Maximum Partial Incapacity Benefits Awarded to Massachusetts Employee in Reviewing Board Decision, Based on Policy Considerations Not to Deny Benefits to Seriously Injured Workers

A recent appeal before the Massachusetts Department of Industrial Accidents Reviewing Board addressed whether an employee seeking benefits from her employer for work-related injuries was entitled to receive continuing benefits.  In this case, the judge had found that the employee’s ongoing disability was no longer related to her work-related injury, and her benefits were issued in a closed period. The procedural history is complex in this case, but ultimately the Board relied on the policy rationale of ensuring that an employee receives benefits for work-related injuries, as provided by Massachusetts law.

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In a previous decision, the judge had awarded section 34 benefits from the date of the work-related injury, July 11, 2011, to July 6, 2012. This was the date that an impartial medical examiner’s report concluded the employee’s work injury was not related to the ongoing partial disability and incapacity she suffered, about one year later.  The employee then appealed this decision on the ground that the judge had denied her motion for a finding of inadequacy regarding this medical report. The Board agreed, stating that the report was confusing and inconsistent.

Then, the judge made findings based on medical opinions in a record that had not been admitted in evidence. The Board vacated the judge’s findings that the employee was partially disabled but that it was not related to her work injury of July 11, 2011. On committing the case, the Board focused on the consideration of additional medical evidence and findings related to benefits the employee would receive after the July 6, 2012 date. They stated this was because her first appeal challenged the part of the decision that terminated her benefits at that date.

The employee submitted her doctor’s medical report of July 2, 2015 on recommittal. The judge relied on the opinions within this report to support his award of ongoing section 34 benefits. On appeal, the self-insurer contended the judge erred when he found that the employee remained totally disabled, and he erred in relying on the July 2, 2015 report, written after the close of evidence in the underlying hearing.  The self-insurer alleged that they were prejudiced.

The Board stated that the judge was required to admit additional medical evidence regarding the employee’s entitlement to benefits from July 6, 2012 forward.  This is because the judge erred when he denied the employee’s section 11A(2) motion. The Board stated that the judge was to look at all the evidence to determine whether the employee’s disability after July 6, 2012 was causally related to the injury.

The Board noted that the self-insurer did not object to the admission of the July 2, 2015 report. In fact, the self-insurer submitted medical reports and records dated after the judge’s first decision. Based on these facts, the Board stated the self-insurer had not been prejudiced by the judge concerning the July 2, 2015 report.

Turning to the purpose of the Workers’ Compensation Act, the Board stated that when section 34 benefits have been exhausted, benefits should not be denied to a more seriously injured worker, while those who are less seriously injured are granted benefits. In this case, the Board stated that the judge’s award of ongoing section 34 benefits was based on the July 2, 2015 medical opinions and report, which post-dated when the employee’s section 34 benefits were exhausted. The record supported modifying the order to require that maximum partial incapacity benefits were paid from July 12, 2014 forward.  This was  the date that the employee’s entitlement to section 34 benefits was exhausted.

At the Law Offices of Attorney Michael O. Smith, we provide experienced representation for injured individuals pursuing workers’ compensation benefits.  If you have been injured in a job site accident, you may be entitled to compensation for your lost wages from work and your injuries.  We offer a free consultation with an experienced Boston workers’ compensation attorney, and our office can be reached at (617) 263-0060.

More Blog Posts:

Massachusetts Reviewing Board Awards Total Incapacity Workers’ Compensation Benefits to Employee Based on Combination of Previous Work-Related Injuries and Industrial Incident, Boston Workers Compensation Attorney Blog, October 17, 2016

Study finds there can be benefits for injured workers and insurers when a nurse case manager is assigned to a workers compensation case, Boston Workers Compensation Attorney Blog, June 22, 2015