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Massachusetts Appeals Court Reverses Erroneous Termination of Benefits Based on Finding of Maximum Medical Improvement

The Massachusetts workers’ compensation system is complex and features many different procedural steps, findings, and terms. If you were hurt at work, and you are either considering filing a claim for compensation or in the middle of a claim dispute, you likely have learned about this complexity firsthand. At Mass Injury Group, our Boston workers’ compensation attorneys proudly assist Massachusetts residents with navigating the workers’ compensation system and helping them pursue the maximum amount of benefits and medical expenses reimbursement that they need during this stressful and painful time. Contact us as soon as possible to start learning more about your right to recovery.

In a recent claim, the Massachusetts Court of Appeal was asked to consider whether a doctor’s finding that a worker reached maximum medical improvement should coincide with a termination of benefits. The worker was injured in his shoulder in 2013 and suffered a second injury involving his back the next year. His employer’s insurance company paid benefits for the injuries in both instances. During 2014, however, the insurer ceased paying benefits, stating that it was not responsible for the injuries and that the worker was suffering primarily from a pre-existing condition. Additional court proceedings were held, and the court made several findings, including a determination that the employee had reached a status known in the workers’ compensation system as maximum medical improvement for one of the injuries. The judge awarded benefits payments for the back injury but not the shoulder injury, based on this finding.

The worker filed an appeal and argued that just because he reached maximum medical improvement on his shoulder did not equate to a requirement that benefits payments be terminated. Maximum medical improvement situations often still require ongoing medical treatment. In the report in which the court had read that the shoulder injury reached maximum medical improvement, the reporting doctor also wrote that it would be reasonable for the worker to undergo surgery to his left shoulder. Based on this, the appellate court agreed that the lower court erred in concluding that the maximum medical improvement finding meant that no additional benefits or medical expenses reimbursement payments were necessary.

The appellate court also found that the lower court made reversible errors when calculating the worker’s average weekly wage. The lower court failed to provide an explanation in the opinion about how it reached a final conclusion on the weekly wage that was contrary to the workers’ compensation rules and procedures. Without a way to validate the method used, the appellate court vacated the determination of his average weekly wage as well.

If you were hurt at work, you may be entitled to receive workers’ compensation benefits payments to replace your weekly wages as well as reimbursement for any reasonable medical expenses that you suffered as a result of the injury. At Mass Injury Group, we will ensure that you receive the patient and attentive legal counsel that you deserve during this stressful time and that your rights are asserted to the fullest extent. Call us to set up a free and confidential consultation at 617-263-0060 or contact us online to get started.

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