Articles Posted in Legal Strategies

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In a recent Massachusetts workers’ compensation case, the Reviewing Board analyzed an appeal by an insurer dissatisfied with a hearing decision. The insurer alleged the judge incorrectly used the wage amount of $1,726.37 to calculate the weekly wage paid to the injured carpenter. The insurer argued the employee was not entitled to the award, since there was no appeal of the conference order.  carpenter's tableThe insurer felt the employee could only use the maximum amount of $1,490.33 to calculate his entitled average weekly wage.

The injured carpenter was hurt in an industrial accident while moving a piece of machinery. The machinery began to tip, he grabbed it, and he caught his ring on the machine. The employer didn’t dispute liability and agreed to initially pay an average weekly wage of $800 a week. The injured employee eventually sought an adjustment, which was at the center of this action. The carpenter initially asked for an average wage of $1,505.09 a week, and he submitted an IRS Form 1099 for checks from his employer, payable to him for 35 out of 52 weeks prior to the injury, as proof. The claim was then withdrawn in October 2012.

In November 2012, the injured man refiled a claim for an adjustment, this time requesting an average weekly wage of $1,490.22 per week. As proof, the employee submitted the same 35 weeks’ worth of checks. This claim was also withdrawn, but he eventually refiled a year later. This third attempt at a readjustment claim was for the same amount, and this was accompanied by medical reports and a 2011 tax return. This amount was sent to a conference. After the conference, the administrative judge ordered $1,490.33 to be used as the weekly wage amount. The insurer appealed, but the employee did not.

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Any award of damages in a Massachusetts injury case, whether through a plaintiff’s verdict or settlement agreement, can still present challenges if the defendants either fail to pay or cannot pay the ordered amount.  The federal First Circuit Court of of Appeals addresses this in Vargas-Colon v. Foundation Damas, Inc. (Nos. 16-1213 and 16-1620).  The underlying injury happened to a child who was born by cesarean section after the mother had been in the hospital for several hours.Operating room  Because of this delay, the child did not receive enough oxygen and suffered permanent neurological defects.

The parents initiated a medical malpractice action in the federal district court, alleging the doctor and hospital were negligent in the care and delivery of the child.  The parties reached a settlement agreement with the defendants paying $1.5 million in eight installments.  This was entered into a judgment, and the district court retained jurisdiction over the terms of the settlement.  After the first payment of $400,000, the hospital failed to make the scheduled payments.  Instead, the hospital filed for bankruptcy.  The plaintiffs moved to dismiss the hospital’s bankruptcy petition alleging several claims including fraud and bad faith.

The bankruptcy case proceeded, and a reorganization plan was confirmed for the hospital for the court.  Within the plan was a supplement that assured any medical malpractice claimant that they could still file a motion or legal action against the hospital in the pursuit of an action or collection of funds.  The plan also did not preclude medical malpractice claimants from pursuing actions against third parties.  At this point the plaintiffs only received a little under $645,000 – less than half of the $1.5 million agreed upon in the settlement agreement. 

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As a responsible Massachusetts driver or homeowner, one obtains an insurance policy in the event of an accident or emergency. If someone else is injured in a policy holder’s home or vehicle, the insured relies on the insurance company to help defend against personal injury claims. This also applies to corporate policies. In a recent case, the Massachusetts Supreme Court examined whether an insurer’s duty to defend extends to a counterclaim brought by the insured. Counterclaims are actions filed by the defendant against the plaintiff, alleging the plaintiff was negligent and liable for damages.  As an example, one could look at someone injured in a car accident.  Contract signatureThe defendant party could choose to claim the plaintiff was independently liable for her or his negligence. If the duty to indemnify extended to counterclaims, an injured party may be subject to additional litigation backed by the pockets and experience of attorneys working for the defendant’s insurance company.

