A Massachusetts worker recently appealed the summary decision of the reviewing board of the Department of Industrial Accidents, which let stand an administrative judge’s decision denying him benefits. The worker argued that the judge considered evidence to support ruling on an issue other than the issue for which the evidence had been submitted. He also argued he was entitled to specific benefits for loss of function and medical reimbursement.
The case arose out of the worker’s job as a heavy equipment operator. In 2007, the worker slipped and fell on cement at work. He hit his head, back and shoulder. While the initial workers’ compensation proceeding was still pending, he filed another claim for specific compensation benefits for losing function of his neck and back. He asked for reimbursement of $15,000 in pain medication. Due to the complexity of the medical issues, the judge asked for more materials from both parties.
The worker testified that his neck felt “better” and “okay”. An IME report supported his claim that he was okay. The judge found that the worker did not suffer a permanent loss of function in the neck. The judge also decided that the original proceedings were res judicata for purposes of determining the cause of the worker’s new back injuries. “Res judicata” is claim preclusion—the legal doctrine that a matter that has already been decided in one forum cannot be raised independently again in the same forum or another.
In the judge’s view, the worker didn’t show a causal link between the new back claims and the original injury. This view was based on evidence from the worker’s own primary care physician. The issue went to the reviewing board.
When the reviewing board returned the issue to the judge for clarification, she clarified that the worker had filed a motion to open the medical records and that this was why the parties submitted the extra medical evidence in the first place. The employee argued he did not file a motion.
The worker appealed to the reviewing board, arguing that in the original proceedings, the issue was: what caused the disability? Therefore, a finding in the original proceedings could not bar via res judicata the instant issue that function had been lost.
The reviewing board agreed with the worker and asked the judge to make a finding on the worker’s loss of function finding. It also asked the judge to look at whether the doctor’s evidence was admitted for a limited scope like the issue of medical payment or for a general scope like loss of function.
When the reviewing board remanded the case to her, the judge again determined the worker failed to meet his burden of proof. Although the IME said that the worker had aggravated an underlying degenerative disk disease causing loss of function, she adopted the doctor’s opinion, which went against the worker.
The appellate court’s standard of review was to decide whether the lower decision was “arbitrary or capricious” meaning inadequately supported both in evidence and fact. Although the worker argued that the medical evidence by the doctor was introduced for a limited purpose, the judge had said in her first and second decisions that she planned to consider the submitted medical evidence for all purposes.
The appellate court ruled that the judge had discretion to accept one medical opinion over another based on credibility. It affirmed the judge’s ruling.
If you or a loved one has suffered an injury in the workplace, we can help you resolve the legal issues that arise in this context. Contact the experienced Massachusetts workers’ compensation attorneys at Kantrovitz & Associates. Call us at 617-367-0880 or contact us via our online form.
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