Massachusetts Worker Requests Total Hip Replacement

In a recent Massachusetts Reviewing Board decision, the Board affirmed a decision denying a worker’s claim for payment of medical benefits. The 46-year-old worker had wanted a total right hip replacement among other medical care for his injuries. He worked as a merchandiser, setting up displays and moving products by lifting and carrying. He started the job in 2003, and he weighed 245 pounds at that time. By the time he left he was 280 pounds. He had played football in high school and street hockey for fifteen years of adulthood. In 2002, he hurt his right knee and needed arthroscopic surgery. He didn’t play street hockey after his surgery.

The worker claimed that in 2009, he suffered right hip pain related to his job. He sought treatment with a doctor who referred him to an orthopedic surgeon. The surgeon administered epidural steroid shots over the year and experienced some relief. The worker didn’t tell the doctors that his hip pain was due to his job. One doctor diagnosed his condition as bilateral hip dysplasia, degenerative changes, and arthritis.

An impartial physician agreed with the diagnosis and found the worker suffered bilateral degenerative arthritis of the hips, arising from his congenital hip dysplasia. The worker asked for payment of medical treatment and was denied. He appealed. The administrative law judge (ALJ) accepted the insurer’s offer of proof that the worker had a combination injury. He took lay evidence and a permitted the deposition of one of the treating doctors. The parties submitted extra evidence.

The ALJ denied the claim for payment. He found the worker didn’t meet his burden of proof that a work accident had occurred on the job between 2003-2009. The worker appealed and argued that the ALJ had failed to conduct the appropriate combination injury analysis and mischaracterized the impartial physician’s opinion as finding no causal connection. He claimed the ALJ had failed to make findings under section 1(7A) (dealing with combination injury) on whether the work injury had combined with the pre-existing injury.

The reviewing board found that the judge had not conducted a combination injury analysis because he had already found the worker didn’t sustain an industrial injury at all. This finding was based on his adoption of the opinion of the impartial physician that the worker’s conditions were not caused or worsened by the job. The doctor also stated the hip condition would have been the same no matter what he had done after 2002. An expert medical opinion is a prerequisite to finding that a work accident happened at all. The judge had adopted medical opinions that negated the prerequisite. Without a work accident, there was no need to go further to conduct the combination injury analysis.

The worker also argued that the judge had mischaracterized the impartial physician’s opinion when he decided the doctor had concluded there was no causation from a job accident. The worker argued that the physician had changed his opinion and stated the job played an equal part with his weight in creating osteoarthritis. The Review Board found this mischaracterized the doctor’s opinion at deposition, which made clear he found no causal connection between the worker pushing a pallet that weighed 1950 pounds and the injury.

If you are hurt at work, you may be entitled to workers’ compensation benefits. An experienced Massachusetts workers’ compensation attorney can evaluate whether you have a sound claim and fight to make sure that your employer and its insurer follow the rules or give you guidance if there is no insurance available. Contact us by calling 800-367-0871 or using our online contact form.