The Massachusetts Reviewing Board recently assessed the issue of causation in a workers’ compensation case, alleging that psychological injuries rendered an employee disabled. The Board stated that psychological harm resulting from injuries suffered in an industrial incident requires proof that those injuries were in fact caused by a work-related incident. In this case, the judge had made inconsistent findings of fact, and relying on these, his finding that the employee’s two surgeries and status as totally disabled were caused by an industrial incident was arbitrary and capricious.
In this case, an employee had been awarded ongoing weekly section 34 benefits, as well as sections 13 and 30 medical benefits. The employee had a Master’s degree in Science and Administrative Studies, and she worked as vice president of marketing for her employer. This position required that she maintain attention to detail and strong communication skills.
The work incident at issue involved a magnet, weighing approximately 8-12 ounces, which fell from a door jamb and struck the plaintiff on the forehead. She suffered a concussion and, after being taken to the hospital, began to experience neck and back pain.
After returning to work part-time and full-time, the employee underwent a surgery for her trigeminal nerve. She then stopped work entirely and underwent another surgery. She was determined to be totally disabled from returning to work and claimed section 35 benefits.
A judge ordered the benefits to be paid, and upon an appeal, the judge concluded that she had suffered an industrial injury, that she was totally disabled, and that her psychological harm was causally related to the work injury. The insurer appealed on the ground that the judge made inconsistent and erroneous findings on the injuries and had mischaracterized the medical evidence.
The Board found that the judge had in fact made inconsistent findings regarding the causal relationship between the two surgeries. While the judge adopted medical opinions stating that the surgeries were not causally related, the judge then concluded that the surgeries had been reasonably and causally related to the work injury.
The employee stated that it could be inferred her injuries were caused by the work incident, since she underwent two surgeries. But the Board stated this only showed that the surgeries had been reasonably necessary, which the medical opinion also stated. The Board made clear that in a complex medical situation, such as this case, there must be expert medical evidence regarding causation. The judge failed to cite medical causation, and by ordering payments for the surgeries and finding a causal relationship, the judge’s findings were arbitrary and capricious.
The Board also agreed with the insurer that the judge failed to adopt the most recent medical opinion regarding the connection of the employee’s headaches to the work injury. This error was not harmless, according to the Board, since the case involved the psychological harm caused by a physical injury. A causal relationship of a psychological injury depends on the cause of the employee’s physical harm (at work, due to a work incident).
The insurer argued that the judge had an inadequate foundation for claiming that the employee’s anxiety and depression were causally related to the work injury. Since there had been inconsistent findings on the part of the judge, the error was not harmless because it factored into his judgment in favor of the employee.
The Board stated that the decision would be vacated and the case reassigned to a judge for a hearing.
At the Law Offices of Attorney Michael O. Smith, we provide experienced representation for injured individuals pursuing workers’ compensation benefits. If you or a loved one has suffered a work injury, you may be entitled to compensation for your lost wages from work, as well as your injuries. Contact our office to set up your free consultation with an experienced Boston workers’ compensation attorney. We can be reached at (617) 263-0060.
More Blog Posts:
Top 10 list of items to consider if you sustained a Workers Compensation Injury, Boston Workers’ Compensation Attorney Blog, December 7, 2015
Maximum Partial Incapacity Benefits Awarded to Massachusetts Employee in Reviewing Board Decision, Based on Policy Considerations Not to Deny Benefits to Seriously Injured Workers, Boston Workers’ Compensation Attorney Blog, October 27, 2016