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Articles Posted in Workers’ Compensation

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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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Massachusetts workers’ compensation is available to employees of businesses who are injured while performing duties for the employer in the scope of their employment.  Whether or not benefits are issued to an injured person hinges on whether the injured person is considered to be an employee.  The Massachusetts Supreme Court recently reviewed in SJC 12368 whether or not an employee should be defined by the the workers’ compensation act in General Laws Section 152 or the independent contractor statute, found in G. L. c. 149,§ 148B. 

The injured person in this case worked as a delivery-woman for a company acting as a middleman to deliver publications to subscribers.  Over the course of her employment, she signed several contracts identifying her as an independent contractor.  She was given a route, but she had the freedom to choose the delivery time and path she liked as long as the deliveries were completed by 6 AM on weekdays and 8 AM on weekends.  The injured person made deliveries in her own car for 12 years.  She was paid based on each newspaper delivered, with an additional stipend for delivering papers to those who did not receive a scheduled delivery. 

In 2010, the appellant injured herself while loading papers in her car using a hand carriage.  She fell off a ramp and injured her right hand and right knee.  She reported it to her employer but continued on with her workday, seeking no medical treatment.  The injured person experienced another accident a few months later, slipping on ice while delivering papers and hurting her right leg.  For this injury, the injured person had to undergo two surgeries for her right leg and right hand. 

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The Commonwealth’s Appeals Court recently issued a Massachusetts workers’ compensation decision affirming the determinations made by the Administrative Judge and Reviewing Board granting temporary and permanent benefits to a bank teller who suffered a series of back injuries at work. The employee first reported transitory back pain in 2011, but she was asymptomatic for two years following her treatment. In 2014, she had another round of back pain after lifting several coin rolls from the floor to take to a service window. The employee managed to return to work but experienced increasing back pain for several months. The employee left to treat the pain and came back, but she eventually left for good in January 2015 after the pain refused to subside.

At the hearing, the judge found the teller suffered an industrial injury in 2014, which resulted in total disability from July 12, 2014 through November 3, 2014, and again from January 2015 and ongoing. The insurer was directed to pay the compensation for those periods as well as payment for the necessary medical treatment provided. The insurer appealed, arguing the Board’s decision upholding the administrative judge’s award was arbitrary and capricious, and it was not based on the evidence provided in the record.

The appellate court found the evidence, although conflicting, supported the judge’s findings and conclusions in favor of the teller. The administrative judge found the teller’s testimony to be credible and persuasive, and he adopted her account for all of the substantive points. The submitted notes and testimony from the treating and examining physicians backed up the teller’s testimony, and the accident in March 2014 was determined “with reasonable medical certainty” to be the cause of the teller’s pain. The judge adopted the opinion of the physician who concluded the teller was unable to carry out her previous work functions. While this opinion differed from the other physician’s testimony, the court found it was within the judge’s discretion to adopt one opinion over the other.

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The Workers’ Compensation Act has a provision that states that any employee who files a claim or accepts payment for a personal injury that occurs in the workplace releases their employer from any and all related claims. The Massachusetts appellate court recently issued a decision examining whether or not this provision barred a negligence lawsuit filed by an injured employee. The employee claimed he was hired as an independent contractor to work as a chef, which entitled him to pursue a tort remedy in civil court. The injured man’s case claimed he slipped and fell on ice while working, which caused him to suffer a broken right ankle. The chef asserted his damages included more than $28,000 in medical bills, lost wages, permanent impairment, and physical and emotional anguish.

The chef initially filed a Massachusetts workers’ compensation claim, which was denied by the employer. The employer justified the refusal of benefits by arguing that they were not liable and that he was an independent contractor. The case was settled by a lump-sum payment and allowed for payment of medical expenses incurred up to the date of the approval of the settlement. The settlement excluded payment for future medical treatment of the injury. After the settlement, the injured person filed a negligence lawsuit against his employer. The employer moved to dismiss the action, arguing the action was barred by the settlement agreement.

The injured worker countered the claim was not barred because the Department of Industrial Accidents (DIA) never resolved whether or not he was an independent contractor or employee. The appellate court determined Section 23 of the Act barred his claim, regardless of whether a distinction was made regarding the type of employment. The employee entered into a settlement agreement option allowed by the Workers’ Compensation Act, which resolves a matter without acknowledging fault. The court compared it to a prior Massachusetts case, Kniskern v. Melkonian, 68 Mass. App. Ct. 461, 465-466 (2007), with an injured worker who claimed he was an independent contractor. In that case, the court pointed out a lump-sum settlement under the Act would not have been possible if the injured person were an independent contractor instead of an employee. Anything received under the Act can only be provided to employees, so the injured person’s ability to settle the claim results in an indirect determination he was an employee.

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Workers’ compensation benefits make a distinction between two categories – whether an injured employee was partially disabled or totally disabled, and whether the disability was temporary in nature or permanent. Benefits are calculated based on the combination the injured worker possesses. Administrative hearings are conducted to help determine which category applies, and this affects the amount of benefits received and the length of time it is provided to the injured employee.

The Massachusetts Workers’ Compensation Reviewing Board recently issued a decision that considers these distinctions. A personal care assistant suffered a workplace accident while assisting a bedridden patient. This accident caused radiating pain, beginning in her lower back and going into her left leg and foot. She was eventually diagnosed by an impartial physician with chronic lumbar strain and left leg radiculopathy. The diagnosis also included a degenerative condition in her spine. At the hearing, it was agreed she would not be able to continue work as a personal care assistant, due to her inability to carry out the physical demands of the job.

The employee’s treating physician eventually cleared her to do light duty work “if available.” A month after that, the doctor conducted another examination and advised there was no work disposition until further workup and treatment. The judge utilized the first assessment and found the employee could perform light duty work but rejected the physician’s opinion that she could not work unless she received additional treatment. The judge adopted the opinions of other physicians who examined the employee six months prior to the treating physician’s assessment she could return to light duty. Total temporary benefits were awarded from December 2012 to September 2013 and partial disability benefits from September 2013 onward. The injured employee appealed, disagreeing with the assessment she was only partially incapacitated, based on the note regarding light duty and the physicians’ opinions given based on examinations performed six months before.

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