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Medical Reports Made by Insurer’s Physicians in Massachusetts

nurseii-4-1158337-mAre Massachusetts workers’ compensation claimants entitled to copies of reports made by an insurer’s physician? A 2011 case answered this question. In the case, a school employee hurt his back while working at a school department, lifting trash barrels. He filed a workers’ compensation claim.

The self-insurer asked him to submit to a medical examination by a physician of its choice. The worker complied. Afterward, the self-insurer didn’t file a copy of the report with the Department of Industrial Accidents and no copy was provided to the employee.

The administrative judge ordered the self-insurer to pay the employee a closed period of total temporary benefits, as well as partial disability benefits and medical benefits. The self-insurer did not believe that work caused the worker’s injury, so it appealed.

An impartial physician was appointed. The self-insurer did not submit the report from its own doctor in fighting the emAployee’s claim. Before the impartial exam, the employee tried to compel discovery of the self-insurer’s doctor’s report. The administrative judge did not issue an order and the self-insurer did not voluntarily produce the report.

The impartial examiner conducted his examination and was deposed by the employee. The impartial physician’s report and testimony were the only pieces of medical evidence used to render the administrative law judge’s decision. He adopted the impartial physician’s opinion and ruled that the employee had a preexisting chronic degenerative disc disease aggravated by the lifting of trashcans. He also found that the injury resolved by the date of the impartial examination and discontinued the benefits.

On appeal, the employee argued he should have been allowed to discover the self-insurer’s physician’s report and that he should have been able to use it to cross-examine the impartial physician. The board agreed that workers are entitled to discover any medical reports about their injuries in connection with an insurer’s request that they submit to a medical exam.

The self-insurer appealed the board’s decision. The Supreme Judicial Court decided to review the case. It reasoned that an employee may obtain a report created at the request of a self-insurer. The board had relied on some non-controlling language in an earlier opinion that stated employees have a right to look at copies of medical reports made by employer or insurer’s physicians.

The appellate court also reasoned that the statute itself requires medical records and reports to be filed and open to inspection if they are relevant to the claim. The appellate court explained that since all medical reports are open to inspection, the section 45 report of a self-insurer’s physician is, too.

The self-insurer argued that this statutory language did not apply to a non-treatment medical report. It claimed that non-treatment reports that were not going to be used as the basis of its decision did not need to be filed.

The appellate court disagreed. It reasoned that the workers’ compensation laws intended the medical reports and records to be transparent to all parties. It also reasoned that the act and department regulations were liberal as to the discovery of medical records and reports generally. The appellate court agreed with the board that the employee should have been able to discover the report and use it to cross-examine the impartial examiner.

If you are hurt at work,  you may be entitled to workers’ compensation benefits. An experienced Massachusetts workers’ compensation attorney can evaluate whether you have a sound claim and fight to make sure that your employer and its insurer follow the rules. Contact us by calling 800-367-0871 or using our online contact form.More Blog PostsMisclassification of Workers in Massachusetts, November 6, 2013

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