing that another date should have been used as the date the injury occurred. Based on the evidence in the record, the lower court rejected the insurer’s claim and set July 29 as the date the injury happened.

The lower court also rejected the insurer’s argument that the employee had a pre-existing condition that was the major cause of her injuries, specifically referring to a breast reduction surgery the employee underwent previously. The lower court rejected this argument as well, stating that the pre-existing condition did not warrant further analysis.

The insurer appealed. On review, the appellate court noted that there was ample evidence in the record supporting the lower court’s conclusion that July 29 was the date the injury took place. Regarding the insurer’s pre-existing condition claim, however, the appellate court agreed that the trial court did not conduct a sufficiently thorough evidentiary analysis regarding the nature of the alleged pre-existing injury and its relation to the claimed work injury. The appellate court also found that the trial court adopted conflicting medical opinions regarding the employee’s pre-existing condition that reached two conflicting diagnoses regarding her work-related injury. Accordingly, the appellate court vacated the lower court’s decision and ordered additional evidentiary analysis regarding the employee’s pre-existing condition.

If you were hurt at work, you may be entitled to receive benefit payments through the Massachusetts workers’ compensation system. One of the best ways to ensure that you receive the full amount of benefits that you deserve is to retain an experienced and committed workers’ compensation lawyer. At Pulgini & Norton, we pride ourselves on providing client-focused, personalized, and compassionate legal counsel to injured workers and their families throughout Massachusetts. To schedule your free consultation, call us now at 781-843-2200 or contact us online to get started.

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