Massachusetts Appellate Court Reverses Denial of Penalties Against Insurer That Failed to Pay Reimbursements for Prescription Medications

The workers’ compensation process involves many steps and hurdles that a claimant must complete in order to receive benefit payments. At each of these steps, a judge will make a key determination in your case that may affect your right to receive benefits, the amount of benefits that you receive, and whether your medical expenses will be reimbursed. At the Law Office of Michael O. Smith, we have assisted numerous injured workers throughout Massachusetts with navigating the benefits system and ensuring that judges are making the correct decisions in their claims.

In a recent Massachusetts workers’ compensation court case, an injured worker alleged that an insurer did not provide reimbursement for medications that he was prescribed in relation to his work injury. The judge in the claim had issued an order requiring the insurer to provide reimbursement for these medications. The insurance company appealed this order and failed to make the full number of reimbursement payments.

Before the hearing on the insurer’s appeal of the order awarding the injured worker reimbursements for the prescriptions, the employee filed a motion seeking penalties against the insurance company for failing to provide the reimbursements pursuant to the order. When the employee filed the order, however, he failed to comply with some of the procedural rules governing motions seeking penalties. Specifically, the employee did not provide an affidavit listing the dates when the insurer was due to make payments and failed to make them. The affidavit must also include the amount of reimbursement that the employee is owed.

Before the judge had an opportunity to hear the employee’s motion for reimbursements, the insurer made the outstanding payments. The judge then dismissed the injured worker’s request for penalties on the basis that the employee did not provide an affidavit pursuant to the workers’ compensation rules. The injured worker appealed.

On review, the injured worker noted that while he did not comply with the affidavit requirement, but that different pieces of evidence offered at the hearing provided the information that was supposed to be in the affidavit. He pointed to testimony that he provided at the hearing listing the payments that were missed, the amount of each payment, and the total outstanding¬†balanced owed to him. The appellate court ultimately reversed the lower court’s denial of his order seeking penalties, agreeing that enough evidence was presented at the hearing to satisfy the affidavit requirement. Even though the insurer had caught up on payments, the court ordered the injured worker the highest amount of penalties, which is $10,000.

On-the-job injuries can be incredibly painful and disruptive for the victim. Our team of Boston work injury lawyers has seen firsthand how an injury can change the victim’s life forever, leaving them to cope with permanent disabilities and the inability to make a decent income. We will fight zealously to ensure that you receive the benefits and medical expenses reimbursements that you need and deserve and that judge’s make fair decisions in your claim. To schedule a free consultation, call us at 617-263-0060 or contact us online.