Worker’s Comp Agency May Ignore Erroneous Medical Report

Appeals Court has held that the Massachusetts Bureau of Workers Compensation, which administers benefits to employees injured on the job, properly granted disability benefits to an injured truck driver, despite an independent medical report to the contrary. This decision to provide some comfort to injured employees who receive a negative evaluation of their claim from a Bureau-affiliated doctor.

Under Workers’ Compensation law, a person claiming a work-related injury may be required to submit to an independent medical examination. In Robert Dalbec’s Case, 69 Mass. App. Ct. 306 (06-P-358) (June 2007), a tanker truck driver was unable to work after a slip-and-fall injury on the job. The Independent Medical Examiner found that the claimant was capable of returning to unrestricted full-time work. The Administrative Law Judge (Judge), who heard testimony from the claimant about the physical stresses required by the job and his ongoing physical pain, rejected the IME report and awarded partial disability benefits.

The Appeals Court ruled that a negative IME report creates a presumption that the employee is ineligible for benefits. But this presumption, the Court held, can be rebutted simply by critiquing the report and determination that it is unfounded or unreasonable. The Appeals Court agreed that the IME doctor’s report and deposition testimony suffered from several major weaknesses, including a failure to assess the injury in light of the job duties and a failure to conduct critical tests about the employee’s fitness. Whereas the doctor appeared not credible, the Judge found the injured employee to be highly credible and the Judge conducted his own comprehensive analysis of the injuries and the job duties.

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