Massachusetts Employee Denied Workers’ Compensation Benefits Due to Insufficient Evidence

The Massachusetts Department of Industrial Accidents Reviewing Board recently reviewed an appeal involving workers’ compensation benefits in the matter of Steven Lupa v. United Parcel Service. The employee in the case appealed a decision of an administrative judge denying his claims for § 34 total incapacity benefits and § 35 partial incapacity benefits, as well as § 13 and § 30 medical benefits for bilateral knee replacements. On appeal, the employee contended that the administrative judge mischaracterized the impartial examiner’s opinions regarding the causal relationship between the injury and his work and his need for medical treatment.

The employee had worked for the United Parcel Service for 35 years before recently retiring, incurring several injuries that were accepted by the employer during his employment. In pursuing his present benefits claim, the employee was examined by an impartial medical examiner pursuant to § 11A. The administrative judge adopted the opinion of the impartial medical examiner that the employee’s work-related incidents, combined with the pre-existing degenerative osteoarthritis of both knees, caused the employee’s present complaints, disability, and need for treatment. However, the administrative judge also adopted the impartial medical examiner’s testimony that he could not state to a reasonable degree of medical certainty whether the employee’s arthritic changes resulted from the work-related incidents, or whether they occurred naturally and progressively. Based upon this testimony, the administrative judge concluded that the bilateral knee replacement surgery could not, within a reasonable degree of medical certainty, be found to be caused by the work-related accidents.

On appeal, the employee argued that the judge misinterpreted the opinion of the impartial medical examiner. Although the Reviewing Board agreed, it explained that the burden of proof had shifted to the employee to prove that the work injury remained a major, but not necessarily predominant, cause of his need for the bilateral knee replacement. Since the impartial medical examiner was under no statutory obligation to opine on the need for surgery, and he did not make any such opinion, the employee had the burden to prove this element of his claim. The Reviewing Board went on to explain that it was the responsibility of the employee’s counsel to question the impartial medical examiner regarding whether the proposed surgery was reasonable, adequate, and causally related.

As a result, the Reviewing Board concluded that since the insufficient opinion of the impartial medical examiner was the only evidence before the administrative judge, the employee’s benefits claim was appropriately denied.

Most workers who have suffered on-the-job injuries are entitled to coverage for medical treatment and expenses, as well as lost wages, under the Massachusetts Workers’ Compensation Act. At Pulgini & Norton, our injury attorneys provide aggressive and dedicated legal representation to individuals seeking workers’ compensation benefits in Massachusetts. To discuss your benefits claim with one of our skilled attorneys, contact our office at (781) 843-2200 or online and schedule a free consultation.

More Blog Posts:

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

Reviewing Board Addresses Evidence of Pre-Existing Condition in Massachusetts Workers’ Compensation Appeal, Massachusetts Workers’ Compensation Lawyer Blog, published January 27, 2016

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