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Workers’ Compensation Decision Looks at Whether to Hold Multiple Massachusetts Insurers Responsible for Payment of Benefits

A Massachusetts workers’ compensation reviewing board decision earlier this year looked at whether subsequent insurers should be responsible for helping to pay the benefits awarded to a roofer injured over the course of 30+ years of work. The roofer installed duct work and metal roofing since 1970. He carried aluminum weighing up to 60 pounds and kneeled often. He experienced his first knee injury in 1981 and was given workers’ compensation in that state. He underwent arthroscopic surgery and returned to work without any further injuries until 1998.
Roof shingles

In 1998, his knee began locking and eventually “popped” while working on a roof, causing excruciating pain. A second arthroscopic surgery was needed, and he received workers’ compensation benefits for three to four months and returned to full duty work once again. No additional medical treatment was needed after his return to work for an additional 10 years. In 2008, he was diagnosed with arthritis in his left knee.

The injured employee kept working but experienced pain when he had to climb or kneel. He later described his pain as the same whether it was “climbing ladders at work or climbing stairs at home.” To relieve the pain, he received three cortisone shots to his left knee. The injured employee testified that they did not help much, and he kept working without additional treatment until three years later. Shots were tried again but eventually discontinued due to the employee’s allergy to the injections. The employee kept working until he was laid off, but he did not pursue any other work, since he had to undergo total knee replacement surgery.

The injured employee filed the workers’ compensation claim at the center of this decision based on the 1998 injury. On appeal, the employer’s insurer argued the subsequent insurers should have been joined in the action, based on the injured man’s medical records between 2008 and 2012. The injured employee filed two additional claims himself against the subsequent insurers for injuries in 2008 and 2012. A conciliation was held in 2014 for all three claims, but the 1998 claim was the only one allowed to move forward, based on the lack of medical evidence for the later claims.

Following the conciliation, the insurer for the 1998 claim requested several status conferences for the purpose of joining the subsequent insurers. Coverage was addressed, but ultimately no additional documentation was produced by the insurer for the later injuries and aggravations. Only when no additional continuances were allowed did the 1998 insurer obtain a medical examination of the injured employee. The insurer asked the administrative judge to reconsider its denial of the motion to join the insurers, which was again denied.

The judge awarded total temporary incapacity benefits as well as permanent and total incapacity benefits, based on the testimony of the medical expert. The judge relied on the opinion offered by the expert that there were no new injuries or aggravations at work after 1998. The board found the insurer failed to produce any medical evidence supporting its motion. The board did not think the administrative judge acted arbitrarily or capriciously by refusing to reconsider the motion to join the insurers. The board looked at the many opportunities the judge gave to the insurer to provide records for the successive insurer defense and found the insurer failed to provide records in a timely manner.

The board felt the judge was also within his discretion by finding the causal relationship between the 1998 injury and the need for total knee replacement. The insurer attempted to use this connection to support the renewed motion for joinder, but the judge disagreed. The board affirmed this ruling, based on the testimony of the injured employee and the report of the medical expert. The administrative judge’s findings were affirmed, and the award of benefits for the injured employee remained intact.

The Massachusetts workers’ compensation attorneys at Karsner & Meehan can help you with your claim for benefits. For a free, confidential consultation today, call 508.822.6600.

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