Massachusetts Appellate Court Overturns Lower Court Denial of Continuing Medical Treatment in Shoulder Injury Claim

If you were hurt at work, you could be entitled to receive benefits and medical reimbursement payments for your injury until you return to good health. Sometimes, an insurer and an injured worker do not agree about when an employee who was hurt on the job is able to return to work and no longer requires medical treatment. If your right to benefits and payments is reversed, you may find yourself in a difficult financial position. The worker’s compensation system in Massachusetts is intended to support people who were hurt while working on behalf of their employer, not to leave them dealing with expensive medical bills and no income. Boston workers’ compensation lawyer Michael O. Smith provides diligent and responsive legal counsel for employees who are seeking benefits after suffering an injury on the job.

In a recent appellate opinion, the Massachusetts Court of Appeal assessed a claim involving a worker who reported experiencing a shoulder injury and a back injury while on the job. The worker was awarded benefits, but the insurance company for the employer eventually argued that there were issues of causation stemming from an alleged pre-existing injury that meant that the worker should no longer receive benefit payments. A hearing was held to determine whether the employee’s benefit payments should be terminated. The worker requested that he receive payment for the reasonable cost of the shoulder surgery that he was told he needed to fix his condition.

The court determined that the worker was at the point of maximum medical improvement for the shoulder injury, but that he still suffered a partial disability. The worker was awarded benefits for the back injury as well, concluding that it was sufficiently related to the worker’s employment. In the award, the judge also stated that the worker was seeking medical benefits in a general sense.

The worker and the insurer filed an appeal. The reviewing court ultimately reversed the lower court’s award, finding that the judge did not provide an appropriate explanation of the analysis that was used in awarding benefits. Looking at the evidence contained in the record, the appellate court agreed with the employee that surgery was necessary and reasonably related to the work injury. The lower court judge had improperly equated reaching maximum medical improvement with no longer needing medical treatment. When courts award benefits to employees, there are certain pieces of information that they must include in the statement of decision to help a reviewing court understand how a particular decision was reached.

If you were injured on the job, please contact the Law Office of Michael O. Smith as soon as possible to schedule your free consultation with our knowledgeable Boston workers’ compensation lawyers. We know just how devastating a work injury can be for you and your family, which is why we will fight zealously on your behalf to ensure that you receive the outcome that you deserve. This can be especially important if your health history involves pre-existing conditions or a complex injury that requires substantial evidence and evaluation. To schedule your appointment, call us at 617-263-0060 or contact us online.