COVID-19 Notice - We remain here for you and can answer any questions or concerns you may have. Learn More »

Massachusetts Appellate Court Reverses Denial of Shoulder Surgery Based on Improper Interpretation of Medical Evidence

If you are hurt at work, one of the first things you should do is file a workers’ compensation claim to receive reimbursements for your medical expenses and missed wages associated with the injury. Massachusetts maintains a workers’ compensation system that provides these benefits, but the system can be difficult to navigate and understand especially if this is your first time filing a claim. The dedicated lawyers at Mass Injury Group have substantial experience handling Boston workers’ compensation claims and are prepared to stand by your side during this challenging time.

Recently, the Massachusetts Court of Appeal considered a claim where the employee suffered an injury involving his left shoulder. The insurance carrier for the employer provided benefits to the employee to cover his missed wages. A few months later, the insurance company stopped paying benefits and said that the worker suffered a preexisting injury that was primarily to blame for his pain and injury, not the work-related conditions.

In response, the employee sought the maximum amount of benefits available for the injuries that he experienced at work. The judge presiding over the claim determined that the employee was entitled to benefit payments for the injury affecting his shoulder. The parties both appealed this decision, which means they challenged this outcome as involving some type of reversible error. The worker then requested compensation for a shoulder surgery. The judge, however, reviewed medical opinions and determined that the worker had reached a status called maximum medical improvement regarding his shoulder injury and that the surgery was therefore unnecessary. The parties filed another appeal.

The reviewing appellate court reversed the lower court’s decision that the employee did not need to have surgery for his left shoulder injury. The medical reports provided in the claim showed that one of the doctors felt the surgery would be necessary and reasonable to address his injury. It also stated that the injury to the left shoulder was a direct result of the injury that happened at work. Just because an injury reaches maximum medical improvement does not mean that additional therapies and attempts to manage the injury are out of the question. The lower court judge solely relied on a statement in the medical reports indicating that maximum medical improvement had been reached when denying benefits instead of considering whether the surgery was reasonable and necessary. As a result, the left shoulder surgery was reauthorized.

Work-related injuries are always stressful and inconvenient even if they are minor and will resolve in due time. Although the workers’ compensation system is intended to provide benefits for missed wages and medical expenses, there are many steps you may have to take in order to be awarded those benefits. At Mass Injury Group, we pride ourselves on ensuring that you receive the compassionate and responsive legal counsel that you deserve during this difficult time. We will handle all aspects of your claim including gathering evidence and negotiating with insurance companies. Contact us today at 617-263-0060 or contact us online to schedule your free and confidential consultation.

Contact Information