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Termination Date for Disability Benefits in Massachusetts

convenient-1081209-mBack injuries are common in worker’s compensation cases in Massachusetts and elsewhere. Often people have pre-existing back conditions. Even people with minimal back pain may have degenerative conditions. What happens if that pre-existing injury is aggravated by a work injury? Does worker’s compensation still cover the injury?

In a recent case (Farah Ahmed Gurey v. Tables of Content, Inc.), an employee immigrated from Somalia and started work as a dishwasher. He worked consistently for the same employer for two years before slipping and falling on a wet floor at work. He hit his back and was admitted to the hospital for a stay of several days. He continued to receive medical treatment and physical therapy. No surgery was recommended, but he was referred to a pain clinic.

The insurer paid temporary total incapacity benefits voluntarily for several months. When the employee asked for further benefits, a conference was held and the judge ordered the insurer to pay both temporary benefits and ongoing benefits. Both parties appealed. The insurer disputed disability, the extent of incapacity, and the idea that the work injury had caused the disability. It did not contest liability.

An impartial doctor examined the employee. At his deposition, he stated the opinion that the employee had sprained his lumbar spine on top of existing degeneration within the spine. He didn’t think that the work injury worsened the pre-existing degenerative condition. The doctor’s opinion was that there wasn’t an ongoing disability caused by the work injury.

However, an MRI was performed after the impartial examination, and so the judge found the exam inadequate, asking the parties to submit further evidence. The judge adopted the pain clinic doctor’s opinion. He had opined that the employee had acutely sprained and strained his back, aggravating a pre-existing degenerative lumbar spine condition. He also found that the work injury was a major cause of the employee’s disability.

The judge also adopted the employee’s primary care physician’s opinion as to the extent of the incapacity, finding that the employee could not work after the injury and remained unable to work. However there was no evidence on the issue of whether the employee was still disabled beyond a date in December 2010. Accordingly, the weekly benefits were terminated on that date because the judge believed there were no medical opinions on disability after the date.

The employee argued the judge was wrong. There was an addendum in the primary care physician’s report and in it, the doctor wrote that he felt “at this time” “the employee is unable to work due to significant back pain.”

The reviewing board found that the judge had misinterpreted the primary physician’s opinion. An expert opinion stating that someone could not work on one day, did not mean he could work the next day unless it expressly stated so. Otherwise there was no foundation from which to conclude that the benefits should be terminated.

As you can see, worker’s compensation depends upon medical experts’ opinions. However, it is also critical to consult with an attorney who can help present these opinions in an organized fashion and develop a persuasive argument for the judge. An experienced Massachusetts workers’ compensation attorney may be able to help you obtain benefits and advise you on next steps. Contact us by calling 800-367-0871 or using our online contact form.

More Blog Posts:

Woman Sentenced in Massachusetts Insurance Fraud Case, October 4, 2013

Causation in Massachusetts Workers’ Compensation Cases, October 1, 2013

Penalty for Massachusetts Employers Who Repeatedly Violate OSHA, September 23, 2013