Massachusetts Reviewing Board Upholds Denial of Reimbursement for Nursing Home Expenses in Leg Amputation Claim

If you were hurt on the job, the Massachusetts workers’ compensation system is designed to provide you with benefit payments and reimbursement for your medical expenses. This sounds relatively straightforward, but the claims process can be long and complicated, especially if your injuries are complex. One of the biggest issues that our seasoned Boston work injury lawyers encounter has to do with whether or not medical treatment will be reimbursable.

This issue was discussed in a recent decision from the Massachusetts Department of Industrial Accidents. In the claim, the injured worker and the employer’s insurance carrier filed appeals after the judge denied and dismissed the worker’s claim for insurance coverage for the costs of his long-term care. The order also required the insurer to reimburse certain costs of allocating a guardianship for the worker’s property and person.

The worker suffered an injury while he was employed as a custodian and working on a hot tar roof. The worker claimed that he suffered blisters all over his left foot and burns. Although the employee was treated promptly, he suffered ulcers, ongoing infections, and other conditions in his left foot. The worker filed a claim for workers’ compensation benefits, and the judge awarded the worker temporary incapacity benefits for his foot injury as well as his depression.

Shortly thereafter, the employee was required to undergo an amputation of his left toe and eventually an amputation of his left leg below the knee. The employee sought a lump sum settlement that the judge approved. The insurer accepted full liability for the left leg amputation and depression. The Workers’ Compensation Trust Fund later agreed to reimburse the insurer for 67 percent of its medical expenses for the employee.

Fourteen years later, the employee filed a claim seeking reimbursement for nursing home care and associated expenses. Medicaid filed a third party claim seeking reimbursement for nearly $1 million in medical expenses. The insurer then filed a motion to join the Workers’ Compensation Trust Fund. At the hearing, the worker’s daughter and guardian requested compensation for placing her father in a skilled nursing home facility and reimbursement for establishing a legal guardianship. The judge denied the claim for reimbursement of the skilled nursing facility but awarded compensation for the establishment of a guardianship. The parties appealed.

On review, the panel affirmed the judge’s ruling, finding that the cost of the skilled nursing facility was not causally related to the employee’s work injury. As an example, the appellate panel noted that the record was void of any evidence indicating why the employee was able to live alone with an amputation for several years and only recently required nursing home assistance.

If you were injured on the job, it is critical that you receive the maximum amount of compensation and medical expenses reimbursement that you need and deserve. The dedicated Boston workers’ compensation lawyers at Pulgini & Norton proudly assist victims with exploring their legal options and rights. We offer a free consultation, so call us at 781-843-2200 or contact us online to get started.

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