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Massachusetts Workers’ Compensation Reviewing Board Analyzes Case Determining Award of Total Incapacity Benefits

In Massachusetts workers’ compensation claims, an award of partial incapacity benefits rather than total incapacity benefits can make all the difference to a worker and his or her family. It can be the difference between financial strain and an existence that resembles life before the accident. Massachusetts workers’ compensation law Ch. 152 §1(7A) allows compensation for workplace injuries that exacerbate pre-existing conditions, as long as there is a determination of whether or not the compensable injury remains a major cause of the disability or need for treatment. The workplace injury does not have to be the predominant cause of the disability. In Herrera vs. Mediate Management, Inc. (Bd. No. 010696-10), the Reviewing Board chose to return the case to the Administrative Law Judge for additional findings of fact regarding whether or not the compensable injury was a major cause of the disability. cleaning janitorThe board did so because it felt there was insufficient analysis in the determination of whether or not the janitor’s current medical condition entitled him to receive total incapacity benefits instead of partial incapacity benefits.

In this case, the janitor tore his medial meniscus and underwent physical therapy and arthroscopic knee surgery. The janitor testified that his pain did not abate, and he was unable to work in the same occupation due to this injury. The ALJ, in his findings, wrote that he agreed with the medical opinion of the insurer’s expert witness, which concluded he had a pre-existing condition that was unrelated to the injury and progressive in nature. However, he also wrote that he agreed with the janitor’s medical expert, who placed restrictions on the employee’s movement and opined that the work-related injury remained a major contributing factor to his need for treatment. The ALJ then concluded, based on the testimony of the impartial physician (which was not formally adopted), that the arthritis and continuing degeneration were not caused by the workplace injury. The judge went on to rule that the janitor could work light duty and qualified for partial incapacity benefits, but not total incapacity benefits.

The Reviewing Board said it could not figure out from the findings whether or not the janitor suffered a combination injury, or two separate injuries that did not combine in a way that would prolong the janitor’s disability. The board noted that the insurer properly raised a § 1(7A) defense, and so all parties were entitled to a specific set of findings on whether or not it applied. The board pointed to its previous decision in Vieira v. D’Agostino Assocs., 19 Mass. Workers’ Comp. Rep. 50, 52-53 (2005), which provides the template for this type of determination. The board chose to leave the janitor’s award of partial incapacity benefits alone, but it felt a new set of findings was necessary to address the award or rejection of total incapacity benefits.

The Massachusetts workers’ compensation attorneys at Karsner & Meehan know how important it is for an injured worker to receive the maximum amount of benefits available to help recover and reintegrate in the workplace. For a consultation about your workers’ compensation case, call our office at 508.822.6600.

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