Articles Posted in Workers’ Compensation

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Work-related injuries don’t always arise from accidents but can be caused by repetitive use. Proving that a repetitive use injury is work-related can be complicated, and employers will often try to avoid paying workers’ compensation benefits by arguing an injury was caused by wear and tear rather than conditions encountered in the work environment.

In Maldonando v. CPF Incorporated, the Department of Industrial Accidents Reviewing Board explained the difference between an injury due to wear and tear and a compensable injury in a workers’ compensation claim. If you suffered injuries in an employment-related accident, it is in your best interest to consult an experienced Massachusetts Workers’ Compensation attorney to discuss what benefits you may be able to recover.

Claimant’s Work Duties and Injuries

Allegedly, the claimant, who was in her late fifties, worked placing labels on soda bottles in a factory. The bottles traveled down a conveyor belt and often fell over, and the claimant was required to upright them and make sure the labels were placed properly. Her shifts lasted ten to twelve hours per day, and she was required to walk or stand constantly during her shifts.

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In workers’ compensation disputes it is common for the claimant and employer to agree on some issues and disagree on others. In a hearing to determine whether a claimant is entitled to workers’ compensation benefits, only disputed issues should be considered and ruled upon by the hearing judge.

In Milton v. GT Advanced Technologies, the Industrial Accidents Reviewing Board found that an administrative judge improperly expanded the parameters of a workers’ compensation claim by evaluating undisputed issues, and overturned the judge’s findings.  If you were harmed in a work-related injury it is in your best interest to consult an experienced Massachusetts workers’ compensation attorney to evaluate your case and any potential obstacles to your recovery of benefits.

Factual Scenario

The claimant was employed with the first employer from 2007 through 2012. He then left the first employer to work for the second employer. The claimant’s responsibilities in both positions required him to undertake physically strenuous work. In 2015, the claimant filed a claim against both employers seeking workers’ compensation benefits due to a lower back injury. Following a hearing on the matter, an administrative judge denied both claims. The claimant appealed and on appeal, the reviewing board agreed with the claimant and reversed the decision.

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In analyzing whether an employee suffered a work-related injury, it is common for an employer’s workers’ compensation insurer to require an employee to undergo a medical examination, after which the examining physician will issue a report. The physician report can make or break an employee’s case, depending on whether or not the physician finds the employee suffered a work-related injury.

In Reymundo Villar v. Advanced Auto Parts, the Industrial Accidents Reviewing Board recently held that the specific phrase that an injury did not arise out of employment is not necessary to support a finding that an injury is not work-related in a Massachusetts workers’ compensation claim. If you suffered a work-related injury, you should meet with a skilled Massachusetts workers’ compensation attorney to ensure your claim is evaluated properly.

Facts of the Case

Reportedly, the employee in Villar, injured his right shoulder and thumb while working for the employer. He was unable to work for a short period, after which he underwent physical therapy and returned to work light duty. He then felt pain in his left shoulder, after which he stopped working. The employee continued to undergo physical therapy for several years and ultimately underwent several surgeries on his right shoulder and thumb, with no improvement in his symptoms.

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While most illnesses are apparent at the time of onset, many work-related illnesses are not diagnosed for several years. If you contracted an illness due to your employment, you should be entitled to recover compensation regardless of when the illness became apparent. In Jones’s Case (Gregory B. Jones vs. NSTAR & others, 2017-P-0951), the Court of Appeals of Massachusetts found that an employer was liable for a claimant’s disability benefits for an illness contracted during the claimant’s employment, even though the claimant was not diagnosed for several years after his employment ended. If you are suffering from a work-related illness, you should confer with an experienced Massachusetts workers’ compensation attorney to ensure you recover the workers’ compensation benefits you are owed.

Factual Scenario

Reportedly, the Claimant worked for Employer from 2001 to 2007. In 2006, he began feeling ill, and in 2011 he was diagnosed with Lyme disease. Shortly after that, he took a medical leave from his position with his new company.  After a year of treatment, he was able to resume work. A workers’ compensation benefits hearing was held in front of an administrative judge, during which the Claimant introduced testimony and evidence from medical experts which supported the finding that the Claimant contracted Lyme disease during his employment with Employer.

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While many injuries sustained at work are minor, some workplace injuries cause permanent disabilities that leave the injured employee unable to earn a living. Under Massachusetts workers’ compensation law, you must prove that you are unable to earn wages of any kind to show that you are permanently disabled. If you do not present sufficient evidence of your permanent disability, you will be denied compensation. In Rivera’s Case, the Court of Appeals of Massachusetts held that simply showing an employee is unable to return to his prior employment is insufficient to show the employee was unable to earn wages in any position. If you were injured at work, it is important to consult with a seasoned workers’ compensation attorney in your pursuit of workers’ compensation benefits, to ensure your case is properly handled.

