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Massachusetts Reviewing Board Vacates Award of Total Incapacity Workers’ Compensation Benefits

The state allows employees to receive Massachusetts workers’ compensation benefits for both physical and psychological injuries. An employee is considered to be injured if the disability was predominantly caused by an accident that occurred while performing tasks for the employer. An injured employee can also recover for aggravated mental injuries that preceded the workplace accident if the workplace accident is a major, but not necessarily predominant, cause of the disability or need for treatment. In this instance, the injured employee does not have to provide as much medical proof to show she or he qualifies for benefits.

A recent Reviewing Board decision (Board No. 020182-15) looks at the difference between the burdens of proof. The self-insurer/employer sought to reverse a ruling awarding the employee total incapacity benefits. The employer argued several errors were made by the administrative judge. Under StrainThe board declined to dismiss the employee’s claim but did recommit the case for additional findings of fact.

In its decision, the board felt the nature of the dispute required a deeper scrutiny of the facts. The employee was a chaplain working at a hospital when a resident lunged from his wheelchair and hit the chaplain in the face. The employee maintained he sought workers’ compensation for his physical injury sustained from the incident as well as benefits for his pre-existing mental health issues. On appeal, the employer argued the employee was only attempting to seek benefits for a pure mental or emotional injury. The record indicated otherwise. The board noted the judge seemed to view the case as the injured employee presented it – a physical injury resulting in emotional sequela, or an aggravation of his previous injury. The employer felt it was deprived of due process by the judge’s treatment of the claim by allowing the lower burden of proof to prevail. The injured employee countered that there was no stipulation to the heightened standard of medical proof regarding causation.

The board acknowledged that many discussions occurred off the record, much to its chagrin and against its previous warnings in earlier decisions. On record at the original hearing, the judge stated the employee was asking for temporary total incapacity and medical benefits for the psychiatric injury, but the judge failed to indicate whether the medical benefits were for a pure mental or emotional stress injury or for a physical injury with a disabling psychiatric sequela.

The employer’s defenses were read into the record, which included a request to apply defenses for the pre-existing condition. The employer then cited the report of the impartial medical examiner (IME) regarding the injured employee’s anxiety and depression. The judge and the attorneys discussed the report and whether it met the standard of a psychiatric injury. The exchange indicated the higher burden of proof was expected by all of the parties to show the accident was the predominant cause.

Despite this exchange, the board looked at the defense, strategy, and arguments raised by the employer, which demonstrated the employer expected the possibility of the lower standard of proof. There was no objection to the admission of notes by the employee’s primary care physician about the physical symptoms he experienced afterward. In its closing argument, the employer incorporated points against a physical injury with a mental or emotional sequela. The board determined the lower standard of proof for a physical injury with psychiatric sequela was applied. While the court found for the injured person on the type of standard needed for an award of benefits, it still vacated the decision and recommitted the claims, due to the problematic findings of facts adopting inconsistent medical opinions from the testifying medical experts.

If you have suffered a physical or psychological injury due to a workplace incident, the experienced Massachusetts workers’ compensation lawyers of Karsner & Meehan can help you with your claim. The above decision shows a deep knowledge and understanding of the law can change the course of your action and the ultimate award of benefits. Call our office today for a free, confidential consultation at 508.822.6600.

More Blog Posts:

Massachusetts Workers’ Compensation Reviewing Board Looks at Mental Health Benefits, December 30, 2016, Massachusetts Injury Lawyers Blog

Massachusetts Appeals Court Finds Son Cannot Receive Underinsured Motorist Benefits From Mother’s Policy, December 20, 2016, Massachusetts Injury Lawyers Blog

Federal Circuit Court of Appeals Case Gives Insight on Social Security Disability Determinations, November 18, 2016, Massachusetts Injury Lawyers Blog