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Whether state court or federal court, the civil justice system relies upon due process to ensure all parties are fairly heard and considered. Part of due process is the statute of limitations, which provides deadlines for parties for many parts of the litigation, including filing, responding, requesting evidence, and providing evidence. If deadlines are missed, the party missing the deadline can potentially be precluded from either moving forward with the litigation as the plaintiff, or maintaining an affirmative defense as the defendant. The First Circuit Court of Appeals addressed the effect of a missed deadline in a Massachusetts Social Security Disability appeal for benefits in a recent case (No. 16-2188).

The SSI claimant filed for Social Security Disability Insurance benefits (SSDI) in 2012, which were denied three months later and on reconsideration three months after that. A hearing was held 14 months later, ultimately concluding in an unfavorable decision for the claimant. The ALJ found he was not disabled and was ineligible for SSDI. The claimant then asked the agency’s Appeals Council to review the administrative law judge’s determination. The council denied the request, finalizing the ALJ’s denial of benefits.

The council’s denial included a notice that the claimant has 60 days to file a civil action or ask a federal court for a review. The notice specifically stated that the 60 days start the day after the claimant receives the letter and that it is assumed the letter was received within five days after the date stamped on the Notice, unless the claimant can show otherwise. The notice also advises that if the claimant is unable to file for a review within 60 days, an extension is available as long as there is a good reason for waiting more than 60 days to ask for a court review. This request for an extension must be in writing.

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Massachusetts workers’ compensation offers benefits for both physical and psychological injuries an employee suffers after an accident. By their nature, physical injuries are easier to connect to a workplace accident. Detailed proof and testimony must be offered by an injured person to show the workplace accident was the major factor in the psychological injury. A recent Massachusetts workers’ compensation action (Bd. No. 031456-05) offers a glimpse into which proof can be offered in a successful bid for workers’ compensation for a psychiatric injury.

In this lawsuit, the Reviewing Board assessed whether or not an employee should have been awarded both §§ 34 and 34A benefits. The employee suffered multiple fractures in her left foot after she slipped and fell in an industrial accident. Her employer agreed the foot injury was caused by a workplace accident and agreed to cover the initial costs related to her psychiatric issues stemming from the injury. The employee exhausted her § 35 and § 34 benefits after a fusion in 2006, followed by another in 2012 and a third in 2013. The second surgery seemed to provide some relief to her condition but did not resolve her pain or her difficulties walking on uneven surfaces. The third surgery did not do much to alleviate pain in her heel or the pain that had since developed in her knee. Since the accident, the injured person could not leave the house on cold days because it took her foot hours to feel warm, which then resulted in additional psychological tension. Because of the constant pain and inability to perform typical daily functions, the employee often felt sad, cried, and had fits of anger.

At the hearing, the administrative judge found the employee was permanently and totally disabled due to both the orthopedic and the psychological conditions. The employee was awarded § 34 and § 34A permanent and total incapacity benefits. The employer/self-insurer appealed the ruling, alleging the psychiatric disability should not have been tried at the hearing, since the issue had not been raised at the pre-trial conference. The Reviewing Board disagreed, pointing to the submissions and transcript of discussions before the hearing.

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In a recent Massachusetts workers’ compensation case, the Reviewing Board analyzed an appeal by an insurer dissatisfied with a hearing decision. The insurer alleged the judge incorrectly used the wage amount of $1,726.37 to calculate the weekly wage paid to the injured carpenter. The insurer argued the employee was not entitled to the award, since there was no appeal of the conference order.  The insurer felt the employee could only use the maximum amount of $1,490.33 to calculate his entitled average weekly wage.

The injured carpenter was hurt in an industrial accident while moving a piece of machinery. The machinery began to tip, he grabbed it, and he caught his ring on the machine. The employer didn’t dispute liability and agreed to initially pay an average weekly wage of $800 a week. The injured employee eventually sought an adjustment, which was at the center of this action. The carpenter initially asked for an average wage of $1,505.09 a week, and he submitted an IRS Form 1099 for checks from his employer, payable to him for 35 out of 52 weeks prior to the injury, as proof. The claim was then withdrawn in October 2012.

In November 2012, the injured man refiled a claim for an adjustment, this time requesting an average weekly wage of $1,490.22 per week. As proof, the employee submitted the same 35 weeks’ worth of checks. This claim was also withdrawn, but he eventually refiled a year later. This third attempt at a readjustment claim was for the same amount, and this was accompanied by medical reports and a 2011 tax return. This amount was sent to a conference. After the conference, the administrative judge ordered $1,490.33 to be used as the weekly wage amount. The insurer appealed, but the employee did not.