Facts of the Case

In Rivera, the employee injured his knees breaking up a fight at work in 1996, and subsequently underwent bilateral knee surgery. He received total incapacity benefits from his employer until he returned to work in 2006. In 2011, the employee then sought additional treatment for his left knee and filed a claim for benefits to enable him to undergo an evaluation. An administrative judge set forth a conference order stating employer was required to pay for the evaluation. The employee then underwent an MRI of his knee and an orthopedic surgeon recommended the surgery. The employer appealed the conference order but at the same time issued a utilization review approval of the suggested surgery. The employee underwent surgery, for which the employer denied coverage. The employee was out of work from March 13, 2012 through June 18, 2012, for which he filed a claim for benefits. The employer then paid for the surgery and medical services, but did not offer total incapacity benefits for the period of time the employee did not work.

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While some workplace injuries resolve in a relatively short time, others continue to cause issues years after the initial injury. Employees are entitled to recover compensation for almost all work related injuries, but when an employee suffers more than one injury, it can become unclear who is responsible for providing workers’ compensation benefits. Pursuant to Massachusetts’s workers’ compensation law, only one insurer is liable for benefits for a disability, even if the employee suffers two or more injuries that contribute to the disability. In Lombardo’s Case, the Court of Appeals of Massachusetts explained that whichever insurer provided insurance at the time of the latest injury that contributed to an employee’s disability is liable for the entire amount of compensation benefits. If you sustained injuries in a work related accident, you should retain an experienced workers’ compensation attorney to assist you in recovering the full amount of benefits to which you are entitled.

Factual Background

Allegedly, the employee in Lombardo suffered a knee injury while in the course of his job duties. His employer’s workers’ compensation insurer accepted his claim and paid him the benefits he was owed. The employee subsequently returned to work without issue for ten years. Reportedly, he was then diagnosed with arthritis and eventually underwent a total knee replacement. He retired prior to his knee replacement and filed a claim with the Department of Industrial Accidents for additional disability benefits.

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Collateral estoppel is a long-standing rule of law that people can only get “one bite of the apple.” In other words, people are not entitled to re-litigate the same facts or claims until they reach a verdict of their liking. There are certain requirements that must be met to preclude litigation due to collateral estoppel, however, and simply because facts were previously decided in another forum does not automatically prevent a court from allowing the same facts to be litigated. In workers’ compensation cases it is important to know whether you or your employer’s insurer are held to facts determined in a prior proceeding. In Yahoub’s case, the Appeals Court of the Commonwealth of Massachusetts held that an employer was not barred from litigating facts in a Massachusetts workers’ compensation claim that were previously found by the Department of Industrial Accidents.

In Yahoub, claimant was working as a custodian for the town of Milton when he sustained injuries in an altercation with his supervisor. After an investigation, claimant was determined to be the aggressor of the incident and was terminated. He then filed a claim for unemployment benefits with the Division of Unemployment Assistance who awarded him benefits after finding the town had not proven claimant engaged in deliberate misconduct that constituted a willful disregard of the town’s interest. The town appealed to the District Court, but the District Court affirmed the decision of the Division of Unemployment Assistance.

Claimant then filed a claim with the Department of Industrial Accidents seeking workers’ compensation benefits for severe emotional distress, which he alleged was caused by the altercation. A hearing was conducted in which testimony was presented from claimant, his supervisor, and a witness. During the hearing, the town’s workers’ compensation insurer argued claimant was not entitled to recover benefits due to the fact that his actions amounted to willful and serious misconduct and his termination was a bona fide personnel action.  Following the first day of the hearing, claimant moved to prohibit the insurer from re-litigating the facts found by the Division of Unemployment Assistance, under a theory of collateral estoppel. The administrative judge denied claimant’s motion due to lack of privity between the parties in each proceeding. At the conclusion of the hearing, the administrative judge agreed with the insurer and found claimant had initiated the altercation, and denied claimant’s claim. Claimant subsequently appealed to the reviewing board. The reviewing board affirmed the administrative judge’s ruling. Claimant subsequently filed an appeal with the Appeals Court of the Commonwealth of Massachusetts.

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If you are injured while performing the duties of your job, you are most likely entitled to workers’ compensation benefits. Under Massachusetts workers’ compensation law, you are only entitled to benefits that are reasonable and related to your injury. There are guidelines set forth as to what treatment is considered reasonable, and any deviation from the guidelines is presumed to be both unreasonable and inappropriate. In Thibeault’s Case, however, the Court of Appeals of Massachusetts held the presumption of unreasonableness can be overcome if the facts of the case indicate other treatment is acceptable.In Thibeault, the employee was a heavy equipment operator, who injured his lower back moving a steel plate while working for his employer. He was diagnosed with discogenic back pain and a tear and disc bulge in the lumbar region. The employee underwent treatment for his back injury but declined to undergo surgery. He filed a workers’ compensation claim and received a lump sum settlement. The employee continued to get treatment from his primary care physician for his back injuries after he received the settlement. Part of the employee’s treatment included prescriptions for narcotic pain medication.

