Massachusetts Appellate Court Reverses Denial of Benefits Based on Erroneous Finding of Maximum Medical Improvement

If you are hurt at work, the Massachusetts workers’ compensation system can provide you with compensation to cover your missed wages while you heal as well as payments for any medical expenses you incur as a result of your injuries. There are many work-related injuries that get better over time with rest and appropriate medical treatment. There are other unfortunate situations, however, where the injured worker will face a lifetime disability due to the accident at work.

A workers’ compensation claim can be a very long process with many steps. In the beginning, you will likely need to undergo medical exams to determine the status of your injury and when you may be able to return to work. An important determination that the court will examine is whether you’ve reached maximum medical improvement (MMI). This impacts your eligibility to continue receiving benefit and medical reimbursement payments. Some insurance providers will try to argue that you’ve reached MMI before you actually have so that they are no longer required to make payments. At the Law Office of Michael O. Smith, our lead attorney will help you ensure that you receive the fair treatment that you deserve.

The Massachusetts Court of Appeal issued an opinion recently in a case where the plaintiff appealed the lower court’s decision that he reached MMI. The man was hurt at work in 2013 and suffered a left shoulder injury. He had another work injury in 2014 involving his back. The man received workers’ compensation benefits for both of his injuries until 2014 when the insurance company stopped paying benefits. The insurer argued that the man had pre-existing conditions, meaning that his injuries were not substantially related to his occupation.

The man underwent additional examinations and the court concluded based on medical evidence and testimony that the man had reached MMI regarding his left shoulder injury. The injured worker filed an appeal arguing that the court reached this conclusion in error. In concluding that the left shoulder injury had reached MMI, the lower court judge adopted the opinion from a medical examiner that stated that the left shoulder injury reached MMI. The same doctor also wrote in the report, however, that the additional medical treatment for the left shoulder injury including surgery would be reasonable and necessary.

Based on this finding, the appellate court reversed the lower court’s denial of benefits for the left shoulder injury and remanded the case for additional proceedings to determine the amount of benefits that the man was entitled to receive.

If you were hurt while at work, you can file a workers’ compensation claim to receive the financial support that you deserve. This process can be quite overwhelming, especially if your injury is severe and painful. The dedicated legal professionals at the Law Office of Michael O. Smith have experience handling a variety of workers’ compensation claims on behalf of residents throughout Massachusetts. Attorney Smith offers a free consultation to discuss your situation and whether he may be able to assist you with obtaining benefit payments. Call today at 617-263-0060 or contact the office online to get started.