Massachusetts Employee Awarded Reimbursement of Medical Co-Payments for Treatment

A recent decision by a Massachusetts Department of Industrial Accidents Reviewing Board, King v. APA Transport, Inc., No. 030256-99 (June 18, 2015), affirmed an administrative judge’s order requiring the insurer to pay an employee medical benefits pursuant to M.G.L.A. 152 §§ 13 and 30. The insurer appealed to the Reviewing Board, arguing that the judge erred by ordering it to reimburse the employee for co-payments made for work-related medical treatment, including prescription medications.

The employee had been previously awarded worker’s compensation benefits for a back injury that he sustained in 1999. He then filed a claim for §§ 13 and 30 benefits, seeking payment for medical expenses related to his back injury. Specifically, the employee requested reimbursement of the co-payments he paid for office visits to his psychiatrist, who was treating him for depression, as well as co-payments for the medications prescribed to him by his psychiatrist. The employee also sought co-payments for office visits to his primary care physician, who was treating him for his back injury, and co-payments for pain-related medications that were prescribed to him by his doctor.

The insurer denied liability for the employee’s psychiatric illness and anti-depressant medications, as well as co-pays for any medical provider or prescription. The employee was examined by a psychiatrist pursuant to § 11A(2), who testified at the hearing. The administrative judge adopted the psychiatrist’s medical opinion that the employee’s major depressive disorder stemmed from the losses he suffered as a result of his work injury. The psychiatrist also testified that the medications prescribed to him had resulted in partial remission of the employee’s depression.

The insurer argued that a previous holding of the Reviewing Board in Estey v. Burns Int’l Sec. prohibits awards for reimbursement of co-payments. The Board disagreed, stating that its finding in Estey merely stated that in paying only the employee’s co-payments, the insurer failed to satisfy its obligations under § 30 by paying only a fraction of the medical expenses related to the injury. The Board also noted that the employee in the present case had no option but to go through his own health insurance company, since the issue regarding the insurer’s legal responsibility for his mental condition was not yet resolved. Ultimately, the Board held that the administrative judge’s order in King made it clear that the insurer was to pay all of the employee’s medical benefits under §§ 13 and 30, not just the co-payments. Accordingly, the Board found that the order was not contrary to Estey and affirmed the administrative judge’s ruling.

If you have sustained a mental or physical injury while at work, you may be entitled to compensation for your injury, including medical expenses and lost wages. At Pulgini & Norton, our experienced attorneys provide legal guidance and representation for Massachusetts clients pursuing workers’ compensation benefits. To discuss your claim with one of our seasoned attorneys, contact our office at (781) 843-2200 or online and schedule a consultation.

More Blog Posts:

For Massachusetts Workers’ Compensation Recipient, USPS Earnings Not Included in Average Weekly Wage, Massachusetts Workers’ Compensation Lawyer Blog, published August 5, 2015

Massachusetts Court Finds No Newly Discovered Evidence in Workers’ Compensation Case, Massachusetts Workers’ Compensation Lawyer Blog, published July 15, 2015


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