Subsequently, eight years after the employee received his lump sum settlement, he filed a post lump sum claim for medical benefits, which was denied. He then underwent an independent medical examination, after which the examining doctor issued a report and was deposed. The doctor stated, in part, that the employee suffered from chronic low back pain, which the employee was treating with medication. The doctor further stated that, although there did not seem to be any steps taken to reduce the dosage or wean the employee off the medication, continuing to treat with medication was reasonable, and the treatment was causally related to the employee’s workplace injury.

A hearing was held on the employee’s claim for post lump sum benefits, after which the administrative judge ruled in favor of the employee. The judge noted that while treating with medication was not the preferred protocol under the treatment guidelines, the doctor who performed the employee’s medical exam found the treatment to be reasonable and related to the original injury. The insurer appealed to the Department of Industrial Accidents reviewing board, which affirmed the administrative judge’s ruling. The insurer then appealed to the Appeals Court of Massachusetts.

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Under the Massachusetts Workers’ Compensation Act (the Act) an individual who suffers a workplace injury is entitled to benefits. While obtaining benefits due to a covered injury is generally a relatively straightforward process, it can become complicated if your employer is unable to provide benefits. Generally, employers maintain insurance policies that provide coverage for workers’ compensation claims, but if your employer is self-insured and becomes insolvent it may not initially be clear who is responsible for your benefits. Recently, the Appeals Court of Massachusetts addressed the issue of who bears the responsibility of paying benefits when an employer becomes insolvent, and ultimately held that under Massachusetts Workers Compensation law a reinsurer is required to pay workers’ compensation benefits if a self-insured employer’s surety bond is exhausted.

In Janocha, the facts were undisputed. The employee suffered a workplace injury, which resulted in a permanent and total incapacitation for work. At the time of the employee’s injury the employer was self-insured, and held both a surety bond with a bond holder and a reinsurance policy with a reinsurer, pursuant to the terms of the Act. The reinsurance policy contained a retention provision, which stated the reinsurer would provide indemnification for covered losses once the benefits paid for a covered loss reached $400,000. The employer paid the employee’s benefits directly from the time of the employee’s injury until the employer’s bankruptcy in 2007, after which the bond holder issued payments directly to the employee. In 2012, the bond was exhausted and no further payments were made to the employee; however, the $400,000 retention limit had not been reached.

The employee filed a claim against the reinsurer, seeking reinstatement of his benefits. Following a hearing, an administrative judge held that once the employer’s bond was exhausted the employer was uninsured under the terms of the act and, therefore, the workers’ compensation trust fund was responsible for providing the employee’s workers’ compensation benefits until the payments reached $400,000. The trust fund appealed. On appea,l the workers’ compensation board reversed the administrative judge’s ruling, finding that the provisions of the Act stated the trust would only be the responsible party when the employer was uninsured on the date of the injury. As such, the board found the reinsurer to be responsible for paying benefits directly to the employee. The board further ruled that the reinsurer must act as a guarantee of a self-insured employer’s ability to pay benefits, and found the retention limit was void, as it conflicted with the reinsurer’s statutory obligation to provide benefits to the employee. The reinsurer appealed to the Appeals Court of Massachusetts.

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Insurers can raise an “affirmative defense” during the proceedings related to a claim for Massachusetts workers’ compensation benefits.  One such defense is allowed by the Worker’s Compensation Act, which prevents someone from receiving benefits when they’ve rejected treatment that can lessen her or his suffering through reasonable remedies and operations available through the medical profession.  The injured needn’t try every possible medical procedure, just those where it appears there is substantial gain to be had, which do not subject the injured to unusual risk or danger. 

Recently, the Massachusetts Reviewing Board looked at whether an affirmative defense was appropriately raised and considered.  The employee claiming § 34 temporary total incapacity benefits in this action was a vending machine route delivery driver.  He worked for over twenty years in this position as part of his forty-year work history.  His job involved repetitive motions carrying heavy boxes of coins weighing up to 100 pounds.  In 2015, he injured various locations on his right arm after falling down steps at work.  The deliveryman’s employer began the payment of § 34 temporary total incapacity benefits, and the employee has not worked since. 

After ten months, the insurer filed to modify or stop the § 34 benefits after a medical report from the insurer’s examining physician.  This report relayed that the employee was able to return to light work with limited lifting.  The employee filed for permanent and total incapacity benefits.  The claims moved onto a §10A conference where the judge granted the motion for permanent benefits and ended the insurer’s motion to discontinue.

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