Massachusetts Appeals Court Holds Workers’ Compensation Insurance Company at Time of 1998 Injury Liable for 2012 Surgery and Other Benefits

Most Cape Cod workers’ compensation cases are opened and closed within a few months or, in cases involving more severe injuries, perhaps a few years. Sometimes, however, a particular injury is of such a nature that the case may not be fully resolved for decades.

In a case recently decided on appeal, the original injury happened some 20 years earlier. The insurance company that paid the original claim resisted being held liable for surgery needed by the employee some 14 years later, but both the workers’ compensation tribunal and the appellate court held otherwise.

Facts of the Case

In a recent (unreported) appellate case, a workers’ compensation claimant hurt his left knee at work in 1998. He had surgery, received all of the workers’ compensation benefits to which he was entitled at that time, and went back to work. In 2008, he was diagnosed with arthritis. This condition worsened over time, eventually necessitating a total knee replacement in 2012. The employee sought additional disability benefits. The insurance company that covered the 1998 injury sought to join subsequent insurers to the proceedings, arguing that the employee had suffered a second work-related injury or an aggravation of the original injury for which the other insurers should be held financially liable.

The administrative law judge disagreed, finding that there was no evidence to support the insurance company’s position. Accordingly, the judge ordered the insurance company to pay all of the workers’ compensation benefits due the employee. The reviewing board affirmed the administrative law judge’s decision, and the insurance company appealed.

Decision of the Court

The Massachusetts Court of Appeals affirmed. The court began its discussion with a reiteration of the rule that “where an employee suffers two or more compensable injuries that are causally related to a resulting incapacity, only one insurer is chargeable.” Only when a second injury contributes to the employee’s incapacity does the insurance company in place at the time of that injury have responsibility to pay workers’ compensation benefits.

It was a factual issue as to whether there was a subsequent compensable injury after the employee’s original 1998 knee injury. Unless the administrative law judge or the reviewing board lacked evidentiary support for their decision in the employee’s favor, the court of appeals lacked the ability to reverse those decisions. During the hearing, the employee testified that he had suffered no other work-related injuries since the 1998 incidence, and this testimony was corroborated by a doctor’s impartial medical report. Given this evidence, the administrative law judge properly denied the insurance company’s motion to join other insurers.

Schedule a Free Consultation with a Massachusetts Workers’ Compensation Attorney

If you have been injured on the job, you need to know your legal rights. The most effective way to do this is to talk to an experienced Cape Cod workers’ compensation attorney as soon as possible. To schedule an obligation-free, completely confidential case evaluation, call the Law Offices of John C. Manoog, III, at 888-262-6664 today. We have offices in both Hyannis and Plymouth. If necessary, we can arrange an appointment in your home or hospital room.

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