Articles Posted in Workers’ Compensation

The Massachusetts Workers’ Compensation Act was designed to provide prompt financial relief to an injured worker or deceased worker’s family if a work-related accident occurs. Workers’ compensation claims and appeals are handled through a separate system and do not go through any of the standard civil court processes until all the administrative portions are concluded. Recently, the Appeals Court in Merchants Insurance Group vs. Spicer (14-P-798) ruled in favor of the injured worker after an insurance company attempted to stop benefits through an action in Superior Court.

The worker was seriously injured while working as a landscaper and sought workers’ compensation. His hand was dismembered by a log splitting machine. His medical bills were over $700,000, and his treatment was ongoing. The insurer for the employer providing the benefits contested the claim, but the administrative judge for the Department of Industrial Accidents (DIA) granted the injured landscaper temporary total incapacity and medical benefits, pending a formal hearing and ruling. The insurer, following an appeal of that order, also sought to have the policies rescinded in Superior Court, claiming the injured worker’s employer materially misrepresented the information provided on the applications for policies. The insurer claimed it had no duty to indemnify the employer and sought damages of the amounts already paid to the injured worker.

The injured worker and the employer did not formally object to the proceedings in Superior Court, and the judge entered a summary judgment in favor of the insurer. As part of the order, the judge ruled that the insurer did not have to pay any of the sums on the claims arising out of the injured worker’s claims. The insurer took the judgment to the DIA, which denied the insurer’s motion to dismiss the suit. As its reasoning, the administrative judge ruled that the Superior Court did not have jurisdiction, that the employee was not a party to the initial application (and alleged misrepresentation) with the insurer, that the insurer did not terminate the policy according to statute, and that as a matter of public policy the judge did not want to encourage insurers circumventing the administrative process by going to the Superior Court.
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When an injury occurs in the workplace, financial concerns of how to pay for the medical bills and daily expenses quickly appear. When an injury takes an employee away from work for an extended period of time, maximizing the amount of workers’ compensation is in the victim’s and victim’s family’s best interest. A pair of recent appellate cases, Joseph F. Driscoll’s Case (14-P-776) and Driscoll v. Contributory Retirement Appeal Board (14-P-420) analyzed whether a city employee’s injury was considered ongoing, and whether or not he was entitled to accidental retirement benefits.

The injured employee hurt his back when he jumped into a garbage truck while working for the city’s highway department. He sought benefits from his employer, which was self-insured, and was paid weekly incapacity benefits for two months immediately following the injury. The injured employee also sought ongoing workers’ compensation benefits and accidental retirement benefits. The ongoing workers’ compensation benefits were initially denied by the self-insurer and the Dept. of Industrial Accidents (DIA). The ALJ at the DIA did grant temporary total incapacitation benefits, extending from the date of the accident to approximately nine months afterward. The Contributory Retirement Appeal Board (CRAB) and the Division of Law Appeals (DALA) both denied the injured employee’s request for accidental disability retirement benefits. The injured employee, seeking to maximize the benefits available, appealed both decisions.
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Workers’ compensation may be available in different forms, depending on who your employer might be. If you work in construction, your claim would likely be filed through your employer’s insurance company and benefits reviewed through the boards and hearing officers under Massachusetts’ Workers’ Compensation Act. If you are employed as a civilian defense contractor through the United States Government, and are hurt or killed while working in construction or work related to national defense, war activities, or a public use of the U.S., you or a qualified family member can file a claim through the Defense Base Act (DBA), which is an extension of the Longshore and Harbor Workers’ Compensation Act. Like state workers’ compensation claims, the injury or death-causing accident generally occurs during the course of employment. However, under the DBA, an exception exists for injuries caused while in a “zone of special danger,” where it isn’t necessary for the injury to occur during work hours or during activities that would ultimately benefit the employer.

In Battelle Memorial Institute v. Dicecca (No. 14-1742), the First Circuit Court of Appeals reviewed whether an injury occurred in a zone of special danger in an appeal by an employer and its insurance company. The petitioners in this case argued against the award of death benefits under the DBA granted by the Benefits Review Board (Board) to the widow of a contract employee in Tbilisi, Georgia. Her husband was allowed a special stipend for vouchers to use on taxis to get around the city for any purpose, whether professional or personal, and was provided an extra 25% salary supplement for “hardship pay” for working in conditions that are unusually difficult or dangerous, or facilities that are inadequate. The man was traveling to a grocery store 20 minutes away when another driver hit his taxi and killed him. The wife filed suit for death benefits under the DBA, pointing to the special pay allotted for dangerous conditions as support for her claim, in addition to the perpetual “on call” nature of her spouse’s job.
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Under Massachusetts General Laws, an injured worker with serious, catastrophic injuries can qualify for permanent and total incapacity benefits. If an injured worker is still unable to work in any capacity after reaching maximum medical improvement, where he or she is unable to physically improve or recover even with additional surgery, that worker is entitled to benefits under the Commonwealth’s Workers’ Compensation Act. In King v. City of Newton, the Reviewing Board looked at an appeal filed by a self-insured employer who challenged the award of permanent and total incapacity benefits, disfigurement benefits, and reasonable and necessary medical expenses that included a motorized chair lift.

