Massachusetts Appellate Court Affirms Judge’s Discretion to Choose Between Medical Opinions

The Massachusetts appellate court recently heard In re Stawiecki’s Case. This case arose in 1989 when a sixty-five year old claimant’s back was injured while he worked as a laborer for the Massachusetts Highway Department. He filed for workers’ compensation benefits including temporary total disability benefits and temporary partial disability benefits.

After an initial workers’ compensation conference, the administrative judge ordered the employer’s self-insurer to pay permanent and total disability benefits as well as medical benefits to the claimant from 1999 forward. In 2000, the claimant submitted a claim for disfigurement benefits on the basis of his limp. The self-insurer agreed to pay a lump sum of $2553.60 to settle the claim. This settlement was approved by the Department of Industrial Accidents.

In 2009, the claimant filed another claim, stating that his 1989 back injury had transformed from a limp to an injury that required first a cane, then a walker, and finally confinement to a wheelchair. For this progressive injury, he sought more disfigurement benefits in the amount of $15,000.

The administrative judge denied this claim, but the parties decided not to use an impartial medical examiner. Instead they went straight to a hearing in front of the administrative judge. The claimant was elderly and in a nursing facility. He did not testify, but his nephew testified as an eyewitness to his injuries. Moreover, medical evidence was submitted by the claimant’s orthopedic physician and the self-insurer’s orthopedic physician.

The administrative judge determined that the claimant had not met his burden of proof to show that the original workplace accident led to his wheelchair confinement after 2002. The judge cited the self-insurer’s physician for that opinion. The reviewing board affirmed the judge, rejecting the claimant’s argument that the report from the self-insurer’s physician mandated that causation be found.

The employee appealed, arguing that the reviewing board’s decision was arbitrary, capricious and constituted an abuse of discretion. He contended that the decision ignored the portions of the report of the self-insurer’s physician that the workplace accident may have “contributed ‘negligibly’ to the subsequent need of a wheelchair”.

The employee argued that the reviewing board ignored that he had been awarded previously benefits for all the subsequent disabilities. In his view, these awards by their very nature acknowledged a causal relationship between the workplace accident and the following injuries.

The appellate court’s review standard was whether the reviewing board decision had demonstrated adequate evidentiary and factual support. The court found that the judge’s decision to adopt the self-insurer’s medical evidence was sound. The self-insurer’s medical report was consistent and certain that the claimant was confined to a wheelchair for three other reasons: his demented condition, inability to recover from a hip fracture sustained after the accident, and progressive degenerative changes to his lumbar spine.

The report also stated that any contribution of the workplace accident was negligible. The doctor could find no structural damage added by the workplace injury. Rather, he opined to a reasonable degree of medical certainty that the vast majority of the claimant’s medical condition was due to a pre-existing degenerative change.

The physician also cited an earlier opinion by another doctor who said that the strain on the spine caused by the workplace accident would have resolved within 1-3 months. He said that it was the underlying degenerative condition, not the workplace accident, that was continuing to cause problems. In contrast, the claimant’s doctor did not offer strong evidence, even conceding he could not point to a medical opinion on why the claimant was confined to a wheelchair. The administrative judge had discretion to choose between the conflicting experts and the appellate court affirmed his decision.

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.