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Injured Massachusetts employees may be surprised to learn that workers’ compensation includes benefits for psychiatric injuries. Compensable psychiatric injuries can be caused by hostile supervisors, bullying by coworkers, or traumatic events. Anxiety and depression stemming from a physical injury can also be compensated. Claims for psychiatric benefits are discussed in a recently issued Reviewing Board decision (Bd No. 0061111-12), which looked at whether or not the administrative judge erred by ceasing all claims for benefits after May 2013.  The injured worker was a court officer whose duties included transporting prisoners and providing security in the courtroom. In 2012, the employee was injured by a prisoner and taken to the hospital to care for harm to his ribs, right arm, and wrist. The officer also experienced headaches and vertigo months after the incident.

The self-insurer accepted liability for the physical injuries. Benefits for those were resolved in 2013. At this conference, the employee added claims for psychiatric counseling, PTSD, and further indemnity benefits. The insurer objected, disputing the liability for the neurological injury and PTSD claim. The insurer asserted there was no causal relationship between the psychiatric injury and the workplace.

In his decision and denial of benefits, the administrative judge adopted the expert testimony opinion the employee did not have an objective neurological impairment related to the inmate altercation in 2012, as well as the opinion of another expert who determined the injured employee did not have a psychiatric condition limiting his ability to work. The judge found that the employee’s physical injuries had resolved by May 2, 2013 and that he was able to perform the full range of activities consistent with employment.

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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.  The 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 medical malpractice actions, the injured person must take extra steps by going before a tribunal before formally entering the circuit court process. The injured party’s case has to be approved by a tribunal primarily made up of members of the medical community. In its creation of these panels, the Massachusetts legislature set limits on what is considered in this forum. The legislature did not want to recreate the entire litigation process. To ensure that an injured party is filing a serious claim, the Commonwealth also requires the plaintiff to post a bond. To assist injured plaintiffs who are unable to pay, the legislature does allow the plaintiff to apply for a waiver of the bond and fees. The question of what is excluded and what is required in a medical malpractice tribunal review is found in a recent appellate decision (16-P-954).

In this case, the plaintiff alleged an out-patient addiction treatment center was negligent by failing to appropriately address his complaints of pain. Along with the filing of the case, the injured party filed an affidavit of indigency, asking the court to waive the filing fees. The injured party also sought funds to retain an expert witness to help with his action. The request for the expert funds was separate from the other motions, and it was not accompanied by its own motion or an explanation about the necessity of these fees.

For the tribunal, the injured man only submitted two handwritten pages with his allegations written out. These were not supported by a medical expert’s report. Without the affidavit of a medical expert supporting his claim, the tribunal ordered the plaintiff to post the statutory $6,000 bond. The injured man moved for a reduction, which was granted at $2,500. However, the injured man did not pay the reduced amount. The treatment center moved for a dismissal of the complaint, which was granted. The injured man appealed.

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Many types of Massachusetts workers’ compensation benefits are directly paid after proof of treatment or travel is provided to the employer’s insurer. Some, like lost wages, require the application of a formula found in Massachusetts’ General Laws. This formula takes a percentage of the highest wage paid over a period of time and divides it by the number of weeks in this period to find what the injured employee’s Average Weekly Wage payout will be. A miscalculation can cause the employee to be underpaid or overpaid for a long period of time before correction. Many workers’ compensation awards go before the Reviewing Board or an appellate body to see if an employee has been overpaid benefits.

This can be seen in a recent Board decision (Bd. No. 00294-13). In this case, a medical health assistant was injured after she slipped on black ice at her workplace. This accident caused an injury to her back that was treated with injections, physical therapy, and diagnostic testing. This treatment occurred over two years, beginning with care performed by a nurse practitioner and eventually leading to a consultation with an orthopedic surgeon. During this period, she performed modified work at her original position, part-time bartending, and baby-sitting. Over a year after the accident, the injured worker went to an Independent Medical Examiner, who agreed with her treating physician that she had a lumbar spine strain with a small central disc protrusion. He also agreed that the workplace injury was the major contributing cause of her disability and need for treatment. The IME opined that she could still work a 40-hour work week with no repetitive stooping and bending, along with lifting and carrying restrictions.

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Hazards come in all shapes and sizes. In a Massachusetts premises liability action, the injured party must show that the owner or property manager was negligent by failing to clear a hazard. A court will only find negligence if the hazard was something of which the owner or manager knew or should have known. Those responsible for a business or an accessible-to-the-public property must use reasonable care in maintaining the premises.

