Reviewing Board Addresses Evidence of Pre-Existing Condition in Massachusetts Workers’ Compensation Appeal

The Massachusetts Department of Industrial Accidents Reviewing Board evaluated an appeal involving MGLA 152 § 34 workers’ compensation benefits in the matter of Adrian Aleman v. City of Boston. The parties appealed from a decision awarding the employee § 34 benefits after a work-related accident was found to be a traumatic aggravation of an underlying lumbar disc derangement. The employer argued that the medical evidence supporting the finding was insufficient and that the employee had not met his burden of proof under MGLA 152 § 1(7A).

The employee began working for the City of Boston as a meter servicer in 1994. The employee had sustained previous, non-work-related injuries to his back from two car accidents that occurred in 1996 and 2006. In 2008, the employee was injured while working when he stepped on uneven concrete, twisting his right foot and ankle. He received § 34 total incapacity benefits until July 4, 2009, when he returned to limited duty work. He then began receiving § 35 partial incapacity benefits until he returned to full duty work in October 2009. The employee continued to work full time until July 25, 2012, when he fell in the course of his employment, resulting in the leg and back pain injury at issue.

Under Massachusetts workers’ compensation laws, if a compensable injury combines with a pre-existing condition, which resulted from an injury that was not covered by workers’ compensation, and thereby causes or prolongs a disability or a need for treatment, the resulting condition is covered only to the extent that such an injury remains a major but not necessarily predominant cause of a disability or a need for treatment. MGLA 152 § 1(7A).

In Aleman, the medical evidence provided by multiple doctors indicated that the July 25, 2012 injury was an aggravation of a preexisting condition causing a total disability. The employee’s back pain was also directly attributed to the work-related injury on July 25, 2012. Adopting these opinions, the administrative judge found that the employee met his burden of proof under MGLA 152 § 1(7A), despite the statutory language requiring the incident to be a major cause of the disability.

On appeal, the Reviewing Board found that the medical evidence was insufficient to support a finding of major causation pursuant to MGLA 152 § 1(7A). The Board explained that while strict adherence to specific statutory language is not necessarily required to satisfy the MGLA 152 § 1(7A) burden of proof, the medical language must be substantially equivalent to that language. In Aleman, the Board found that the medical evidence only established that the July 25, 2012 incident aggravated the pre-existing condition, and it did not support a finding that the injury remains a major cause of the employee’s disability or need for treatment. In particular, the records failed to address the relative degree to which compensable and non-compensable causes (i.e., the 1996 and 2006 car accidents) have brought about the employee’s disability. The Board therefore reversed the award of § 34 benefits.

If you have suffered a work-related injury, you may be entitled to coverage for your medical treatment and expenses and lost wages under the Massachusetts Workers’ Compensation Act. At Pulgini & Norton, our experienced attorneys provide aggressive and thorough legal representation to clients seeking workers’ compensation benefits in Massachusetts. To discuss your benefits claim with one of our lawyers, contact our office at (781) 843-2200 or online and schedule a free consultation.

More Blog Posts:

Massachusetts Employee Has Standing to Bring Claim for Reimbursement of Benefits Paid by MassHealth and Medicare, Massachusetts Workers’ Compensation Lawyer Blog, published December 10, 2015

Massachusetts Appeals Court Rules Injured Employee Failed to Establish Partial Incapacity, Massachusetts Workers’ Compensation Lawyer Blog, published January 13, 2016

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