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Impact of Misrepresentations About Your Activities in Massachusetts

surgery-3-1158306-mIn a recent case Joseph F. Driscoll v. Town of Framingham, an employee appealed from a decision that awarded him medical and total incapacity benefits for under a year from 2003-2004. The employee alleged he suffered a back injury from work and was paid benefits for several months. The employee filed a claim for ongoing benefits. The self-insurer denied the claim. The judge denied the claim, leading to the plaintiff’s appeal to the Massachusetts Reviewing Board.

Before the hearing in 2007, the employee was examined by an impartial medical examiner. In a detailed report the doctor explained that the back strain was caused by an industrial accident. The doctor also believed the injury was disabling for up to 12 weeks and that the rest of the treatment was excessive. He explained that initially the employee would need to be limited to sedentary work because he had not been in the workforce. The doctor looked through the worker’s medical records and noted pre-existing degenerative disc disorder. Otherwise, he found them unremarkable.

The self-insurer alleged it wasn’t liable and that the worker had a combination injury. The judge permitted the self-insurer and the worker to present further medical evidence to address the worker’s medical condition before the doctor’s independent examination.

At a deposition, the doctor changed his opinion and testified that the worker would at most have been disabled for sixteen weeks. He claimed this was based on his exam and records review.

The judge credited the workers’ account, but relied on the worker’s tax documents and other materials to find that he could not credit the worker’s version of what had happened during the period after the injury but before the present. The worker had worked for contractors and construction companies though he had told doctors he hadn’t worked. The judge expressed he could not rely on medical opinions based on the workers’ misrepresentations about his disability.

The judge adopted the revised opinion of the doctor and found the period of disability finite. He also adopted another doctor’s opinion that the employee was completely unable to work immediately after the accident. He found the 16 week period expressed by the independent doctor to be speculative. Therefore, he adopted another doctor’s opinion that disability related to the work injury would have ended by April 2004.

The judge ordered the self-insurer to pay a set period of benefits for under a year. The worker appealed on a variety of issues of which the court only addressed one. The worker argued that the judge had misconstrued a doctor’s opinion. The judge had written that the worker’s physical exam results weren’t inconsistent with degenerative disc disease as a sole cause. The self-insurer agreed that the doctor’s actual opinion had been that the results weren’t entirely consistent with degenerative disc disease. The employee used this discrepancy to argue he was still entitled to further benefits. The appellate court disagreed.

It explained that the worker had back strain. The judge had discredited his claims of ongoing pain and noted that he misrepresented his level of activity. Because of this the judge could reject medical opinions based on how the worker had reported his situation. Just because exam results are not totally consistent with degenerative disc disease does not mean a worker has carried his burden of proof to show continued incapacity.

If you are hurt on the job,  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. It is important to be honest with doctors and employers during the process. Contact us by calling 800-367-0871 or using our online contact form.More Blog PostsMisclassification of Workers in Massachusetts, November 6, 2013

The Coming and Going Rule in Massachusetts Workers’ Compensation, October 28, 2013

Impartial Physician Reports in Massachusetts Workers’ Compensation, October 23, 2013