Court Clarifies “Major Cause” in Workers Comp

In Goodwin’s Case, the Massachusetts Appeals Court affirmed the Department of Industrial Accidents Reviewing Board decision affirming the Hearing Judge’s interpretation and application of G.L. c. 152, s. 1(7A).  That section of the Massachusetts workers compensation statute deals with cases where an employee has a pre-existing, non-work related medical condition that combines with a work injury resulting in disability from work and need for medical treatment.  When an employee has a pre-existing non-work related medical condition and, later, is injured at work, the employee has a heightened burden of causation and must prove through a supporting medical opinion that the work injury combined with the pre-existing non-work related medical condition and that the work injury is “a major cause, but not necessarily predominant cause” of the work disability and need for medical treatment.

Therein lies the legal tug of war between insurance attorneys and employment attorneys.  What did the Massachusetts Legislature mean by the term “a major” cause.  It is certainly not themajor cause; it is a major cause.  However, where do you strike the balance in determining when the employee has met his or her burden in order to be entitled to receive workers comp benefits?

In Goodwin’s Case, the impartial physician assigned to evaluate the employee on behalf of the DIA opined that the work injury was responsible for 40% of the employee’s disability and that a pre-existing degenerative condition was responsible for 60%.  The self-insurer argued that 40% could not be “a major cause”, and, therefore, the employee should lose.  The Massachusetts Appeals Court held that the DIA Hearing Judge correctly interpreted and applied G.L. c. 152, s. 1(7A).  The Appeals Court explained that the self-insurer’s argument is inconsistent with the legislative intent and would increase the employee’s burden of proof beyond the statute.

The above case illustrates a very common fact pattern that workers comp attorneys face on a daily basis representing injured workers.  For example, a middle aged construction worker may injure his back lifting something heavy on the job.  He may have had minor back injuries over the years working construction, but he always returned to work.  However, the lifting injury is bad, and the employee in all likelihood will not be able to return to heavy construction work.  At some point, the insurance company sends the employee for an insurance medical examination (IME).  The IME report says that the employee has arthritis and degenerative disc disease in the lumbar spine.  The IME report concludes that the employee may have suffered a lumbar sprain/strain which has since resolved and that the ongoing problems and disability are not related to any work injury.  Then, the insurance company terminates the employee’s workers compensation benefits and refuses to approve any future medical treatment.

The above fact pattern is typical and is the basis for the legal defenses addressed in Goodwin’s Case.  Without an experienced workers comp lawyer, that injured employee may not be able to secure further benefits under the Massachusetts workers compensation law.

If you have any questions concerning Massachusetts workers compensation benefits, even if you’re receiving benefits, you should contact Attorney John Sheehan to discuss your case.