Massachusetts Reviewing Board Holds Missing Medical Evidence Requires Vacating the Decision Denying an Employee’s Claim for Benefits

In a recent decision, the Massachusetts Department of Industrial Accidents Review Board addressed whether a judge’s decision denying an injured employee’s claim for workers’ compensation benefits could be upheld when medical evidence submitted by the parties had not been considered, including the employee’s most recent disability opinion.  After suffering an injury while working as a cook and laborer for his employer, the employee in this case had received total incapacity benefits according to Massachusetts law (§ 34 benefits). Once the employer sought to modify or discontinue these benefits, a hearing was held. Ultimately, the judge found that the injured employee’s medical documentation was dated, and he found the employee partially disabled, capable of light-duty work.  The employee appealed, and the Board analyzed the judge’s decision and findings of fact.

After being treated at the hospital for a back injury due to a work-related slip and fall, the employee in this case was unable to perform his work, and he remained out of work at the time of the hearing.

Initially, the employer paid § 34 benefits, and then it filed a complaint to modify or discontinue those benefits.  After the judge allowed the discontinuance request (the order was to pay the employee closed § 34 benefits from January 2013 to June 2015), the employee appealed and underwent a § 11A medical examination.  The employee then filed a motion to join § 34A benefits and to strike the medical report.  The judge allowed the joinder but did not strike the medical report. The parties submitted a joint exhibit of 13 entries of their respective additional medical records.

At issue was the benefits period after July 12, 2015 (the date the employee’s § 34 benefits would end) and the joined claim for § 34A benefits from June 2015 forward.  In his decision, the judge found that the medical evidence submitted by the employee was old, written in 2012-2014. According to the judge, the most recent note, in August 2014, written by the employee’s treating orthopedic doctor stated that the employee’s disability was caused by a work-related injury.

In his determination, the judge found the employee partially disabled, able to perform light-duty work.  Since his light-duty capacity work wages were more than his stipulated average weekly wage, the judge stated the employee was not entitled to § 35 partial disability weekly wage replacement compensation.  The judge also noted that the most recent total disability opinion for the employee had been offered over 19 months before the hearing. The judge denied the employee’s claim for wage replacement benefits under §§ 34, 35, and 34A.

On appeal, the employee argued that the parties’ joint exhibit showed additional medical evidence, providing medical opinions on total disability from 2015 and 2016.

The Board stated that there was no trace of this exhibit, meaning it had not been submitted at the hearing.  They also made clear that the parties are to check OnBase, the department document management system. This ensures that the documents appear in the Board’s file. Significantly, the Board noted that OnBase is the department’s only board file and record.

In holding that the decision must be vacated and recommitted for further findings of fact, the Board stated that when a judge directly receives evidence at a proceeding from the parties, it is the judge’s responsibility to ensure the evidence is entered into the document system. In the facts at hand, the judge’s decision mistakenly stated the last disability note submitted by the employee was August 13, 2014, and he did not view the parties’ joint exhibit. This joint exhibit was the only additional medical evidence that had been submitted at the hearing.

The Board stated that the judge’s decision must be vacated, and it recommitted for the judge to review the missing evidence and make further findings of fact and rulings after considering that evidence.

If you have been injured or are suffering from a work-related medical condition, you may be eligible for compensation, including medical benefits and missed wages from work.  The workers’ compensation lawyers at the Massachusetts firm of Pulgini & Norton represent individuals pursuing workers’ compensation benefits, providing personal attention and dedicated advocacy. Contact our office by phone at (781) 843-2200 or complete our online form and discuss your benefits claim with an experienced attorney.

More Blog Posts:

Massachusetts Reviewing Board Holds Medical Opinion Necessary to Support Finding of Compensability and Evidence Supports First Insurer’s Liability for Injured Painter’s Incapacity Period, Massachusetts Workers’ Compensation Lawyer Blog, January 26, 2017

Reviewing Board Holds Judge Made Findings Contrary to Medical Evidence and Massachusetts Workers’ Compensation Rules of Law Concerning Modification of Benefits Award, Massachusetts Workers’ Compensation Lawyer Blog, December 22, 2016

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