Massachusetts Appellate Court Upholds Award of Benefits to Injured Worker, Rejecting Insurer’s Affirmative Defense

Insurance companies will try many different tactics to avoid paying benefits to injured workers. As seasoned Boston workers’ compensation attorneys, we are well versed in dealing with insurance companies and ensuring that our clients are treated fairly. A recent decision from Massachusetts’ Department of Industrial Accidents highlights a common strategy that insurers take to avoid paying claims.

In the case, the insurer appealed a decision awarding the worker total incapacity benefits. The employee was a union laborer who suffered a variety of industrial accidents during a period of years. A series of back injuries were the primary subject of the appeal. The work accidents that gave rise to the back injuries occurred in 1991, 1995, 1996, and 2001. The insurer accepted liability for each accident and paid the worker benefit payments as well as lump sum settlements in each case. In 2004, the employee went against the advice of several doctors and returned to heavy work. He reported experiencing moderate pain but used methadone to control it, as well as Percocet. He attempted to refuse the most intense jobs like bricklaying and jackhammering.

In April 2012, the employee suffered another back injury when he was struck with a piece of staging that another employee dropped. He left work and did not return despite doctors giving him a light-duty clearance. The man reported the claim and sought workers’ compensation benefits. In response to the claim, the insurer argued that the man was not entitled to benefits because the accident occurred as a result of his serious and willful conduct. The insurer stated that despite the doctor’s recommendation that he not return to work, the man went back anyway and performed intense work duties. The insurer also argued that as a result of his four prior injuries and medical advice, the worker had actual knowledge that the risk of returning to the same level of work involved a substantial probability that he would suffer an additional and debilitating back injury.

The judge ultimately rejected the insurer’s position, finding that although the man had actual knowledge that he was at high risk of suffering another back injury if he returned to work, he did not engage in any willful misconduct at the time of the injury.

The insurer appealed, arguing that the judge erred in failing to conduct a proper analysis regarding the man’s alleged willful misconduct. According to Section 27 of Massachusetts’ workers’ compensation laws, if an employee suffers an injury as a result of his or her willful misconduct, he or she is barred from receiving benefits. The appellate court affirmed the lower court’s finding, concluding that the man suffered injuries as a result of another employee’s negligent conduct that had nothing to do with the man’s back injury.

If you were injured on the job, you may be entitled to benefits and medical expenses reimbursement. At Pulgini & Norton, we know how confusing and difficult the claims process can be. Our seasoned team of legal professionals can ensure that your questions are answered and that you understand how the process works. To set up a free consultation to learn more about how we can assist you with seeking the maximum amount of compensation that you deserve, call us at 781-843-2200 or contact us online.

Related Posts:

Massachusetts Appellate Court Upholds Award of Benefits to Worker Involved in Car Accident While Traveling Home from Job Site

Massachusetts Reviewing Board Upholds Decision Declaring Truck Accident Victim Capable of Working 30 Hours Per Week

Massachusetts Reviewing Board Upholds Denial of Reimbursement for Nursing Home Expenses in Leg Amputation Claim

Contact Information