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Massachusetts Court Discusses Medical Benefits in Workers’ Compensation Cases

If you sustain harm in the workplace, you may be prescribed medication to treat your injuries and manage the pain. Pursuant to the Massachusetts Workers’ Compensation Act, employees who are injured on the job in are entitled not only to weekly wage loss benefits to replace their missed pay, but also reimbursements for medical expenditures that arise out of their injuries. Despite the clear provisions of the act, however, many insurers try to refuse coverage for medical procedures and medications, as demonstrated in a recent Massachusetts workers’ compensation case. If you were hurt at work, it is smart to contact a Massachusetts workers’ compensation to discuss what benefits you may be owed.

The Claimant’s Harm

It is alleged that the employee suffered harm in an accident during a company barbecue. Specifically, he slipped and injured his left knee. He attempted to resume work but was unable to do so. He subsequently underwent numerous surgeries on his ankle and knee. He filed a claim for  workers’ compensation benefits. The court found that the claimant’s harm was work related, and ordered the insurer to pay the claimant benefits for any medical care that was reasonable and necessary, including prescriptions. The insurer appealed the lower court’s decision to award benefits and medical reimbursement payments, arguing the connection between the alleged harm and the treatment sought was not clear.

Medical Benefits in Workers’ Compensation Cases

On appeal, the insurer argued the award of workers’ compensation benefits was improper, as the lower court judge failed to conduct an adequate analysis of the causal relationship between the damage and the treatment. It further claimed that the lower court misinterpreted information about the claimant’s obesity status.

The appellate court found that the insurer had not offered sufficient evidence to establish that the claimant’s weight played a significant role in the harm, rejecting the insurer’s claim that its counsel’s remark at a hearing that the employee’s obesity qualified as a medical condition satisfied the offer of proof criteria. Specifically, the court explained that the requirement that a party raising pre-existing conditions as a defense in a case provide an offer of proof requires a more substantive evidentiary showing than mere hearsay.

Additionally, the court noted that the insurer had many opportunities during the claim process, including a deposition of a medical specialist who examined the worker, to collect information about whether the employee obesity was a contributing factor in his harm, but failed to do so. As such, the court affirmed the trial court ruling.

Confer with a Dedicated Massachusetts Workers’ Compensation Lawyer

People hurt at work are often entitled to wage loss payments and medical benefits, including adaptive devices and prescriptions. If you were hurt at work, it is in your best interest to speak to an attorney regarding your rights James K. Meehan of the Law Office of James K. Meehan is a dedicated workers’ compensation lawyer, and if you engage his services him, he will diligently pursue the best possible result under the facts of your case. You can reach him by calling 508-822-6600 or using the online form to set up a meeting.

 

 

 

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