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Massachusetts Case Assesses Whether Injured Employee Receives Reimbursement for Medical Treatment

When an injury occurs in a Massachusetts workplace, an injured employee can receive payment for the medical treatment of the injury as long as it was related to the workplace accident. In Thomas A. Novack’s Case (15-P-1090), a nursing home employee sustained a lower back injury while on the job. He eventually received a lump-sum payment with an agreement that the insurer would keep paying for medical treatment that was adequate, reasonable, and stemming from the workplace injury. Money PileThe injured employee received treatment from various providers after the settlement, and those costs were paid by the insurer for the next five years. The insurer then ceased payment, and Medicare began paying for all of the medical treatment received thereafter.

The employee filed for reimbursement from the Department of Industrial Accidents for the treatment paid for by Medicare. The Administrative Law Judge (ALJ) pondered whether the injured employee could even seek reimbursement when a third party made the payment, but the ALJ ultimately stopped at the finding that the treatment was not adequate, reasonable, or causally related to the workplace injury. The ALJ also noted in the decision that there was a lack of proof that bills were submitted to the insurer before they were given to Medicare. The request for reimbursement was denied, and the injured employee appealed.

The Appeals Court looked at the conclusions of the ALJ to see if the evidence supported the findings. The ALJ did not find the treating physician’s letters persuasive in their attempt to show the connection from the back treatment to the workplace accident. The appellate court felt the ALJ documented sufficient evidence to rule against the injured employee. The ALJ’s ruling in favor of the insurer was affirmed.

When a workplace accident happens, there are several types of benefits that your family or you may be eligible to receive: temporary and total incapacity benefits, partial incapacity benefits, permanent and total incapacity benefits, medical benefits, permanent loss of function and disfigurement benefits, survivors’ and dependents’ benefits, and burial expenses. These benefits help cover lost wages, medical care, prescriptions, and mileage reimbursement, and they may be ongoing. Certain benefits are a one-time lump sum payment if you have suffered either a permanent loss of certain functions or scarring on your face, neck, or hands. Benefits for spouses and dependents may also be ongoing if they meet the specific criteria established by the workers’ compensation statutes.

While workers’ compensation was designed to be more expedient than filing a personal injury lawsuit, the process to get the benefits you deserve can be challenging. The Massachusetts workers’ compensation attorneys at Karsner & Meehan have the experience you need to assist you with your workers’ compensation benefits claim. Our firm understands how challenging life becomes when you are faced with a difficult recovery and strained finances, and we can tirelessly work to assist you with your case. Call our office today at 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