Massachusetts Appeals Court Agrees that Injured Worker Was Entitled to Prescription Drug Coverage and Reimbursement for Medical Appointments

Under Massachusetts workers’ compensation laws, a person who is hurt at work may seek compensation for several types of benefits – including temporary disability, permanent disability, and medical expenses.

Ideally, the employer’s insurance company will pay these benefits in a timely and non-contentious fashion. Unfortunately, this is not always the case, and an employee’s claim may be unfairly denied.

In such situations, the employee has a legal right to retain an attorney who is familiar with workers’ compensation laws to assist him or her with the claim.

Facts of the Case

In a recent unreported workers’ compensation case, an injured employee filed a claim for the payment of certain medical benefits relating to an injury for which the employee had previously entered into a lump-sum settlement agreement. The administrative law judge ordered the defendant workers’ compensation insurer to pay the medical benefits requested by the employee. The reviewing board of the Department of Industrial Accidents affirmed the administrative law judge’s decision in the employee’s favor, and the insurer appealed.

The Appellate Court’s Decision

The Commonwealth of Massachusetts Appeals Court affirmed. First, the court noted that, in reviewing a decision of the board, it had the authority to reverse or modify a ruling only if the board’s decision was based on an error of law, was arbitrary or capricious, or was otherwise not in accordance with the law. Although the insurer argued that the board’s decision was arbitrary, capricious, and contrary to law, the appellate court disagreed.

In holding that the employee was entitled to payment for prescription drugs and medical appointments relating to her 2005 injury, the court stated that the element of causation had been established in the lump-sum agreement previously entered into by the parties. The court also rejected the insurer’s argument that its due process rights had been violated by the administrative law judge’s consideration of a proffered medical expert’s report when the report had not been admitted into evidence. Given that the insurer had offered the report at a prior conference before the same judge and at a hearing, the court found that the insurer could not have been surprised that the judge had considered the report and that the insurer’s claim that it had “no prior notice” was “disingenuous and inconsistent.”

The court also allowed the employee’s request for attorney fees under Massachusetts General Laws ch. 152, § 12A, granting the employee 10 days in which to file an affidavit and supporting documentation for the fees so requested.

Talk to a Lawyer About Your Cape Cod Work Injury Case

Sometimes, it seems like an insurance company is predisposed to deny every claim made against it, even when it seems obvious that the claim is valid. If you need help fighting for the benefits to which you may be entitled following a work injury, the seasoned Cape Cod workers’ compensation attorneys at the Law Offices of John C. Manoog, III, can help. Call us at (888) 262-6664 and ask for a free, confidential case evaluation.

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