Massachusetts Workers’ Compensation Reviewing Board Looks at Mental Health Benefits

One workers’ compensation benefit that may not be as well known is the benefit provided for harm to a worker’s mental health. Like physical injuries, these injuries must be caused by an accident that occurred in the workplace or during the performance of work-related duties. The Reviewing Board decision of O’Rourke v. New York Life Insurance (Bd No. 012706-11) reveals the considerations an ALJ must make when determining whether or not to award medical and total incapacity benefits for injuries that affected both physical and mental health.

In this lawsuit, the injured worker was a vice president of marketing and held a Master’s degree in Science and Administrative Studies. She was injured when a magnet weighing half to three-quarters of a pound fell from a door jamb onto her forehead. The woman was taken to the hospital and diagnosed with a concussion. Her injuries produced severe headaches and tingling along the left side of her nose and face, around her jaw, and up the other side of her face. The woman additionally suffered lower back and neck pain. She returned to work within a week part-time, and eventually she returned full-time. However, the pain, combined with depression and anxiety, prevented her from concentrating and fully functioning at her job.

The injured worker attempted various schedules, both part-time and full-time, while also seeking treatment for her numerous injuries. Two surgeries were performed in order to reduce the headaches and pain in her jaw. While the surgeries were partially successful, they failed to fully remove the pain in her jaw and teeth. After three years passed, the worker’s surgeon opined that she was unable to continue working. The worker claimed partial disability benefits from August 1, 2013 to September 15, 2014, and then total disability from September 16, 2014 onward. The judge ordered that the benefits be paid based on her earnings from August 1, 2013. All parties appealed.

The administrative judge who heard the case credited the injured worker’s testimony regarding her constant headaches and facial pain. The judge chose not to adopt the opinion of the impartial physician but instead combined the opinions of the worker’s treating doctors and the insurer’s examining physicians. Specifically, the judge relied on the testimony of a doctor hired by an insurer, who opined that the head trauma did not cause the nerve injury. He estimated that the facial nerve pain could be a complication of surgery. The judge also adopted the opinion of the insurer’s hired psychiatrist, who thought that the chronic pain was part of her anxiety and depression, which was caused by the accident at work.

Ultimately, the judge concluded that the woman suffered an injury during the course of her employment when she was struck by the magnet. He ruled her to be totally disabled, based on the opinions of her neurosurgeon, her primary care physician, and her psychiatrist, alongside her own testimony of pain and suffering since the accident. The judge awarded total incapacity benefits and all reasonable treatment, including treatment for the anxiety and depression.

The Board agreed with the insurer’s argument that the judge made inconsistent findings regarding the nerve injury and the causal relationship between the surgeries performed and the woman’s ongoing pain. With this lack of connection and specificity, the Board remanded the case for another administrative hearing with a new ALJ, since the previous one no longer worked for the Department of Industrial Accidents.

The Massachusetts workers’ compensation attorneys at the Law Office of James K. Meehan have the experience you need to assist you with your claim. Call today for a free, confidential consultation at 508.822.6600.

More Blog Posts:

Appeals Court of Massachusetts Case Reveals The Difficulty People Face When Contesting a Will, Massachusetts Injury Lawyers Blog, March 3, 2016

Rear-end Collision Appellate Case Helps Illustrate Burden of Proof Considerations in Massachusetts Personal Injury Cases, Massachusetts Injury Lawyers Blog, February 3, 2016