Sometimes, a Massachusetts employee’s workplace accident injury causes pain beyond the period during which he or she may receive disability benefits. In Rivera v. Dept. of Corrections, a corrections worker apparently injured his knees during an altercation between two Massachusetts inmates that occurred in 1996. Following the workplace injury, the correctional officer underwent surgery on each knee. At the time, the man’s employer paid him the maximum number of weeks of §§ 34 and 35 disability benefits allowed by law. The correctional worker later returned to his full-time duties.
In 2011, the employee filed a request for authorization for a medical evaluation by his treating physician due to ongoing pain in his left knee. The correctional officer’s employer denied the man’s request, based on the report of another doctor who stated the worker did not require additional medical treatment for his knees. After that, an administrative judge issued a conference order authorizing an additional medical evaluation under §§ 13 and 30. In response, the man’s employer filed an appeal.
In 2012, the correctional officer was examined by an impartial physician under § 11A. In his report, the doctor stated he believed further medical treatment was necessary and suggested the worker undergo an MRI. Following the procedure, a tear in the man’s meniscus was discovered. As a result, the employer authorized arthroscopic surgery. Following surgery, the employer refused to pay for the procedure and denied the correctional officer’s request for weekly disability benefits. The employer also asserted that it was unclear whether the man’s 1996 workplace incident caused his most recent knee injury.
Next, the correctional officer sought to join his surgery payment request with a § 34A benefits claim. He also asked an administrative judge to issue § 14 penalties against his employer. After the employer denied the worker’s prescribed physical therapy claim, the administrative judge allowed the correctional officer to join his claims. In June 2012, the parties agreed to have the impartial physician conduct another medical exam on the correctional worker.
In his second report, the doctor stated the correctional officer’s subsequent surgery was medically necessary and related to his 1996 workplace accident. The doctor also stated the officer could return to his normal work duties full-time. The employer then withdrew its appeal and offered to pay for the worker’s surgery but continued to deny his partial disability benefits request.
Over his employer’s objection, the administrative judge allowed the worker to join two additional injury dates to his claim at a May 2013 hearing. In response, the employer denied liability for the new injury dates, argued the correctional officer was not entitled to permanent and total disability benefits under the law, and asked the judge to refuse the worker’s request for § 14 penalties. Although the administrative judge found that the employee was totally incapacitated from the date of his surgery until he returned to work, he ruled that no new workplace accidents occurred. Despite this, the judge awarded the worker closed period § 34A benefits for the timeframe at issue.
Additionally, the judge ordered the employer to pay all costs for the workers’ compensation proceeding because the employer had no basis for refusing to pay for the man’s surgical procedure. He also awarded the correctional officer double back benefits under § 14(1)(b) as well as enhanced attorney’s fees pursuant to § 13A(5). In response to the judge’s order, the employer filed an appeal with the Department of Industrial Accidents Reviewing Board.
On appeal, the employer claimed the administrative judge committed error when he issued an award for closed period § 34A benefits. The Board agreed and stated the § 34A award was inappropriate because it resulted in higher benefits than the correctional officer would have received if he had not already exhausted his maximum weekly benefit under the workers’ compensation statute. Because of this error, the Board vacated the award and remanded the case on both the § 34A and double back benefits award.
The Board also agreed that the employer had reasonable grounds on which to deny the correctional officer’s § 34A benefits request because the worker failed to offer any medical evidence in support of his claim. The Board then disagreed with the worker’s contention that his employer was prohibited from contesting the cause of his knee harm after the 2012 surgery was authorized. Since a great deal of time passed between the officer’s initial workplace injury and the subsequent surgery, the Board ruled the administrative judge committed error when he found the employer acted unreasonably by defending the surgery claim and vacated the § 14(1)(b) award.
Finally, the Board stated the record failed to fully demonstrate the procedural history for purposes of a § 13A(5) legal fees award. As a result, the Department of Industrial Accidents Reviewing Board reversed the administrative judge’s order on this issue and recommitted the officer’s case.
If you were hurt at work in Massachusetts, you should discuss your right to recover compensation for your harm with the knowledgeable workers’ compensation advocates at Kantrovitz & Associates, P.C. Our skilled correction officer claims lawyers are here to help you recover the benefits you may be entitled to following a work-related injury. To speak with a seasoned Massachusetts workers’ compensation attorney about your situation, give Kantrovitz & Associates, P.C. a call at 800-367-0871 or contact us through our website.
Rivera v. Dept. of Corrections, Department of Industrial Accidents Reviewing Board Decision No. 007176-96 (July 15, 2015)
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