In this lawsuit, the Commonwealth’s Supreme Court declined to expand the duty to include counterclaims. The insurance policy in this action provided liability coverage for employment practices. The Eye Safety and Cleaning Product Company sought indemnification from its insurer for the wrongful termination claims brought against it during a period of time from 2011 to 2012. The policy stated the insurer was required to defend the claim and pay 100% of the defense costs for the claim up to the policy limit. The company discovered what appeared to be a large misappropriation of company funds. The company terminated an employee, who then began an action for wrongful termination, alleging age discrimination. The insurer provided an attorney who addressed three nondiscriminatory reasons for the employee’s termination:  poor job performance, insubordination, and suspected misappropriation of funds.

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In Massachusetts, an injured party can be partially responsible for her or his own injuries and still recover damages from a negligent party. However, the responsibility for the injury cannot be greater than the defendant party or parties. If the injured person meets the threshold but contributed to the injury, the amount of damages is offset by the amount of fault assigned to the injured party. For example, if an injured person is found to be 47% negligent and awarded $100,000 in damages, the injured party can recover $53,000. If the negligent party is found to be greater than 50% negligent, she or he will receive none of the damages.

Construction scaffoldingThe Appeals Court reviewed this issue in a recent decision, Craffey v. Embree Construction Group (16-P-791), providing insight into the types of proof offered at trial in the pursuit of damages. In this case, the injured worker, a contractor, fell from the scaffolding at a construction site. After the injury, the worker filed suit, alleging the employer was negligent due to violations of both federal and state regulations for workplace safety.

At trial, the court allowed the introduction of the federal regulations under the Occupational Safety and Health Act (OSHA) but did not allow the introduction of state regulations, since the federal regulations pre-empted the state regulations. At the end of the trial, the jury found the defendant to be 49% negligent and the injured contractor to be 51% negligent, resulting in the dismissal of the injured man’s complaint and no award of damages. The injured contractor appealed, asking for a new trial. The contractor argued the judge’s ruling prohibiting the introduction of state regulations negatively influenced the verdict.

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Before participating in a higher-risk activity like skydiving, bungee jumping, or community sports, the company running the program may require a participant to sign a release form, which shows she or he understands the risks involved with the activity and agrees not to hold the owners of the company or the organizers of the event responsible for any injuries that may occur. These help immunize, or protect, a company from liability if an injury-causing accident occurs. Horse riderHowever, exceptions do exist, so a release does not provide a full shield from accountability in the civil court system.

In Markovitz vs. Cassette (15-P-1274), the Massachusetts Appeals Court looked at whether or not a trial court erred in granting summary judgment in favor of a horse farm. A student rider fell off a horse during a group riding lesson. She had ridden that particular horse three times before the accident, and she had taken classes on a regular basis at this location for over a year. Prior to the start of her classes, she signed a release that shielded the horse farm, including its owners, instructors, employees, and agents, from any and all responsibility for any injury sustained while on the premises. The release also contained notice of the applicable Massachusetts General Law that shields an equine professional from liability if there is an injury or death caused by an inherent risk of an equine activity.

The appellate court cited case law that regularly supported defendants’ use of release agreements and courts’ use of summary judgment to resolve cases with signed releases. The injured student claimed in her appeal that her injury was one of the exceptions to the statutory exemption. This exception removes immunity from suit when there was a failure to make a reasonable and prudent effort to determine the ability of the participant to safely manage the particular horse, based on the representations of the rider. The Court of Appeals disagreed with the injured person’s argument that the exception created a new duty of the horse farm in addition to those provided by common law. The court did not feel that the injured person’s circumstances rose above the bar to liability established by statute. Based on this, the lower court’s ruling was affirmed.
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In any civil lawsuit, the plaintiff must ensure the at-fault party or parties receive notice of the claim so that they can appropriately respond. In Massachusetts medical malpractice actions, the General Laws specifically require that an injured patient or estate give written notice to a provider of health care 182 days before the case begins. (See G. L. c. 231, § 60L.) notice boardThe claim must include the factual basis for the claim, the standard of care alleged by the claimant, the breach of the standard of care, the course of action that should have been taken, how the breach injured the patient, and the names of all the health care providers that the injured person intends to sue.

