Massachusetts Employee Denied Workers’ Compensation Benefits for Pre-Existing Condition

When an employee suffers a workplace accident that combines with his or her pre-existing medical condition, there are additional aspects considered in determining workers’ compensation benefits. The Massachusetts Reviewing Board of Industrial Accidents recently reviewed an administrative judge’s denial of benefits in a workers’ compensation appeal in Kelly Anne Martinson v. Atlantic Hospitality Group, LLC.

The employee worked as a manager in a restaurant, assisting the wait staff if it was busy. On December 16, 2012, the employee was assigned to work the buffet at a concert performance on the employer’s premises, and transported food and stacks of plates to the buffet table throughout the day. At the end of the day she experienced pain in her lower back and legs, and subsequently sought treatment from a doctor. On the advice of her doctor, she left work, and after declining an offer of light duty work with the employer, commenced employment elsewhere.

The employee claimed that work-related incidents combined with her pre-existing, non-industrial medical condition, had caused her injury. The employee was examined by an independent medical examiner, who did not find any causal relationship between the employee’s symptoms and a specific injury at work. The employee also submitted additional medical evidence.

Pursuant to G.L. 152 § 1(7A), the aggravation or exacerbation of a pre-existing, non-industrial, medical condition causing a disability, or a need for treatment, is compensable under the Workers’ Compensation Act only to the extent the compensable injury remains a major cause of the employee’s disability or need for treatment. The employee has the burden of proving such a claim, including any medical evidence sufficient to support a finding of a major cause.

The administrative hearing judge adopted the opinion of the independent medical examiner, and, finding that the employee’s work was not a major cause of her resulting disability or need for treatment, denied her claim. On appeal, the employee argued that the judge erred in relying on the medical opinion. The Reviewing Board found no error, as the parties were permitted to admit additional medical evidence addressing whether the employee’s work incidents were a major cause of her condition. The Reviewing Board also noted that the employee could not identify any additional medical evidence that, if allowed to be considered, would have carried her § 1(7A) burden of proof. Accordingly, the Reviewing Board affirmed the decision denying the employee’s claim for workers’ compensation benefits.

Many workers who have be injured in on-the-job accidents are entitled to coverage for their medical treatment and expenses, as well as lost wages, under the Massachusetts Workers’ Compensation Act. At the injury firm of Pulgini & Norton, our hardworking attorneys are dedicated to representing individuals seeking workers’ compensation benefits in Massachusetts. To discuss your benefits claim with one of our experienced 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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