When an employee is injured on the job, he or she can submit a claim for workers’ compensation benefits. This provides compensation for missed wages as well as medical treatments that are reasonably related to the work injury. Unsurprisingly, many insurers will debate whether a medical treatment should be reimbursed, arguing that it was not a reasonable outcome of the accident. As dedicated Boston work injury lawyers, we have the skills and experience it takes to ensure that you are treated fairly.
Recently, a Massachusetts appellate court considered a claim in which an insurer argued that it should not be required to pay for certain treatments related to an injured workers’ spinal injury. The woman worked as a transporter and cleaner when she suffered an injury to her neck. She underwent several operations and treatments including multiple spinal fusions.
Eventually, the woman accepted a lump sum settlement for her neck injury. Next, she received a surgical treatment for her lower back. She then filed a claim seeking reimbursement for medical expenses to pay for a Duragesic patch that would treat her persistent neck pain. Before a hearing on the claim, the employer’s insurance carrier was paying for half of the cost of the patch. After the hearing, the judge ordered the insurer to keep paying for half of the cost of the patch but denied the woman’s claim for compensation for additional medical bills. Both parties filed on appeal.
On review, the woman argued that she was entitled to reimbursement for roughly $25,000 in medical bills for the patch in addition to payments for future medications for the neck injury. The employer argued that it was not required to pay for the patch or future medical expenses. It argued that there was no connection between the neck injury and the need for the patch and that the patch was being prescribed to treat her pre-existing lower back condition.
The employee underwent an independent medical examination and the court deemed the medical issues in the claim complex. This allowed the parties to submit additional medical evidence. The parties also deposed one of the woman’s doctors who had treated her for roughly eighteen years. The woman did not provide any bills, receipts, or reimbursement requests, or any additional medical records. The insurer provided an additional set of medical records.
The judge concluded that the woman had used the neck patch for 12 years before her neck surgery. Reviewing the worker’s testimony, the judge concluded that she was not a credible source of information regarding the history of her injuries and treatment. Based on the supplemental information offered, the judge affirmed the ruling. The employee appealed again, and the court upheld the ruling finding that the worker failed to establish that the patch was directly associated with the work injury.
If you were hurt on the job we are standing by to assist you with understanding your legal right to benefits and compensation for medical bills. Whether you simply want to learn more about the process or you are ready to file a claim, we offer a free consultation to discuss your situation. Our workers’ compensation attorneys have provided compassionate and respectful legal counsel to injured workers and their loved ones throughout Massachusetts. Call us now at 781-843-2200 or contact us online.