Massachusetts Workers’ Compensation and Pre-Existing Conditions

When a worker is injured or becomes ill while on the job in Massachusetts, he or she may be entitled to workers’ compensation benefits. These benefits may include both the cost of medical treatment and wage replacement while the worker is unable to work. Sometimes a worker is hesitant to file a workers’ compensation claim because of a pre-existing condition. While a pre-existing condition can make a workers’ compensation claim a bit trickier, it does not preclude a worker from receiving benefits.

To be clear, a worker cannot receive workers’ compensation benefits in Massachusetts for an injury that occurred prior to beginning work with the current employer or for an injury that occurred while the worker was not working. However, if a worker is injured on the job and that injury combines with a pre-existing injury, or exacerbates a pre-existing injury, the worker may be entitled to benefits.

A recent case before the Massachusetts Appeals Court illustrates the pre-existing condition standard well. In Goodwin v. National Grid, No. 11–P–2088, a 55-year-old pipefitter injured his neck while at work one day. After testing and a complete examination, doctors concluded that the worker had extensive degenerative disc disease as well as some other pre-existing neck and back problems prior to the injury that occurred at work. The physician who examined the worker and reviewed his medical history for purposes of workers’ compensation concluded that his pre-existing conditions were responsible for 60 percent of his injuries and his work injury was responsible for the other 40 percent. Although the insurer denied benefits to the worker based on the argument that the 40 percent attributable to the work injury was not sufficient to be entitled to benefits, the court disagreed.

The standard applied by the court was based on Section 1(7A) of c. 152, as amended by St.1991, c. 398, § 14, which provides in pertinent part:

“If a compensable injury or disease combines with a pre-existing condition, which resulted from an injury or disease not compensable under this chapter, to cause or prolong disability or a need for treatment, the resultant condition shall be compensable only to the extent such compensable injury or disease remains a major (emphasis added) but not necessarily predominant cause of disability or need for treatment.”

To qualify for benefits, a workplace injury must be considered a major cause of the injury on which the claim for benefits is based. As the court’s decision illustrates, to be considered a major cause it is not necessary that the work injury be responsible for more than 50 percent of the injury. For a worker with a pre-existing condition, this means that an additional injury, or an accident that exacerbates an old injury, may still lead to eligibility for workers’ compensation benefits in Massachusetts.

If you have suffered a work-related injury or illness in Massachusetts, you may be entitled to workers’ compensation benefits. If you are concerned about your employer’s workers’ compensation coverage, ask an experienced Massachusetts workers’ compensation attorney what you should do.

Contact the Massachusetts workplace injury lawyers at Kantrovitz & Associates, P.C., at 800-367-0871 or through our online contact form.