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Part 1 of this blog dealt with how weekly workers’ compensation benefits and monthly Social Security Disability benefits can offset each other.  But what happens if you settle your workers’ comp case?

In Part 1, we used an exmaple of someone in an “offset situation.”  That individual was receiving both weekly workers’ comp benefits at the rate of $500 per week, and a monthly SSD check for $633.35.  In this example, his full SSD rate, or PIA, was supposed to be much higher, at $1,200 per month.  But, because of his receipt of weekly workers’ comp checks, he was in offset, and thus, his SSD benefit was reduced.

If this individual were to “settle” his workers’ comp case, he would cease to receive a weekly workers’ comp check. Rather, he would receive a final lump sum cash payment to close out/settle his case.  The question then becomes, what effect does this settlement have on his ongoing Social Security Disability benefit.

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The Short answer is “Yes.”

However, depending upon certain factors, one may not be able to collect his or her Social Security Disability benefit in full.  This is because the receipt of weekly workers’ compensation benefits under M.G.L. Chapter 152 can create an “offset” on Social Security Disability (SSD) benefits.  In other words, workers comp benefits could cut in to and thereby reduce one’s social security disability benefits.  Sometimes, it can eliminate Social Security Disability altogether.

To determine whether or not someone is in an offset situation, you must first determine that person’s high year of income.   This is done one of two ways.  Either, you would take that persons highest year of income within the 5 years prior to being injured, or you would take the average of his income within the past 20 years; whichever is highest.  Let’s say, for example, that an individual were injured in 2011, and between 2006 and 2010, his highest year of income was $42,000mass-state-house

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How Much Is My Workers Comp Case Worth?

This is one of the most common questions asked of attorneys practicing in workers compensation, or any personal injury type of law.  For someone who has sustained a work-related injury, with potentially career ending consequences, this is often times their primary concern.  Are they going to be able to get enough money to support themselves going forward?

Section 48 of Chapter 152 provides that the parties to a workers’ compensation case may enter into an agreement to “settle” the claim by the payment of a lump sum amount.  In other words, the parties can agree to “close out” the case by a payment of a certain sum of money to the Employee.  As mentioned above, the main question on the Employee’s mind is usually, “how much am i going to get?”.

Unlike personal injury cases like a motor vehicle accident, or a products liability case, workers’ compensation cases are valued in a  very specific way.  The two main components to determining the monetary value of a workers compensation case are 1) the Employee’s compensation rate, and 2) the amount of time the Employee could remain on workers comp weekly benefits.  With some limited exceptions, these are often the only two factors that will go into determining a settlement amount.

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What to do when your Employer is uncooperative following an injury at work?

You’ve been injured at work. Your doctor says you’re disabled from working. You need to file a claim for workers’ comp benefits, and you need certain information to do so. Unfortunately, your Employer is refusing to give you the information you need. Though the Massachusetts Workers’ Comp law requires information of this type to be readily available, some Employers simply ignore these requirements.

Or, say you’ve been injured at work, and your Employer has sent you to their clinic to begin treatment. Many Employers have a “preferred medical provider” that they work with. In situations like these, if an employee is injured, the Employer will often take steps to “steer” the employee towards their preferred clinic. They may assure the employee that this is the quickest way to get treatment, and that they won’t be responsible for out of pocket costs. However, the problem is that this provider has both the Employee’s, as well as the Employer’s interests in mind. As a result, many Employees soon learn, or soon suspect that their doctor is not 100% on their side.

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The Department of Industrial Accidents Reviewing Board recently held that the standards M.G.L. chapter 152, section 27 were not met, thus affirming the decision of the Administrative Judge.  Click here for a link to the case.

M.G.L. chapter 152, Section 27, pertains to situations involving an injury caused by the “serious and wilful misconduct” of the Employee.  In these situations, if it is determined that the injury was, in fact, caused by the serious and wilful misconduct of the employee, no compensations shall be awarded.  Section 27 is, in many ways, the counterpart to Section 28, which deals with serious and wilful misconduct of the Employer.Stock photo boston 1

Historically, both sections are rarely applied because of the high thresholds in making a determination/ruling that the conduct in question rises to the level of “serious and wilful.”  In many ways, the conduct must rise above mere negligence, or even gross negligence, and must be almost to the level of quasi-criminal in nature.  In other words, the conduct in question usually must be quite severe to be considered “serious and wilful” per these Sections.

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Every year, the Massachusetts Continuing Legal Education (MCLE) hosts a one-day seminar focused on Workers’ Compensation Practice in Massachusetts.  The day is broken into several sessions focusing on relevant topics in Workers’ Compensation Practice, both in Massachusetts as well as on the national level.  For the second year, attorney Adam Troupe, of the Troupe Law Office, was asked to speak on a panel.

