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Massachusetts Reviewing Board Reverses Award of Benefits for Injured Nursing Assistant in Claim Involving Multiple Insurers

Legal News GavelOne of the most complex aspects of any workers’ compensation claim is dealing with insurance companies, especially when multiple insurers are involved. At Pulgini & Norton, our seasoned team of Massachusetts workers’ compensation lawyers proudly provides legal counsel to injured workers and assists them with ensuring that insurance companies play by the rules.

In a recent opinion, the Massachusetts Department of Industrial Accidents considered a situation in which the first insurer to provide benefits on a claim argued that a subsequent insurer should be liable for paying an injured worker’s claim. The worker was employed as a certified nursing assistant when she suffered injuries after falling down a set of stairs on the job. The first insurer paid total incapacity benefits to the employee, and the worker underwent treatment for her left shoulder injury.

Some time thereafter, the woman reported pain in her right shoulder. The first insurer eventually stopped paying benefits, and the woman stopped working. She was later hired as a certified nursing assistant for a different employer until she left the position to undergo surgery on her left shoulder. While the woman was employed in this second position, she also provided some assistance privately to an independent senior individual. She claimed that he did not require significant assistance. The woman was not able to continue her employment as a certified nursing assistant because she found the job to be beyond her capabilities.

The woman claimed that the surgery did not provide any relief or improvement to her shoulder injury. She filed a claim with the first insurer, seeking benefit payments and medical expenses reimbursement, which the judge denied. The woman then underwent a medical examination and later filed a claim against the insurer that provided workers’ compensation insurance for her second employer and the workers’ compensation insurer for the private care service. The judge concluded that the woman did not suffer any injury or aggravation of an existing injury while she worked for the second and third employers. As a result, the judge denied those claims. The judge made an additional finding that her right shoulder injury was related to the original accident because the injury to her left shoulder required her to overuse her right shoulder to compensate. As a result, the judge ordered the first insurer to provide compensation for the right shoulder injury as well as the left shoulder injury.

The parties appealed, and the reviewing panel concluded that the judge erred in requiring the original insurer to pay for the right shoulder injury. The panel reversed this portion of the judge’s award and remanded the case for additional proceedings.

If you were hurt at work, you may be entitled to workers’ compensation benefits. At Pulgini & Norton, we understand how stressful and confusing this situation is for your loved ones and you, and we know the uncertainty that you are facing when it comes to your livelihood. We proudly serve clients throughout Massachusetts and offer a free consultation to help you learn more about your rights and options. Call us now at 781-843-2200 or contact us online.

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