In this appeal, the focus centered on the testimony of the medical examiner and the Workers’ Compensation Judge’s (WCJ’s) method of issuing findings and accepting the evidence presented. The injured employee worked in the school cafeteria, which is a party of the Massachusetts’ town’s school system. She slipped and fell while clearing tables, hitting one of the tables and harming her right leg. She was seen by the school nurse, who applied ice to her leg, and used a cane the next day to get around. The injured school worker was then told by her supervisor to seek medical treatment. She followed up and was diagnosed as suffering from a sprained ankle and bruising of her right knee and lower left ribs. The city then began to pay her temporary total incapacity benefits.

Sixteen months after these benefits, the self-insured city filed a complaint to discontinue the temporary benefits based on the report of the employer’s examining physician. The WCJ heard that motion in addition to the injured employee’s motion for the employer to pay for a motorized chair lift. At this hearing, the judge granted the request regarding the motorized chair lift and denied the employer’s request to discontinue weekly benefits Following this hearing, the employer appealed and the injured worker was examined again, this time by an impartial medical examiner. After receiving the impartial examiner’s report, the employer moved for a finding of inadequacy regarding the impartial examiner’s report.
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When a Massachusetts worker faces the pain and inconvenience of an injury, the frustration over the inability to work can sometimes be overwhelming. Aside from facing lost wages during the recovery period, the employee may face the daunting reality of learning a new job skill if the injury was severe enough to prevent a full return to the work he or she had previously been able to do. Learning a new trade and potentially changing one’s occupation completely is challenging enough after a serious injury, but it can become a more complex decision if the worker suffers a series of moderate injuries over a period of time instead of catastrophic injuries from one accident.

In the Commonwealth of Massachusetts Reviewing Board Decision, McDonald v. Brand Energy Services, Inc., the Board affirmed the award of Section 34 benefits (Temporary Total Incapacity) for an injured employee. The employee was a union laborer who had worked and been injured in industrial accidents over the years, dating back to 1991. The injured employee suffered back injuries four times prior to the immediate case on appeal. The employee acquired lump sum settlements in each case, and returned to work three years after the fourth accident in 2001. He did not work the heaviest jobs but did push through daily moderate back pain to complete other tasks.

In 2012, the employee sustained another back injury when a piece of staging was dropped by a colleague as they were loading a truck together. The employee was approved for light work following the accident, but he did not return to work. When he brought his application for benefits, the insurer alleged that by returning to work after several back injuries, he was committing serious and willful misconduct that precluded his ability to receive workers’ compensation for this injury. The workers’ compensation judge at the initial hearing ruled against the insurer, making a finding that the employee did not commit willful or serious misconduct and did not misrepresent his injury, since he advised he could not perform the heaviest tasks, like jackhammering. The Reviewing Board also did not believe that the employee’s return to work was misconduct, and it found that the injury was the result of the other employee hitting him, and it was no fault of his own.
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Massachusetts workers’ compensation laws were enacted to provide a quicker route for injured workers to receive benefits, while shielding employers from time-consuming litigation. An injured worker does not have to prove negligence, just that he or she suffered an injury during the course of employment. Claims however, are not always granted by the workers’ compensation insurance, nor are they always awarded by the Workers’ Compensation Judge (WCJ). Sometimes, in order to obtain benefits, an appeal must be filed to the Workers’ Compensation Reviewing Board.

Injured workers may be surprised to learn that they can also receive compensation if they have suffered from negative changes to their mental and emotional health. These are known as psychiatric injuries. They can form the basis of a claim alone, but they typically accompany a physical injury claim. Frequently claimed conditions include depression and anxiety.

An opinion was recently published by the Board that partially reversed a denial of benefits and recommitted the case for another look at the injured employee’s claim for permanent and total incapacity benefits. The injured worker suffered an industrial accident where he suffered injuries to his shoulder and psychiatric injury. The employer paid temporary total incapacity benefits until they were exhausted, but it filed to discontinue them when the injured worker filed for permanent total incapacity benefits.
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When accidents happen at the workplace, the injured person has no control over the severity of the injury and whether or not he or she suffered from other medical ailments independent of the workplace. Pre-existing conditions often present large hurdles to obtaining workers’ compensation benefits. While fault or negligence does not have to be shown, the injury must have occurred while furthering the business of the employer. Complex medical records and expert testimony from physicians or other medical professions may be necessary to show the origins of the injury and what type of medical treatment will be necessary to make the employee whole from the work-place accident.

In Lastih v. Erickson Retirement Community, a bus driver for a retirement community injured her lower back while lifting a resident’s walker. After a denial by the insurance company for benefits, she sought a hearing in front of a Workers’ Compensation Judge, where the insurance company claimed that she had pre-existing conditions as its defense. The judge ruled in favor of the injured bus driver, relying on testimony from the impartial medical examiner, who opined that she sustained lumbar and sacroiliac (lower back) strain that aggravated the pre-existing degenerative joint and disc disease in her spine. The judge found her to be totally incapacitated and ordered benefits. No party appealed this decision.

Two years later, the insurer filed to have the benefits discontinued, which was denied. The insurer then had another impartial medical examiner assess the injured bus driver. The insurer withdrew the appeal following the report, and the employee filed for total, permanent incapacity benefits. After an additional examination, reports, and appeals, the judge awarded total and permanent benefits. The judge found that the employee’s disability was casually related to the injuries she sustained when lifting the resident’s wheelchair onto the bus.
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