Workers' CompensationMassachusetts Appellate Court Remands Termination of Benefits After Identifying Inconsistent Medical Findings in Lower Court’s Decision

October 19, 20180

Many individuals have faced health conditions or physical injuries throughout their lifetimes. This can create complex isseus when it comes to receiving benefits in a workers’ compensation claim. These laws are designed to provide injured workers with benefits and reimbursement for medical expenses incurred as the result of an on-the-job injury, but not necessarily for pre-existing injuries or conditions. Ensuring that the insurance company and administrative professionals treat your pre-existing injury appropriately is a critical aspect of any workers’ compensation claim. Our dedicated team of Massachusetts work injury lawyers are prepared to help you fight for the just outcome that you deserve.

In a recent case, an appellate court in Massachusetts was asked to review an award of benefits to an injured worker who had a history of back injuries and pain. The insurer sought a termination of the benefit payments to the worker on the grounds that doctors determined that the worker had reached maximum medical improvement. The employee was injured in a car crash when he was working as a glass installer in August 2015. The insurance company provided him with temporary total incapacity benefits. It sought to terminate these benefits in November 2016 and provided a report from an independent medical examiner in support of its request.

The reviewing judge ordered a modification of the worker’s benefits from total incapacity benefits to partial incapacity benefits. He also concluded that the man’s earning capacity was $250 per week. The insurance company and the worker filed an appeal.

Next, the worker underwent an additional independent medical examination. A hearing was conducted regarding both appeals and the judge concluded that the matter had become medically complex. This allowed each party to provide additional medical evidence. After reviewing the documentation, the judge determined that the worker suffered from a history of pain in his lower back that was not a result of his occupational duties. He underwent a spinal fusion when he was eight years old, for example.


The judge also adopted medical reports concluding that the worker was experiencing an exacerbation of his existing back condition and that he had returned to the level of capacity that he had before the accident. Additionally, the judge adopted a medical report concluding that maximum medical improvement had been reached and that any remaining impairments were resulting from his history of back pain and not the car accident that occurred during working hours. The judge terminated the worker’s benefits and the employee appealed.

The reviewing judge reversed the termination, finding that the lower court judge had relied on conflicting medical reports in reaching this determination. The judge failed to explain the various aspects of each report on which the judge relied in ordering a termination of benefits. Details in the record suggested that the judge may have also mischaracterized one of the report’s findings in deciding to award the termination. Without further evidence explaining the judge’s process and conclusions, the appellate court remanded the matter for further proceedings.

If you suffered an injury on the job, you deserve experienced and knowledgeable legal counsel to help you ensure that your rights are asserted to the fullest extent. At the Mass Injury Group, we understand exactly how stressful this situation is for you and your family. Our team of dedicated Boston work injury lawyers offers a free consultation to discuss your situation and how we may be able to assist you. Contact us at 617-263-0060 or contact us online to get your appointment scheduled.

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