Workers' CompensationMassachusetts Appellate Court Rejects Insurer’s Appeal Based on the Pre-Existing Condition Doctrine

September 15, 20200

If you suffer an injury at work, you may be given prescriptions for different medications to help you recover and to treat your conditions. The workers’ compensation system in Massachusetts is designed to give employees who are injured on the job weekly benefits to cover their missed wages as well as reimbursements for medical expenses related to their work injury. Even though this mandate is clear, many insurance companies try to deny claims for medical expense reimbursements. The seasoned Boston workers’ compensation lawyers at Mass Injury Group are ready to help you fight for the fair treatment that you deserve.

A Massachusetts Court of Appeal recently considered a matter in which the insurance company was appealing from a lower court order stating that it was required to pay benefits and medical expense reimbursements. The medical prescriptions included ibuprofen and Topamax. According to the insurance company, the lower court judge did not appropriately evaluate whether there was a causal connection between the treatment prescribed and the alleged work injury. It also alleged that the lower court judge did not correctly characterize evidence offered at the hearing about whether the worker was obese.

The worker suffered an injury while he was at his company’s cookout party where he slipped and injured his left knee. Although he was willing to continue working and tried to do so, he was eventually forced to stop. He ended up undergoing a number of surgeries to his ankle and knee. The insurer argued that the employee’s obesity should be viewed as a pre-existing condition. The lower court eventually awarded benefits and medical reimbursements to the employee. The insurer appealed.


According to the appellate court, the lower court’s order was appropriate. The insurance company did not offer enough proof to establish that the worker’s obesity should be classified as a pre-existing condition that constituted a substantial factor in the injury. The lower court also did not adopt any reports or testimony that suggested that the employee’s obesity was part of the reason that the employee required medical treatment. The insurer argued that its attorney made a statement at one of the hearings about the employee’s obesity, but the appellate court rejected this as a sufficient offer of proof to establish it as a pre-existing condition.

The appellate court also stated that the insurer was given several chances during the entire claims process to seek information about whether obesity was a pre-existing condition that contributed to the worker’s injury. But the insurer did not ask any questions during the employee’s deposition about his obesity and whether it may have impacted the injury that he sustained. As a result, the appellate court upheld the award of benefits and medical expenses reimbursement.

If you were injured on the job, then you may be entitled to benefits and reimbursements for medical treatment. The workers’ compensation system in Massachusetts is complex, which is why seeking counsel from an experienced work injury lawyer is so important. Our team will guide you through the process while ensuring that you understand your legal rights along the way. To schedule a free and confidential consultation call our office today at 617-263-0060 or contact us online to get started.

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