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When an injury occurs in a Massachusetts workplace, an injured employee can receive payment for the medical treatment of the injury as long as it was related to the workplace accident. In Thomas A. Novack’s Case (15-P-1090), a nursing home employee sustained a lower back injury while on the job. He eventually received a lump-sum payment with an agreement that the insurer would keep paying for medical treatment that was adequate, reasonable, and stemming from the workplace injury. The injured employee received treatment from various providers after the settlement, and those costs were paid by the insurer for the next five years. The insurer then ceased payment, and Medicare began paying for all of the medical treatment received thereafter.

The employee filed for reimbursement from the Department of Industrial Accidents for the treatment paid for by Medicare. The Administrative Law Judge (ALJ) pondered whether the injured employee could even seek reimbursement when a third party made the payment, but the ALJ ultimately stopped at the finding that the treatment was not adequate, reasonable, or causally related to the workplace injury. The ALJ also noted in the decision that there was a lack of proof that bills were submitted to the insurer before they were given to Medicare. The request for reimbursement was denied, and the injured employee appealed.

The Appeals Court looked at the conclusions of the ALJ to see if the evidence supported the findings. The ALJ did not find the treating physician’s letters persuasive in their attempt to show the connection from the back treatment to the workplace accident. The appellate court felt the ALJ documented sufficient evidence to rule against the injured employee. The ALJ’s ruling in favor of the insurer was affirmed.
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The Commonwealth’s Appeals Court recently reversed and remanded a personal injury lawsuit originally dismissed by summary judgment in favor of the business. In Belanger vs. Boys in Berries, LLC (15-P-1263), the injured customer fell when she tripped on a large octagonal cardboard box and pallet at the end of the checkout counter. The box was visible from the checkout line, but the pallet underneath was hidden from view. Testimony during trial revealed the injured customer commented on the shape of the box. After the customer paid for her items, she caught her right foot on the corner of the pallet, seeing it only seconds before contact. She fell down, injuring her hip and shoulder. Even though the box had arrows to help warn about the pallet, the warnings were obscured from the sightline of anyone standing in the checkout line. There was a large crate of melons near the pallet and box, but there wasn’t any debris on the floor, nor was there poor lighting.

Property owners must maintain their property in a reasonably safe condition. They must consider the likelihood of injury to others, the seriousness of the injury, and the burden to avoid the risk. If there are unreasonable dangers, the property owner must warn any visitors of those dangers if they are aware or should have been aware that they exist. The exception to this is if the danger itself was open and obvious. The appellate court, in its analysis, pointed out that the pallet use itself wasn’t necessarily unreasonably dangerous, but its placement could be. The court looked at Massachusetts case law regarding whether a landlord is liable for the negligent placement of an obstruction in a common area. The court felt a reasonable jury could have found that the store created an unsafe condition by placing a box on top of a pallet in the path from the checkout line to the exit.

The appellate court also felt that the evidence at trial presented a legitimate question of whether the pallet fell under the case law exception as an open and obvious danger that did not require a warning. The court felt there was a possibility that a reasonable jury could find that the box wasn’t really visible until a customer turned to exit the store, so it was not an open and obvious danger. Since the evidence available to the jury presented genuine questions of fact, the Appeals Court felt that the evidence was just strong enough to survive summary judgment. The ruling in favor of the defendant store was reversed, and the case was remanded.
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Breach of duty and causation are two of the main elements to prove in personal injury lawsuits. Even if a breach occurred, it must also be the cause of the alleged injury. In Milambo vs. Catlin (15-P-687), the Appeals Court of Massachusetts reviewed a wrongful death lawsuit brought by the father of a child who was stillborn, on behalf of the child’s estate. At the trial, one of three doctors was found by the jury to be negligent but not a substantial contributor to the child’s death. The estate alleged that the doctors who participated in the child’s delivery were negligent by delaying a c-section.

At trial, the defendants argued that the child died within the womb due to an undetermined cause. The defendants pushed back against the estate’s claim that they delayed the caesarean with the assertion that the mother delayed in giving her consent to the c-section. As part of the defense, the doctors emphasized the mother’s medical history, which included several previous surgical procedures preceding the delivery of her stillborn child. On the date of the delivery, the mother went to the hospital, complaining of constipation and abdominal pain. A fetal heart monitor was placed on the mother, which showed normal results for about five hours. After six hours, the monitor results went from normal to poor, and a c-section was determined to be necessary. The defendants claimed that the father argued with them that the baby was fine and asked for his wife’s gynecologist, asserting they didn’t know what they were doing, and the pain medication was causing the problems.

