Massachusetts Employee Award of Workers’ Compensation Benefits Affirmed

The Massachusetts Department of Industrial Accidents Reviewing Board recently decided an appeal involving medical benefits and mileage reimbursement under the workers’ compensation laws. In Frances Margraf v. Central Berkshire Regional School District, the employer’s insurer appealed a decision of an administrative judge awarding benefits pursuant to G.L.c. 152 § 13 and § 30. On appeal, the Reviewing Board ultimately affirmed the decision, ordering the insurer to pay for all but one of the claimed prescriptions.

The employee was a paraprofessional who worked with special needs students. In March 2005, she suffered an injury to her lower back and right lower extremity, including her hip, thigh, hamstring, and ankle. As a result, the employee underwent reconstructive surgeries on her right ankle. The insurer accepted liability for the diagnoses of chronic lower extremity weakness, right ankle injury, and intervertebral displacement. The employee subsequently filed a claim for § 13 and § 30 benefits for prescription medications for chronic pain, as well as mileage reimbursement for medical appointments.

The employee was examined by an independent medical examiner pursuant to § 11A. The insurer offered additional medical reports from another doctor in order to support its contention that the work injury was no longer a major cause of the employee’s disability or need for treatment under § 1(7A). Finding that the matter was not medically complex, the judge denied the insurer’s motion to allow the additional reports. The judge also found that the employee’s testimony was credible and adopted the opinion of the independent medical examiner that the requested prescriptions were reasonable, necessary, and related to the injury. As a result, the judge ordered payment for those prescriptions, monitoring of those medications, and payment of the mileage request.

On appeal, the insurer argued that the judge erred by failing to make findings regarding the nature of the employee’s pre-existing condition. The Reviewing Board disagreed, finding that the report of the § 11A examiner was clear in describing those conditions, and any error in failing to make specific findings was harmless. The insurer also argued that the judge erred by imposing a new burden of production on it under § 1(7A). However, the Reviewing Board found that the insurer’s arguments were mooted by the judge’s adoption of the opinion of the independent medical examiner, who stated that the 2005 work injury remained a major cause of the employee’s disability and need for treatment. The Board further stated that the opinion clearly satisfies the burden of proof under § 1(7A), regardless of the insurer’s burden.

Finally, the insurer argued that the judge should have determined whether the work injury remained a major cause of disability with respect to alleged subsequent non-work-related activities, such as leaf raking and motor vehicle accidents. The Board held that there is no basis for including such activities in the assessment of the employee’s medical disability status. The Board also affirmed the judge’s finding that any subsequent events did not break the causation chain of the 2005 work-related injury. Therefore, the Board affirmed the decision of the judge in favor of the employee.

If you have sustained a work-related injury, you may be entitled to benefits, including payments for your medical treatment and lost wages. The accident attorneys at Pulgini & Norton represent injured workers pursuing workers’ compensation benefits in Massachusetts. To discuss your benefits claim with one of our knowledgeable attorneys, contact our office at (781) 843-2200 or online and schedule a consultation.

More Blog Posts:

Massachusetts Appeals Court Finds for Worker Claiming Partial Incapacity Benefits, Massachusetts Workers’ Compensation Lawyer Blog, published August 12, 2015

Massachusetts Appeals Court Rules Injured Employee Failed to Establish Partial Incapacity, Massachusetts Workers’ Compensation Lawyer Blog, published January 13, 2016

Contact Information