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Any award of damages in a Massachusetts injury case, whether through a plaintiff’s verdict or settlement agreement, can still present challenges if the defendants either fail to pay or cannot pay the ordered amount.  The federal First Circuit Court of of Appeals addresses this in Vargas-Colon v. Foundation Damas, Inc. (Nos. 16-1213 and 16-1620).  The underlying injury happened to a child who was born by cesarean section after the mother had been in the hospital for several hours.  Because of this delay, the child did not receive enough oxygen and suffered permanent neurological defects.

The parents initiated a medical malpractice action in the federal district court, alleging the doctor and hospital were negligent in the care and delivery of the child.  The parties reached a settlement agreement with the defendants paying $1.5 million in eight installments.  This was entered into a judgment, and the district court retained jurisdiction over the terms of the settlement.  After the first payment of $400,000, the hospital failed to make the scheduled payments.  Instead, the hospital filed for bankruptcy.  The plaintiffs moved to dismiss the hospital’s bankruptcy petition alleging several claims including fraud and bad faith.

The bankruptcy case proceeded, and a reorganization plan was confirmed for the hospital for the court.  Within the plan was a supplement that assured any medical malpractice claimant that they could still file a motion or legal action against the hospital in the pursuit of an action or collection of funds.  The plan also did not preclude medical malpractice claimants from pursuing actions against third parties.  At this point the plaintiffs only received a little under $645,000 – less than half of the $1.5 million agreed upon in the settlement agreement. 

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Injured Massachusetts employees may be surprised to learn that workers’ compensation includes benefits for psychiatric injuries. Compensable psychiatric injuries can be caused by hostile supervisors, bullying by coworkers, or traumatic events. Anxiety and depression stemming from a physical injury can also be compensated. Claims for psychiatric benefits are discussed in a recently issued Reviewing Board decision (Bd No. 0061111-12), which looked at whether or not the administrative judge erred by ceasing all claims for benefits after May 2013.  The injured worker was a court officer whose duties included transporting prisoners and providing security in the courtroom. In 2012, the employee was injured by a prisoner and taken to the hospital to care for harm to his ribs, right arm, and wrist. The officer also experienced headaches and vertigo months after the incident.

The self-insurer accepted liability for the physical injuries. Benefits for those were resolved in 2013. At this conference, the employee added claims for psychiatric counseling, PTSD, and further indemnity benefits. The insurer objected, disputing the liability for the neurological injury and PTSD claim. The insurer asserted there was no causal relationship between the psychiatric injury and the workplace.

In his decision and denial of benefits, the administrative judge adopted the expert testimony opinion the employee did not have an objective neurological impairment related to the inmate altercation in 2012, as well as the opinion of another expert who determined the injured employee did not have a psychiatric condition limiting his ability to work. The judge found that the employee’s physical injuries had resolved by May 2, 2013 and that he was able to perform the full range of activities consistent with employment.

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As a responsible Massachusetts driver or homeowner, one obtains an insurance policy in the event of an accident or emergency. If someone else is injured in a policy holder’s home or vehicle, the insured relies on the insurance company to help defend against personal injury claims. This also applies to corporate policies. In a recent case, the Massachusetts Supreme Court examined whether an insurer’s duty to defend extends to a counterclaim brought by the insured. Counterclaims are actions filed by the defendant against the plaintiff, alleging the plaintiff was negligent and liable for damages.  As an example, one could look at someone injured in a car accident.  The defendant party could choose to claim the plaintiff was independently liable for her or his negligence. If the duty to indemnify extended to counterclaims, an injured party may be subject to additional litigation backed by the pockets and experience of attorneys working for the defendant’s insurance company.

In this lawsuit, the Commonwealth’s Supreme Court declined to expand the duty to include counterclaims. The insurance policy in this action provided liability coverage for employment practices. The Eye Safety and Cleaning Product Company sought indemnification from its insurer for the wrongful termination claims brought against it during a period of time from 2011 to 2012. The policy stated the insurer was required to defend the claim and pay 100% of the defense costs for the claim up to the policy limit. The company discovered what appeared to be a large misappropriation of company funds. The company terminated an employee, who then began an action for wrongful termination, alleging age discrimination. The insurer provided an attorney who addressed three nondiscriminatory reasons for the employee’s termination:  poor job performance, insubordination, and suspected misappropriation of funds.

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In Massachusetts medical malpractice actions, the injured person must take extra steps by going before a tribunal before formally entering the circuit court process. The injured party’s case has to be approved by a tribunal primarily made up of members of the medical community. In its creation of these panels, the Massachusetts legislature set limits on what is considered in this forum. The legislature did not want to recreate the entire litigation process. To ensure that an injured party is filing a serious claim, the Commonwealth also requires the plaintiff to post a bond. To assist injured plaintiffs who are unable to pay, the legislature does allow the plaintiff to apply for a waiver of the bond and fees. The question of what is excluded and what is required in a medical malpractice tribunal review is found in a recent appellate decision (16-P-954).

