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Discontinuing Benefits in Massachusetts Workers’ Comp Cases

mri-head-scan-370098-m-2In Massachusetts, workers’ compensation benefits that are continued over a period of many years can be subject to an insurer’s request for discontinuation if the insurer believes there is no longer a causal connection between medical symptoms and the original work injury.

In a recent case a worker was kicked in the temple of her head while working as a licensed practical nurse at a state hospital. In 1984, an impartial medical examiner concluded the event caused a contusion in her brain, post-concussion symptoms and a depressive and hostile reaction resulting in social withdrawal. The neurologist also concluded she doesn’t have capacity for performance of employment duties. Her treating psychiatrist agreed and found her incapacity was total and permanent.

She filed for workers’ compensation. Based on the medical providers’ opinions that she was totally and permanently incapacitated, the commissioner of the Industrial Accidents Board adjudicated her as such under G. L. c. 152, § 34A. It awarded her reasonable and necessary medical and hospital benefits under G. L. c. 152, §§ 13 and 30.

Years later, her employer, the Commonwealth asked for a discontinuance of her statutory benefits on the grounds that they were no longer causally related to the earlier accident. This request was initially denied. An administrative judge conducted an appeal by de novo hearing. Exhibits included the opinions of an impartial medical examiner plus transcripts of two other physicians’ testimony.

Based on the complexity of the case an administrative judge requested independent evaluations by two psychiatrists and a neurologist.

The opinions of the impartial medical examiner, psychiatrist and neurologist agreed that the worker had emotional disorders of depression, hostility and more because of bipolar disorder or schizoaffective disorder. They manifest in early adulthood around age 28, which was around the same time the worker was injured in her industrial accident.

All three agreed these emotional challenges had never been the result of the industrial injury. One doctor explained that there was a significant amount of evidence that she had a preexisting injury and that her emotional impairment would prevent her from being employable. One of the doctors thought she could work clerical employment, but was likely to sabotage that employment with emotional behavior.

The judge ruled that any remaining injuries of the worker no longer were from the work accident. He allowed the self-insurer to discontinue to benefits. A reviewing board affirmed. The worker appealed.

The worker argued the findings were an abuse of discretion because the worker’s medical history between 1978- 2007 supported the finding of a causal relationship between her emotional impairments and the work injury.

The court inspected the administrative judge’s findings to determine whether it was arbitrary, capricious or an abuse of discretion. It explained that the three expert medical opinions offered ample evidence for the administrative judge’s findings and order.

The court reasoned that each of the experts, including the impartial medical examiner, conducted a thorough review of her documented history in addition to face-to-face interviews. They substantially concurred on the issue of there being no causal relationship between the work accident and the worker’s health as of 2007. The opposing evidence was weak consisting only of periodic evaluations from earlier times, all of which relied on a 1984 determination that there was a causal relationship. The court affirmed the administrative judge’s decision.

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 PostsSubmitting Additional Testimony in Massachusetts Workers’ Compensation, March 12, 2013

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