Massachusetts Workers’ Compensation Judge Must Consider Evidence of Causation for Psychiatric Injury

The Massachusetts reviewing board recently ruled on a question of causation in a work-related psychiatric injury case Eliezer Colon Torres v. Joseph’s Pasta. In that case, an immigrant employee with limited education was working in heavy, unskilled labor that required him to perform repetitive lifting and extensive use of his upper body in order to put boxes on pallets and move them. In fall 2009, the employee’s hand got caught in a pasta machine. His fingers were crushed and cut. He had surgery on one of his fingers to repair the tendon and radial digital nerve.

The employer’s insurer paid compensation for a few months without prejudice. The employee was able to start working again, but said he “did not feel right.” He didn’t feel he could return to his regular job though his employer thought he was ready. On the day he was supposed to return to his regular duties, he thought about suicide and was admitted to the hospital for eight days.

The employee filed workers’ compensation claims both for the physical injury and psychiatric consequences of the injury. Before the hearing, the employee was scheduled for impartial examinations—one orthopedic, the other psychiatric. He missed two of the psychiatric impartial evaluations. The insurer suspended his benefits in 2011. The orthopedic impartial examination was completed, but before he could finish the last psychiatric impartial exam, a doctor referred him to the ER for his expressed suicidal thoughts. The judge determined there was an urgency to move forward and did not reschedule the psychiatric exam for completion. Both parties were asked to submit more medical evidence.

The judge found that the hand injury was caused by the work accident. He also found that the employee was totally physically incapacitated as of a date in 2010. The judge applied “but for” causation to the psychiatric injury. He found that but for the workplace injury, the employee would not have suffered his psychiatric injury.

On appeal to the reviewing board, the insurer argued that the medical opinions the judge relied upon for causation of the emotional injury were inadequate. The employee argued the medical evidence adopted by the judge did establish causation. The reviewing board disagreed with the employee.

In ruling for the insurer, the reviewing board reasoned that under the “but for” causation standard a personal injury could be compensable if employment contributed to the injury. But the medical opinion could not state that the contribution was a mere possibility; it had to express the probability of the causation. The judge had adopted medical opinions that did not meet the standard.

The medical opinions did not clearly opine that the employee’s depression was caused by his hand injury. Rather, the judge adopted portions of medical opinions, all of which opined the employee had depression. Only one doctor expressed a slight causal relationship between the hand injury and the employee’s “confidence and ability to do some things.”

The employee argued it was sufficient from the perspective of the DSM-IV to juxtapose the diagnosis of depression with the diagnosis of physical injury. The reviewing board reasoned that the DSM-IV was not introduced as evidence nor did the employee’s attorney request that the judge take judicial notice of any sections of it. The reviewing board remanded the case on the issue of causation and asked the judge to make findings consistent with its rulings.

If you or a loved one has suffered an injury in the workplace, we can help you resolve the legal issues that arise in this context. Contact the experienced Massachusetts workers’ compensation attorneys at Kantrovitz & Associates. Call us at 617-367-0880 or contact us via our online form.