Massachusetts Board Rules Medical Opinion Insufficient to Establish Workplace Injury Was Predominant Contributing Cause of Mental Condition

In a recent decision, the Massachusetts Reviewing Board of Industrial Accidents considered whether workers’ compensation benefits were properly awarded to an employee suffering from psychiatric injuries. In the case of Jane Sgouros v. Department of Transitional Assistance, the employee filed a claim for benefits due to a variety of mental and emotional conditions she claimed to have suffered as a result of her job as a case manager. Specifically, the employee stated that she was verbally abused by a client on December 23, 2013. She also testified that for 10 years prior to that incident, she suffered continuous verbal abuse from other clients, she was bullied by supervisors, and her requests for assistance were ignored. The employee had been receiving treatment from a psychiatrist for anxiety issues for approximately 10 years.

The employee was examined by a psychiatrist and an impartial medical examiner, who found that the employee was currently medically disabled. On the issue of causation, the doctor opined that although the employee had managed to work in spite of her history of family trauma before the December incident, it triggered a breakdown from which the employee was unable to overcome her symptoms. The administrative judge awarded the employee § 34 benefits for total incapacity, along with § 13 and § 30 benefits.

In Massachusetts, personal injuries covered by workers’ compensation include mental or emotional disabilities only when the predominant contributing cause of such a disability is an event or series of events occurring within the employment. On appeal, the employer argued that there was no medical evidence that the predominant contributing cause of the employee’s disability was an event occurring within her employment. The issue for the Reviewing Board, therefore, was whether the impartial medical examiner’s opinion that the December event “was the proverbial straw that broke the camel’s back” indicated a predominant contributing cause.

Ultimately, the Reviewing Board found against the employee, explaining that a finding of heightened causation must be supported by a medical opinion that addresses, in meaningful terms, the relative degree to which compensable causes have brought about the employee’s disability. The Board also noted that the “predominant contributing cause” standard is higher than the “major cause” standard required to prove a combination injury. As a result, the Board interpreted the medical examiner’s opinion as amounting to only “but-for” causation, which, without more, was insufficient to satisfy the high standard of predominating contributing cause required under the statute. Accordingly, the Board reversed the award of benefits to the employee.

Proving that a mental or emotional condition resulted from an industrial accident can be difficult in some situations, but an experienced injury attorney can help present the facts of your claim persuasively. At the Massachusetts firm of Pulgini & Norton, our workplace injury attorneys provide legal representation and guidance to those pursuing workers’ compensation benefits. To discuss your claim with one of our knowledgeable attorneys, contact Pulgini & Norton by phone at (781) 843-2200 or online.

More Blog Posts:

Massachusetts Reviewing Board Affirms Award of Workers’ Compensation Benefits, Including Handicapped Housing, Massachusetts Workers’ Compensation Lawyer Blog, published November 2, 2015

Massachusetts Employee Has Standing to Bring Claim for Reimbursement of Benefits Paid by MassHealth and Medicare, Massachusetts Workers’ Compensation Lawyer Blog, published December 10, 2015

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