Massachusetts Workers’ Compensation Judge Misstated Medical Complexity Standard, But Employee Not Entitled to Costs for Hip Replacement Because no Abuse of Discretion

Following a workplace accident, injured employees have the right to file a workers’ compensation claim for benefits.  The Reviewing Board for the Massachusetts Department of Industrial Accidents recently assessed whether an employee was entitled to costs for a total hip replacement after suffering injuries in a work-related accident.  At issue in the case was whether the judge had erred when he found that the medical issues were not complex, and therefore there was no need for additional medical evidence.

hospital room

The employee worked for over 30 years for the same company, first as a machine operator and then as an x-ray technician. An accident occurred at work, and the employee received a double knee surgery. During his period of recovery, the employer paid weekly indemnity benefits.

After filing a claim for workers’ compensation benefits that alleged his left total hip replacement was caused by the work injury, an administrative judge rejected the claim, and the employee appealed.  The employee was examined by an impartial physician.

A hearing took place to determine whether the workers’ compensation insurer was responsible for the cost of the employee’s hip replacement. The employee moved to allow additional medical testimony, on the basis that the medical issues were complex. He contended that he suffered pre-existing arthritis in his hip and that when consulted regarding his case, several doctors disagreed.  The judge ultimately denied the motion and held the medical issues were not complex.  The judge also denied the employee’s claim for payment.

The employee appealed and alleged it was an abuse of discretion for the judge to find that the medical issues were not complex.  The Reviewing Board stated that Massachusetts law does not require judges to set forth their grounds for ruling on any motion, including a motion to allow additional medical evidence. The problem, according to the Board, was that the judge set forth an objective standard for his medical complexity analysis.

Instead of setting forth the subjective approach to medical complexity, the Board stated that the judge in this case had asserted a general standard.  This standard has been rejected by the Appeals Court, and an “abuse of discretion” standard has been adopted.  Determining whether medical issues are complex requires a subjective assessment, dependent on individual knowledge, education, and experience.

Acknowledging that the judge misstated the standard, the Board stated that the case did not require recommittal to the same administrative judge.  The Board made clear that the remaining comments on the issue of medical complexity revealed an analysis that was “well-reasoned” and “rational.”  This analysis, according to the Board, did not display an abuse of discretion. Specifically, the judge stated that while there was a disagreement between doctors, this did not show complexity.

In conclusion, the Board stated the denial of the motion for additional medical evidence based on finding no medical complexity was within the judge’s authority, and it was not an abuse of discretion.  The Board affirmed the decision.

At the Boston Law Offices of Attorney Michael O. Smith, injured workers seeking workers’ compensation benefits receive skilled legal representation.  We help people seek benefits under Massachusetts law, including medical costs and lost wages, for work-related injuries and medical conditions.  If you or someone close to you has suffered a work injury, you may be entitled to compensation. Contact our office today to set up a free consultation with a workers’ compensation lawyer. We can be reached by phoning (617) 263-0060.

More Blog Posts:

Massachusetts Worker Not Entitled to Benefits, According to Reviewing Board, Due to His Own Misconduct, Boston Workers’ Compensation Attorney Blog, April 4, 2017

Reduced Worker’s Benefits Award Addressed and Rectified Earlier Omission by Judge; Massachusetts Appellate Court Upholds Decision, Boston Workers’ Compensation Attorney Blog, March 2, 2017