The Appeals Court recently issued an opinion in a recent decision (16-P-1067), looking at whether or not the Superior Court judge erred by granting summary judgment for the defendants in a premises liability action. The plaintiff lived in a condominium complex and injured herself after tripping over a bent marker stake. The snow removal service contracted by the owner of the condominium complex used stakes to mark certain landscaped areas in order to minimize damage to the land. One of these stakes was near a walkway and was bent. The injured party noticed the stake two weeks prior to the accident but did not report the stake to the condominium trust or the owner. No other reports by residents were made to either defendant before her accident related to the bent stake. The injured resident passed the stake three times in the same day prior to the accident, noticing that it was bent but not protruding onto the walkway. The injured resident asserted that when she tripped on it later in the evening, the stake was protruding over the walkway. The injured resident filed suit against the condominium owner, the condo trust, and the company contracted for snow removal, alleging they failed to use reasonable care in maintaining the condominium property.

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Wills sometimes include a residuary clause to help cover items in the estate that were not specifically bequeathed. These remaining possessions and property are dealt with after the other gifts have been dispersed. The Massachusetts Appeals Court recently dealt with questions surrounding a residuary clause in a recent case (No. 16-P-715). The residuary clause in this lawsuit left “any monies remaining” in the estate to the testator’s live-in romantic partner. The executor of her estate and the partner both claimed that she meant for her one-half interest in a property shared with her brother to go to the partner. The brother’s estate claimed that since she did not devise her interest in this real property, the property passed through intestate succession to her now-deceased brother, her sole heir.

The central legal question hinged on whether or not “monies” included real property. The testator’s partner drafted her will by using a model provided to him. The testator executed it approximately six weeks before her death. The property in question was the testator’s childhood home. Her brother lived there with their mother until the mother’s death and then resided there the rest of his life. In her will, she chose, for unknown reasons, to exclude any mention of this property. Her will did include funeral arrangements, investments, a cash gift to a creative arts center, a yearly gift of $8,000 to her brother (who was alive at the time of her death) from a trust fund of $150,000, a gift of $150,000 to her partner, and several specific monetary gifts to charities and individuals. Property like her car, books, manuscripts, and personal possessions were also left to her partner. Real property was also mentioned in her will. Her share of the home bought with her partner was left to her partner, and a Cape Cod property owned with her brother was left to a couple who was to take possession after the life estate granted to her brother.

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Determining if an injured employee is eligible for workers’ compensation benefits is straightforward if the accident occurs at the work site. It is not as clear if the worker is injured while traveling to and from locations. Workers’ compensation benefits are awarded to those injured while performing acts for the employer in the ordinary course of business. Thus, if a position requires an employee to travel, and the employee is injured while traveling for the employer, the employee is eligible for workers’ compensation. However, a worker is barred from receiving compensation if the “going and coming” rule applies. This rule blocks injured workers from receiving compensation if an injury occurs while an employee travels to and from a lone, static place of employment.

Traveling employees are different, though, and this is illustrated in a recent Reviewing Board decision (Board No. 015466-13). In this case, the insurer appealed a decision by an administrative judge that awarded payment of §§ 13 and 30 medical benefits to a nurse seriously injured in a car accident. The injured worker was a psychiatric nurse who was assigned to work in Brattleboro, Vermont. The employee traveled from her home in Massachusetts to work five days a week on the night shift. The injured nurse was provided expenses for a hotel stay and meals for five days of the week. The nurse advised she did not put in for additional travel reimbursement from the employer, nor did she tell her employer whether she traveled home to Massachusetts on her off-days. The injured nurse did not think she was required to go home on those days, nor did she believe she was obligated to tell her employer any time she went home.

The senior market manager for the injured nurse’s company testified at the hearing. The manager stated she provides all traveling employees with a seven-day per diem each week unless she was told they were traveling back to the “permanent tax home.” The manager testified that while she did not assume the contracted medical staff traveled, she did provide additional per diem payments to employees who notified her they were going home to pick up clothes or traveling for a personal event.

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When seeking damages through a personal injury lawsuit, the goal is to become “whole,” or as you were prior to the injury. Some of the damages are to help cover the costs during this period like lost wages. Others are to help pay for the medical care received after the injury and for future medical expenses required to continue healing. An experienced personal injury attorney will seek damages from any and all entities deemed responsible for the payment of damages. Many times, this will be an insurance company that issued an auto, homeowner, or commercial policy that is designed to provide quick, accessible payments. While insurers exist to provide funds in times of emergency, insurance companies often decline to pay the benefits found in a policy. These types of challenges present additional obstacles for the injured person to overcome.

