Massachusetts Appellate Court Upholds Denial of Benefits to Man Injured in Workplace Altercation Based on History of Back Problems

If you have pre-existing medical conditions, seeking benefits after a work injury can be complicated. Insurance companies will often argue that your injuries are results of a pre-existing condition and try to deny coverage for your work-related accident. As seasoned Massachusetts workers’ compensation lawyers, we are standing by to help you pursue the outcome that you legally deserve.

A recent appellate decision from a Massachusetts court highlights the importance of considering pre-existing injuries when filing a claim for benefits. The worker was employed in a position that was largely dedicated to administrative tasks. The position required him to occasionally restrain youths who engaged in violent outbursts. The man suffered an injury during an instance in which he was attempting to restrain a violent youth. He suffered a torn rotator cuff in addition to a lower back injury as a result of the incident.

The worker filed a claim for workers’ compensation benefits in addition to seeking reimbursement for his medical expenses. As part of the claims process, the man underwent an examination by an independent medical examiner. The man also underwent surgery for his back and surgery for his torn rotator cuff.

During a benefits eligibility hearing, the examiner and surgeons each testified regarding the man’s condition. The presiding judge adopted the examiner’s opinion that the right shoulder injury was a major cause of the work-related accident and that the surgery was a reasonable and necessary treatment for the injury. Regarding the lower back injury, the judge determined that the employee’s pre-existing conditions were the substantial cause of his injury and that the work accident was not the direct and substantial cause. In reaching this conclusion, the doctor relied on the worker’s two-year history of back conditions and treatment.

The employee appealed this decision, stating that the judge made a reversible error by relying on only the examiner’s opinion in concluding that the back injury was not a direct and substantial result of the work incident. Specifically, he argued that the court erred when it relied on testimony from the examiner stating that the back injury should have resolved a few months following the accident. According to the worker, this was not a sufficient basis for denying a causal relationship between the injury and the incident. The appellate court ultimately upheld the lower court’s ruling, finding that the record contained sufficient evidence of the man’s prior back injury history and general lack of physical condition. Finding no causal relationship between the back injury and the work incident, the appellate court upheld the denial of benefits and medical expenses reimbursement related to the back injury.

If you suffered an injury as a result of your job, you can seek workers’ compensation benefits to help you address the financial burden and stress that come with a work injury. As dedicated Boston lawyers, we have considerable experience handling a wide variety of injuries and a vast array of job types. We offer a free consultation so that you can learn more about our legal team and how we can assist you. Call us now at 617-263-0030 or contact us online to set up your appointment.

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