Forty-five minutes passed between the time the doctors first told the mother a c-section was needed and when consent was given. Nearly two hours after she was told a c-section was needed, the surgery was performed, and the child was delivered stillborn. The cause of death was certified as “unknown intrauterine fetal demise.” The lone expert for the estate was an obstetrician/gynecologist who testified that the consent form signed four months before should have been valid, that there should have been constant fetal monitoring, and that the delay violated the standard of care governing physicians in their specialty. The defendants had two experts who testified that the three treating physicians followed the standard of care, based on their review of the care provided to the mother and the need to receive her consent on the day of the delivery. The perinatal pathologist who testified for the defense also confirmed that the cause of the stillbirth was unexplained and undetermined.
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The Commonwealth’s Appeals Court recently released an opinion looking at whether or not a niece appointed as attorney-in-fact interfered with an inheritance by not releasing funds held in a joint account from the sale of a house that would have been distributed as part of the estate. In Sarro vs. Ciancarelli (14-P-230), the testator’s health began to diminish in the 1980s, and her niece began providing care and assistance with financial matters. During this time period, the niece opened a joint account to help pay for her aunt’s living expenses. This account was in both of their names and became a focal point of this appeal.

After the niece was made attorney-in-fact, she sold a residence that was a part of the estate to her own son and his girlfriend for $135,000. This residence had previously been conveyed to her brothers, with the testator retaining a life estate, but was eventually restored to the testator after the niece advised her uncles that the transfer to their sister was necessary for Medicare purposes. The proceeds of the sale were placed in the joint account, and some were used for the funeral and final expenses of the testator. $90,000 was left in the account but was retained by the niece.

The testator’s brothers eventually filed a complaint against the niece with several allegations, including interference with inheritance and unjust enrichment. The case went to a jury trial. During deliberations, the jury asked a question about whether the funds from the sale of the house would have gone to the testator’s estate. The judge answered that it would depend on the intentions of those on the account and the terms under which the account was opened. The jury found the niece liable for interference with inheritance and unjust enrichment, awarding the testator’s brothers $45,000 each.
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A large number of premises liability cases arise from situations like slip and falls or hazardous passages. In both of these situations, the owner or manager of a property or business is liable when she or he fails to exercise reasonable care for the safety of the invited public. A recent Appeals Court case, Wess v. Butterworth (14-P-1790), addresses a different type of premises liability case. Here, the court assessed whether the jury instructions were an adequate reflection of the law that creates a duty for landlords to use reasonable care to guard against the foreseeable wrongful and criminal acts of third parties. In this case, the injured man was stabbed by an estranged friend who entered the building without authorization. The injured man alleged the landlord was negligent because the apartment building doors had locks but no peepholes, intercom, or buzzer system to help identify anyone on the other side of the door.The injured man and his wife filed suit against the landlord of the property, complaining of serious physical and psychological injuries. The case proceeded all the way to trial, where the jury found that the landlord had been negligent, but her negligence was not the proximate cause of the harm to the plaintiffs. The verdict returned was ultimately in favor of the defendant, and the injured man and his wife appealed. On appeal, the couple argued that the judge erred by not giving a requested instruction regarding the definition of proximate cause and superseding cause.

The requested instructions included a recitation of the law described above – that the failure of the landlord to use reasonable care to guard against the foreseeable wrongful and criminal acts of third parties may result in a breach of the duty to exercise reasonable care. The appellate court agreed that the proposed instructions reflected the law and could even have included the established law that the specific criminal act did not need to be foreseeable, just the type of crime. The appellate court determined that the supplemental instruction given to the jury accurately described proximate causation and went on to charge that the injured man did not have to foresee the exact manner in which the harm occurred, but the harm he suffered must have been a natural and probable consequence of the defendant’s negligence.
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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.

Draper 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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Many types of employment involve repetitive motions. Over the course of time, these repeated movements can lead to an injury that is compensable under Massachusetts’ workers’ compensation laws. A recent Board Decision in Aguilar v. Old Republic Insurance (Bd No. 029539-12) reviewed a decision that awarded a limited amount of temporary total incapacity benefits, an ongoing award of partial incapacity benefits, and medical benefits for a total replacement for the injured worker’s right knee. In this case, the injured employee worked as a certified nursing assistant (CNA), which required her to move, feed, dress, and bathe patients. During the proceedings, the injured CNA testified that she felt pain in her knees, especially the right one. The nurse stated that she fell to the floor in 2011, landing on the right knee while bringing a tray to a patient.