In the recent decision of Arsenault vs. Battacharya (15-P-197), the Massachusetts Appeals Court looked at whether or not dismissal without prejudice was too harsh a remedy when an injured party failed to provide notice in accordance with G. L. c. 231, § 60L. In this case, the injured patient went to her general practitioner, the defendant in this case, for carpal tunnel in her wrists. The primary care physician injected her wrists with cortisone, with two separate injections on each wrist over three visits. Later, after surgeries on both wrists, she discovered that the tendon ruptures were caused by cortisone injections.

The filed complaint alleged that the doctor should have known that multiple cortisone shots would increase the risk of rupture to her wrists. The knowledge this was a possibility can be seen in a letter written by the doctor for the injured person’s workers’ compensation claim. The injured patient alleged that she became totally and permanently injured as a result of the negligently administered cortisone shots. The claim was filed nearly six years after the first injection to one of her wrists but within three years of the start of the statute of limitations, which began when she was told by an Independent Medical Examiner that her ruptures were caused by the shots. The defendant doctor moved for dismissal, alleging non-compliance with G. L. c. 231, § 60L, and the motion was granted by the trial court.
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In Draper v. Francesco Demolition, Inc. (15-P-702), the Commonwealth’s Appeals Court reviewed a directed verdict made during trial in favor of the defendants in a personal injury action, determining whether an injured man contracted bacterial pneumonia as a result of the defendants’ negligence. In this case, the focus was whether the injured man presented enough proof to show his injury was caused by the defendants. In its analysis, the appellate court affirmed the trial court’s determination that the injured man needed some sort of expert testimony to help the jury distinguish between his pre-existing condition and the injuries caused by the bacterial pneumonia alleged to have been caused by the standing water.

leaves puddleDraper centered around proof of causation, which is one of the four elements in any personal injury action. The four elements in a negligence lawsuit are commonly known as duty, breach, causation, and damages. A defendant cannot be held liable unless she or he owes some sort of duty under the law to the injured party. The injured party must then show that the duty was breached and that the breach was the cause of the injury. Proving causation at trial can be accomplished in many ways, depending on the situation. People who witnessed the scene can be called to testify. Professionals can be called to testify about their field of expertise to help the jury understand a complicated engineering or medical concept. Pictures and research can also be utilized to help illustrate certain ideas or a sense of the place where the injury occurred.

The appellate court in Draper looked at the injured man’s health and lifestyle, which included tobacco and alcohol use, prior lung disease, a pre-existing heart block, and a need for a pace-maker. During trial, the injured man chose not to introduce any medical records or expert testimony. He also chose to change the injury from pneumonia to an unidentified illness, even though the defendants used a medical expert who testified it was pneumonia and caused by his collection of pre-existing conditions. The injured man claimed he was going to rely on his own testimony, his wife’s testimony, and a witness, but that was not enough for the trial court or the Appeals Court.
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Since insurance coverage is mandated by law, most car accident victims must deal with one or more insurance companies when seeking compensation for injuries to their person and property. An insurance company must follow certain settlement guidelines found within Massachusetts’ General Laws in order to ensure fair claims settlement practices. In a recent case, Villanueva vs. Commerce Insurance Company (15-P-697), the Appeals Court looked at whether or not the at-fault party’s insurance company offered a reasonable settlement prior to the trial to an injured pedestrian.

bicycle pedestrian signThe accident that forms the foundation of this action involved a woman who was seriously injured after she was struck by a motorist. The insurer of the driver independently determined that the injured woman was more than 50 percent negligent because she stepped out between two parked cars into traffic while wearing dark clothes on a dark morning. There was a witness to the accident who provided a statement that he saw a car driving too fast, leaving the scene of the accident right after the collision occurred. The driver stated that she circled the block after the impact because it was still dark, and she did not receive a citation from police when they arrived at the scene. The injured pedestrian had no memory of the accident.