In this case, the plaintiff alleged an out-patient addiction treatment center was negligent by failing to appropriately address his complaints of pain. Along with the filing of the case, the injured party filed an affidavit of indigency, asking the court to waive the filing fees. The injured party also sought funds to retain an expert witness to help with his action. The request for the expert funds was separate from the other motions, and it was not accompanied by its own motion or an explanation about the necessity of these fees.

For the tribunal, the injured man only submitted two handwritten pages with his allegations written out. These were not supported by a medical expert’s report. Without the affidavit of a medical expert supporting his claim, the tribunal ordered the plaintiff to post the statutory $6,000 bond. The injured man moved for a reduction, which was granted at $2,500. However, the injured man did not pay the reduced amount. The treatment center moved for a dismissal of the complaint, which was granted. The injured man appealed.

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Many types of Massachusetts workers’ compensation benefits are directly paid after proof of treatment or travel is provided to the employer’s insurer. Some, like lost wages, require the application of a formula found in Massachusetts’ General Laws. This formula takes a percentage of the highest wage paid over a period of time and divides it by the number of weeks in this period to find what the injured employee’s Average Weekly Wage payout will be. A miscalculation can cause the employee to be underpaid or overpaid for a long period of time before correction. Many workers’ compensation awards go before the Reviewing Board or an appellate body to see if an employee has been overpaid benefits.

This can be seen in a recent Board decision (Bd. No. 00294-13). In this case, a medical health assistant was injured after she slipped on black ice at her workplace. This accident caused an injury to her back that was treated with injections, physical therapy, and diagnostic testing. This treatment occurred over two years, beginning with care performed by a nurse practitioner and eventually leading to a consultation with an orthopedic surgeon. During this period, she performed modified work at her original position, part-time bartending, and baby-sitting. Over a year after the accident, the injured worker went to an Independent Medical Examiner, who agreed with her treating physician that she had a lumbar spine strain with a small central disc protrusion. He also agreed that the workplace injury was the major contributing cause of her disability and need for treatment. The IME opined that she could still work a 40-hour work week with no repetitive stooping and bending, along with lifting and carrying restrictions.

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Hazards come in all shapes and sizes. In a Massachusetts premises liability action, the injured party must show that the owner or property manager was negligent by failing to clear a hazard. A court will only find negligence if the hazard was something of which the owner or manager knew or should have known. Those responsible for a business or an accessible-to-the-public property must use reasonable care in maintaining the premises.

The Appeals Court recently issued an opinion in a recent decision (16-P-1067), looking at whether or not the Superior Court judge erred by granting summary judgment for the defendants in a premises liability action. The plaintiff lived in a condominium complex and injured herself after tripping over a bent marker stake. The snow removal service contracted by the owner of the condominium complex used stakes to mark certain landscaped areas in order to minimize damage to the land. One of these stakes was near a walkway and was bent. The injured party noticed the stake two weeks prior to the accident but did not report the stake to the condominium trust or the owner. No other reports by residents were made to either defendant before her accident related to the bent stake. The injured resident passed the stake three times in the same day prior to the accident, noticing that it was bent but not protruding onto the walkway. The injured resident asserted that when she tripped on it later in the evening, the stake was protruding over the walkway. The injured resident filed suit against the condominium owner, the condo trust, and the company contracted for snow removal, alleging they failed to use reasonable care in maintaining the condominium property.

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Wills sometimes include a residuary clause to help cover items in the estate that were not specifically bequeathed. These remaining possessions and property are dealt with after the other gifts have been dispersed. The Massachusetts Appeals Court recently dealt with questions surrounding a residuary clause in a recent case (No. 16-P-715). The residuary clause in this lawsuit left “any monies remaining” in the estate to the testator’s live-in romantic partner. The executor of her estate and the partner both claimed that she meant for her one-half interest in a property shared with her brother to go to the partner. The brother’s estate claimed that since she did not devise her interest in this real property, the property passed through intestate succession to her now-deceased brother, her sole heir.

The central legal question hinged on whether or not “monies” included real property. The testator’s partner drafted her will by using a model provided to him. The testator executed it approximately six weeks before her death. The property in question was the testator’s childhood home. Her brother lived there with their mother until the mother’s death and then resided there the rest of his life. In her will, she chose, for unknown reasons, to exclude any mention of this property. Her will did include funeral arrangements, investments, a cash gift to a creative arts center, a yearly gift of $8,000 to her brother (who was alive at the time of her death) from a trust fund of $150,000, a gift of $150,000 to her partner, and several specific monetary gifts to charities and individuals. Property like her car, books, manuscripts, and personal possessions were also left to her partner. Real property was also mentioned in her will. Her share of the home bought with her partner was left to her partner, and a Cape Cod property owned with her brother was left to a couple who was to take possession after the life estate granted to her brother.

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