The employee stopped working in the year following the fall, and she had the knee replacement procedure. The injured CNA then applied for short-term disability benefits, followed by workers’ compensation benefits. Following the filing of this claim, the CNA was seen by an impartial medical examiner, who agreed with her treating physician that her employment was the major cause of her knee injury. The judge adopted these opinions, ruling out the pre-existing condition defense raised by the insurer. The judge found the injured CNA’s testimony regarding her multiple falls was credible, based on the hospital visit that followed a fall and a report to a supervisor. The judge also felt that she should be credited for all the multiple, documented complaints she made throughout the years preceding the knee replacement to her supervisor.

In addition to arguing the injured employee’s knee was the result of a pre-existing condition, the insurer also argued that the CNA did not prove she fell and struck something during the last reported fall, nor did she prove the rest of the falls described arose out of her employment. The insurer pointed to the employee’s non-work-related diagnosis of vertigo and dizziness as the cause of the falls. While the Reviewing Board agreed that the judge did not make findings about the falls or the nature of the falls, the judge felt that those falls were not really relevant to whether or not the injured CNA suffered a workplace injury. The board found that the focus of these proceedings was the repetitive movements the employee had to make while performing her duties. The board felt that there was plenty of evidence and testimony for the judge to find a workplace injury did occur, and to award all of the temporary, partial, and medical benefits.
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Soon after a lengthy personal injury trial, the unsuccessful party can move for a Judgment Notwithstanding the Verdict and for a new trial, claiming that the evidence did not support the verdict handed down by the jury. This occurred in a recently issued Massachusetts Appeals Court decision, Ellis vs. Peter Clarke (15-P-868), in which the defendant doctor, an emergency radiologist, appealed a jury verdict in favor of the estate of a now-deceased patient. In this appeal, the defendant physician challenged the use of a witness and the conclusions drawn by the jury based on the evidence presented that his actions led to the death of the patient and grantor of the estate.

The defendant radiologist argued that the estate did not use an appropriate witness who was a standard radiologist, rather than an emergency radiologist. The appellate court listed several cites from case law, which has established the standards for a medical expert. A medical expert may be utilized to testify about many things, including the appropriate standard of care for a patient with the health issues around which the litigation centers. Massachusetts case law has specifically addressed that the expert does not have to be a specialist in the area concerned. The medical expert witness just needs to have the sufficient education, training, experience, and familiarity with the main subject matter of the testimony. The trial judge made a prior determination that the estate’s medical expert was qualified based on his experience reading chest x-rays from ERs, alongside his training and education.

The radiologist also questioned the judge’s ruling determining that the estate did not have to produce evidence showing the diagnosis of cancer should have been made by a certain date. The appellate court did not think a date was necessary, particularly since the law presumes that any warning, if given, will be heeded. In this case, the expert witness stated that the deceased patient would have had a greater chance of survival if the appropriate care had been used and she had been warned.
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In Massachusetts workers’ compensation claims, an award of partial incapacity benefits rather than total incapacity benefits can make all the difference to a worker and his or her family. It can be the difference between financial strain and an existence that resembles life before the accident. Massachusetts workers’ compensation law Ch. 152 §1(7A) allows compensation for workplace injuries that exacerbate pre-existing conditions, as long as there is a determination of whether or not the compensable injury remains a major cause of the disability or need for treatment. The workplace injury does not have to be the predominant cause of the disability. In Herrera vs. Mediate Management, Inc. (Bd. No. 010696-10), the Reviewing Board chose to return the case to the Administrative Law Judge for additional findings of fact regarding whether or not the compensable injury was a major cause of the disability. The board did so because it felt there was insufficient analysis in the determination of whether or not the janitor’s current medical condition entitled him to receive total incapacity benefits instead of partial incapacity benefits.

In this case, the janitor tore his medial meniscus and underwent physical therapy and arthroscopic knee surgery. The janitor testified that his pain did not abate, and he was unable to work in the same occupation due to this injury. The ALJ, in his findings, wrote that he agreed with the medical opinion of the insurer’s expert witness, which concluded he had a pre-existing condition that was unrelated to the injury and progressive in nature. However, he also wrote that he agreed with the janitor’s medical expert, who placed restrictions on the employee’s movement and opined that the work-related injury remained a major contributing factor to his need for treatment. The ALJ then concluded, based on the testimony of the impartial physician (which was not formally adopted), that the arthritis and continuing degeneration were not caused by the workplace injury. The judge went on to rule that the janitor could work light duty and qualified for partial incapacity benefits, but not total incapacity benefits.
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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.

The 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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