After the accident, the plaintiff sought the limit of the driver’s policy, but only if the matter settled prior to filing suit. The at-fault driver’s insurer offered only $5,000 to settle the claim, instead of the $100,000 policy limit. The injured pedestrian then filed suit against the driver. The driver’s insurance company tried repeatedly to take testimony from the lone witness, but it was unsuccessful at reaching him until right before the scheduled date of trial. The jury awarded the injured pedestrian $414,500, reduced by the pedestrian’s comparative negligence of 35% in the accident. After the jury verdict, but before post-trial motions, the driver’s insurer paid the policy limit of $100,000.
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When an at-fault party is faced with a lawsuit, they will raise any and all legal defenses available to avoid liability. In all litigation, courts attempt to avoid duplicative processes to provide efficient and effective justice. The legal doctrines of res judicata and collateral estoppel bar re-litigating claims or issues that have been previously decided on the merits in a prior adjudication in a final judgment. pedestrian crossingIn complicated personal injury and wrongful death lawsuits with multiple parties, doctrines like res judicata and collateral estoppel are often utilized to bar or limit claims an injured party, estate, or family member may have.

In Resto vs. City of Lawrence (14-P-1711), an 11-year-old boy was hit by a car crossing a street undergoing a lot of construction. A motorist driving his car at a high rate of speed hit the child, who died as a result of his injuries. The administratrix of the estate filed suit against the driver of the car as well as companies that were hired by the city to perform construction work at the high school. The estate alleged in an amended complaint that the construction companies did not take proper steps to mitigate the intersection’s pedestrian safety issues. A year after the original complaint was filed, the estate filed to amend a second time and added the Massachusetts city as a defendant. The estate alleged the city failed to maintain signage about the increased pedestrian and vehicular traffic.

The trial court judge denied the amendment, determining that the city did not owe a duty to the deceased boy and that its negligence was not the proximate cause of the accident. The companies hired by the city later filed motions for summary judgment, arguing that the court’s reasoning in its prior refusal to allow the addition of the city applied to them. The companies felt this logic should extend to them – that no duty of care was owed to the child who died, and that their negligence was not the proximate cause of the child’s injuries. The judge agreed, and the claims against the companies were dismissed through the court’s entry of summary judgments.
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There are many documents you can and should use for your Massachusetts estate plan. Medical care considerations can become especially complicated as you weigh the resources available to help cover the cost. The recent Massachusetts Appeals Court case of Heyn vs. Dir. of the Ofc. of Medicaid (15-P-166) reinforces a grantor’s ability to create an irrevocable trust, which could then make him or her eligible for Medicaid benefits.

helping-the-elderly-1437135-639x738.jpgIn this case, the grantor, now deceased, created a self-settled irrevocable inter vivos trust, transferring the title to her home to the trust, while retaining a life estate interest that would not make her ineligible for Medicaid benefits. The grantor moved into a skilled nursing facility and applied for Masshealth benefits to pay for the cost of her care, which were originally approved. After a little over a year at the nursing facility, she was notified that her benefits were terminated based on the agency’s determination that the home held by the trust should be considered a countable asset, rendering her ineligible for benefits.

The grantor of the estate appealed, but she died before a decision was issued upholding the termination of benefits. The hearing officer determined that the trust allowed the trustee to sell the assets and invest the proceeds of the sale in other forms of investments, like an annuity. The officer reasoned that annuity payments can create income for the grantor, which should be considered a “countable asset” for determining Medicaid/Masshealth benefits eligibility. The Superior Court upheld the hearing officer’s ruling, and the case went on to the Appeals Court of Massachusetts.
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