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Massachusetts Court Reverses Order Awarding Benefits Based in Part on Lower Court’s Improper Reliance on Dated Medical Reports

In order to receive workers’ compensation benefits, you must prove that your injury was the result of your job duties or some situation at work. This may sound simple, but the insurance company will do everything in its power to show that your injury was the result of some other cause in order to avoid paying benefits. As seasoned Boston work injury lawyers, we will fight diligently to ensure that you are treated fairly throughout the entire claim process.

A Massachusetts appellate court recently considered a claim in which the parties disputed the causal link between the woman’s injuries and her job duties. The woman worked as a flight attendant when she suffered an industrial injury to her left elbow in 2009. She underwent surgery and returned to work with no restrictions 18 months later. In 2014, she left work upon experiencing increasing pain in her right arm and neck. She filed a claim for medical benefits that listed an alleged cervical injury. The insurer denied the claim on the basis that there was not enough evidence to show a link between the injury and her job duties. It also raised an issue regarding her pre-existing injury. Ultimately, the judge awarded the woman compensation for her cervical injury medical treatment and the insurer appealed.

The woman underwent an independent medical examination and the doctor concluded that there was a causal relationship between her injury and the repetitive nature of her work duties. The insurer withdrew its appeal. Sometime later, the insurer filed a complaint for discontinuance, stating that the disability was no longer associated with her work and again raised pre-existing injury as an issue. The judge denied the request and the insurer appealed. A different physician examined the employee who concluded that the worker’s cervical injuries were not associated with her job duties. The judge awarded the woman disability benefits as well as medical benefits for her cervical condition. The insurer appealed again alleging that the judge relied on the wrong report in reaching a conclusion and that the medical opinions upon which the judge relied failed to address the pre-existing injury issue.

The appellate court reviewed the record and agreed with the insurer. The first judge did not rely on the correct report in assessing whether the worker’s injury remained a disabling condition at the time the insurer sought the discontinuance as opposed to the outset of the claim. Turning to the second issue, the lower court failed to address the issue of pre-existing injury on the basis that the insurer’s withdraw of its earlier appeal indicated that it was barred from raising the issue in the future. The appellate court stated that the withdrawal of the appeal did not foreclose the insurer’s right to raise the issue of pre-existing injury later on in the proceedings. Finally, reviewing the medical opinions relied upon in the judge’s conclusion, the court noted that none of them addressed the issue of pre-existing injury. As a result of these findings, the appellate court vacated the order awarding benefits and remanded the action.

If you were hurt at work, we know how confused and upset you likely feel regarding the entire ordeal. Our seasoned legal team of Boston work injury professionals will guide you through the claims process and ensure that you receive the efficient and fair outcome that you deserve. To schedule a free consultation, call us at 781-843-2200 or contact us online.

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