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Massachusetts Appeals Court Reviews Termination of Workers’ Compensation Benefits for an Industrial Accident

In Robert Amaral’s Case (15-P-860), the Appeals Court of Massachusetts reviewed whether or not it was appropriate for an administrative hearing judge to terminate a worker’s total weekly incapacity benefits. The worker injured his shoulder and lower back while helping restrain two juveniles at the Department of Youth Services. He originally received both total and partial incapacity benefits, but his employer, a self-insurer, filed to discontinue the total incapacity benefits.

backache-1620045-639x442.jpgThe employer argued that the injured worker was no longer entitled to weekly benefits because the injury sustained at work was not a major cause of his continued disability. The administrative judge relied upon the employer’s medical expert witness, who opined that his disability mostly stemmed from his pre-existing spinal degeneration and obesity.

In all workers’ compensation cases, the judge is allowed to weigh the medical evidence presented in order to determine whether the injuries sustained by the worker were actually from the workplace and not aggravated by conditions preceding the accident or aggravated by circumstances outside of and unrelated to work. In this case, the injured worker appealed the judge’s ruling and the affirmation of the Reviewing Board, arguing that the judge had abused her discretion by adopting the medical opinion of the employer’s expert.

The appeals court determined that the judge did not abuse her discretion by basing her findings on the employer’s expert. Case law has long determined that an administrative judge can accept all, part, or none of any medical expert’s opinion provided through the hearing process. The court felt that the administrative judge in this case fairly considered all the evidence because of her reference to the Independent Medical Examiner’s testimony, which lined up with the employer’s expert. The administrative judge’s ruling and the Review Board’s affirmation were both upheld, leaving the injured worker with only the partial weekly benefits award.

Amaral shows the importance of having lots of medical evidence available to back your workers’ compensation claim for benefits. Even if there is a pre-existing condition, your ability to receive total incapacity benefits is not precluded. Massachusetts General Laws c. 152, Section 1(7A) allows an award for a compensable injury if it is a major cause of the disability or need for treatment. It does not have to be a predominant cause. The IME and the employer’s expert testified that the worker’s specific injury from the accident in this case had healed and that he no longer exhibited any symptoms.

The Massachusetts workers’ compensation attorneys at Karsner & Meehan have the experience you need to pursue your claim. We understand what is needed to bolster or rebut the insurer’s medical expert testimony, and we will tirelessly work to maximize the benefits you receive. For a free, confidential consultation, call 508.822.6600.

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Appeals Court of Massachusetts Case Reveals The Difficulty People Face When Contesting a Will, Massachusetts Injury Lawyers Blog, March 3, 2016
Rear-end Collision Appellate Case Helps Illustrate Burden of Proof Considerations in Massachusetts Personal Injury Cases, Massachusetts Injury Lawyers Blog, February 3, 2016