Massachusetts Court Reverses Award of Benefits Based on Lower Court’s Inconsistent Interpretation of Medical Reports

Medical opinions often form the basis for an award or denial of workers’ compensation benefits. As a result, it is critical to ensure that the medical examinations you receive are thorough and accurate and that the presiding judge abides by the applicable rules in determining the scope of those reports. At Pulgini & Norton, we have provided countless Boston residents with seasoned legal counsel when pursuing Massachusetts workers’ compensation benefits. We are standing by and ready to help you fight for your rights.

In a recent claim, the employee sought benefits for injuries he alleged that he sustained over time in his job as a union electrician. There were two insurers involved, an original insurer and a successive insurer. The judge ordered the successive insurer to pay temporary incapacity benefits to the worker in addition to reimbursement for medical expenses, which the successive insurer appealed. The judge denied the claim against the original insurer, which the employee appealed.

The worker underwent medical examinations and the insurers asserted a number of defenses including a lack of causal relationship between the injuries and the employee’s job, a lack of proper notice of the disability, and a lack of injury. The judge allowed the parties to submit additional medical evidence and the employee was the only one to testify at the hearing. The judge upheld the original order denying the claim against the original insurer and upholding the award of benefits against the successive insurer.

In reaching this conclusion, the judge relied on two medical opinions. The insurer appealed, claiming that the opinions concerning diagnosis and the causal relationship between the injury and the employee’s job duties were conflicting, which rendered the decision inconsistent and in need of reversal. The insurer also alleged that the judge omitted parts of one of the medical opinions that would have highlighted the evidentiary conflict.

On review, the appellate court agreed with the insurer, finding that the lower court mischaracterized one of the expert’s medical opinions. Massachusetts’ workers’ compensation rules allow judges to adopt all, part, or none of an expert’s testimony, but they prohibit courts from engaging in mischaracterizations or to fail to consider the evidence in context. Here, the judge ignored the fact that one expert stated that there was no objective evidence to confirm a diagnosis by another expert regarding the employee’s condition.

Finally, the appellate court noted that the lower court failed to include any discussion regarding the insurer’s improper notice defenses. Reviewing the record, the appellate court found no discussion or analysis of these defenses, which the insurer raised in a timely fashion. As a result of these findings, the appellate court reversed and remanded the decision.

If you were hurt at work, we are ready to help you start exploring your potential right to workers’ compensation benefits. We know how intimidating this process can seem and how confusing the rules may be. The legal team at Pulgini & Norton can assist you with every aspect of your claim, including investigations and medical examinations. To schedule your free consultation call us at 781-843-2200 or contact us online.

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