A recent Massachusetts case (No. 15-P-1706) was a case in which an insurer was ultimately required by the appellate court to provide coverage. The plaintiff was injured by a dog while she was walking her own dogs.  The injured person tried to protect her dogs during the attack, suffering a broken arm, a laceration to her face, and scrapes on her knees, elbows, and ankles. The aggressive dog had a history of biting other dogs. The owner of the dog had a homeowner’s insurance policy and attempted to file a claim to help pay for the injuries sustained by the injured person. The insurer refused to provide coverage, pointing to the application submitted by the owner that left out the prior bites. The trial court, despite protests from the dog owner and the injured woman, granted the insurance company’s motion to dismiss the claims against it seeking payment of benefits. Both the owner and the injured person appealed.

The dog owner acknowledged he owned a dog on his initial application for homeowner’s insurance. Under a section asking him to “Note breed and bite history”, he wrote, “American bull dog — no biting incidents.” The dog owner signed and verified that his answers were ‘true, complete and correct to the best of my knowledge and belief.” After the injury in this case, the insurance company investigated the claim and found that the offending dog had previously bitten two other dogs before the owner’s application was turned in. In its motion to dismiss, the insurer argued the answers were a material misrepresentation that voided the policy and its benefits.

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In Massachusetts, an injured worker can receive workers’ compensation benefits for a work-related injury that aggravated a pre-existing condition as long as the injury is a major cause of the disability. This differs from the requirements for psychiatric injuries under G. L. c. 152, § 1(7A), which place a higher burden on the injured person to show the workplace injury was the predominant contributing cause. To determine whether or not the work-related injury rises to this standard, the Administrative Judge (AJ) hears from medical experts who have either examined the worker or looked at the injured person’s records. An award of benefits hinges on whether or not there is sufficient evidence to support the claim of psychiatric disability.

In a recent case (16-P-837), the Appeals Court reviewed an appeal of a decision of the Department of Industrial Accidents (DIA) reviewing board, which reversed an AJ’s decision in favor of the injured worker.  The board determined the injured woman did not show the employment-related event was the predominant contributing cause. The injured worker appealed, arguing the decision should have been affirmed, or in the alternative, recommitted to the AJ for additional findings. The claim originated from the worker’s repeated encounters with clients through the Department of Transitional Assistance (DTA) who were verbally hostile and threatening. The woman sought psychiatric treatment in 1997 after working there for several years, but she had a stressful incident in 2013 when she was threatened by a client during an interview. The worker sought help from a supervisor but received no support. Paralyzed by anxiety, the injured worker did not return to work.

Prior to her employment, the woman suffered physical and emotional abuse from her mother. The woman did not have any family support, nor any mental health treatment during this period. During the hearing with the AJ, the independent medical examiner testified that her childhood experiences and experiences at work contributed to her diagnosed mental health disorders. The doctor affirmed that she was medically disabled and that the cause of this disability stemmed from the combined experiences. The doctor testified that after several years of traumatic incidents, the threatening client at work in 2013 was the “proverbial straw that broke the camel’s back.” In its review, the board concluded this was not enough to show the work-related incidents were the predominant cause of her disability.

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Estate planning is much more than dividing your belongings and assets after death. Estate planning can include the strategic use of property law to maximize assets for medical care. A recent appellate decision (16-P-282) discusses which type of control a grantor can maintain after executing a deed through a special power of appointment. The grantor in this action decided to protect her home from a lien provision found in the Massachusetts Medicaid program, MassHealth. To do so, she transferred property to her three daughters and son-in-law in equal shares, retaining a life estate. Following this transfer, she decided to remove one of the daughters’ share, redistributing the difference to the others.

When the grantor passed, the executrix presented the will for probate. The excluded daughter objected to the probate and sought a declaratory judgment voiding the reapportionment made through the grantor’s reserved power of appointment. The matter went to trial, at which the court found the reservation of appointment to be valid. The daughter appealed, arguing that the deed was misinterpreted.

In its analysis, the appellate court recognized the tension between two objectives in this document. Both parties agreed that the grantor intended to divest the property, keeping a life estate for herself, to minimize the impact of the MassHealth look-back regulations. They also agreed that she intended to keep the ability to alter the conveyance before her death. The deed reflected this intent. The first grants a present ownership interest, but the second allows the grantor to wipe out those interests. The daughter challenging the deed argued that even though the grantor intended to retain her interest, that reservation of power in the deed was void under the law.

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