This year, he was part of the panel discussing the ongoing paradox of dealing with chronic pain.  Members of this panel included two Administrative Judges from the Department of Industrial Accidents (The Honorable Maureen McManus, and The Honorable Roger Lewenberg), one Administrative Law Judge from the DIA (The Honorable William Harpin), Diane Neelon, also from the DIA, as well as Attorney Edward Moriarty.  Guest speakers included a pain specialist, Dr. David DiBenedetto, MD.

Dr. DiBenedetto gave a general background about the physiology associated with chronic pain, as well as treatment plans, guidelines, and goals.  Attorney Adam Troupe then presented the considerations of the Employee’s attorney when dealing with cases involving chronic pain, with particular focus on the injured employee and how they may respond in these situations.  Attorney Moriarty addressed the Insurer’s point of view, and the Judges then expressed their concerns from a Judicial perspective.

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Recently, the DIA Reviewing Board in Boston addressed in a recent opinion what percentage a work injury must contribute to establish a “compensable injury” under the Massachusetts Workers’ Compensation Act, where multiple, non-work-related factors are present.

In this most recent case, Jane Sullivan v. Centrus Premier Home Care, the Insurer appealed the decision of the Administrative Judge after Hearing.  One of the points raised on appeal was that the requirements set for in Chapter 152 § 1(7A) were not met with respect to disability after 9/23/09, which was the date of the § 11A Impartial examination.  Section 1(7A) states, in part, that where a work injury combines with a  pre-existing condition, not compensable under the MA Workers’ Comp Act, the resultant condition shall only be compensable to the extent that the compensable/work-related injury remains “a major, but not necessarily predominant cause of disability and need for treatment.”

In laymen’s terms, § 1(7A) states that where a work injury combines with a pre-existing, non-work-related injury, you must show that the work injury remains “a major, but not necessarily predominant cause” of the resultant condition.  The phrase “a major, but not necessarily predominant,” has thus become subject to extensive interpretation by the Judges at the DIA, as well as the Reviewing Board.

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Attorney William H. Troupe recently received a favorable decision from the DIA Reviewing Board in Boston.  The case involved a registered nurse who injured her back while helping to transfer a patient.  She began receiving workers’ compensation temporary total disability benefits for approximately five months, at which point the self-insurer reduced her payments to maximum partial disability.  The employee, through her counsel, filed a claim at the Department of Industrial Accidents, to get her benefits increased back up to the total disability rate.

Stock photo boston 1Pursuant to Section 11A of the Workers’ Compensation Act, the employee was examined by an impartial physician.  After the hearing, the Judge ultimately adopted the opinion of the impartial physician, who found that the employee was restricted “to work which requires her to be able to change positions frequently and not require sitting of more than 30 minutes at a time, no lifting more than 10 pounds and no more than 4 hours a day.”  The Judge was also “persuaded by the employee’s testimony” concerning her subjective complaints of pain.  In her decision, the Administrative Judge ultimately awarded the Employee ongoing total disability benefits.

The Self-Insurer appealed the decision on 3 grounds:  1) that the expert medical evidence failed to support a causal relationship between the employee’s work injury and her disability, 2) the judge’s finding that the employee is totally disabled was not supported by the evidence and reasonable inferences therefrom, and 3) the judge failed to consider all of its evidence.

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The Massachusetts Department of Industrial Accidents Reviewing Board recently addressed the issue of when and how a workers’ compensation claim should be dismissed. In the end, the case was recommitted back to the hearing level for further findings of facet. The reviewing board essentially ruled that situations like this are very fact specific, and certain findings must be made to determine if dismissal is the appropriate course of action.

Stock photo boston 1In this case, the employee’s counsel failed to show up at a scheduled hearing at the Department of Industrial Accidents. The insurer argued that as a result of this absence, their rights under M.G.L. chapter 152, section 10A(3), to a full evidentiary hearing on the matter, were violated. The workers’ compensation insurer contended that they suffered “significant prejudice” to their rights to defend this pending claim.

As a result, the Insurer, through counsel, moved to have the matter dismissed with prejudice. The insurer argued that a dismissal with prejudice was the only proper remedy, because a dismissal without prejudice, would simply allow the employee to file the claim again. As such, the matter could simply be brought forward again, on the same claim and same issues.

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In a recent decision, the Department of Industrial Accidents Reviewing Board in Boston, ruled that in a claim for section 34A permanent and total disability benefits, where a previous decision found the employee partially disabled, the Employee has the burden of proving, not only that his condition “worsened” to the point of rendering him totally disabled, but also that the worsening must be shown to be causally related to the original work injury, and not due to other factors, such as age, or a subsequent injury.

Stock photo boston 1In this case, the employee originally sustained a work injury to his back while lifting a garage door on 2/12/07. A claim for benefits was filed and the matter was ultimately heard at hearing. The Administrative Judge, in his decision, ordered the Insurer to pay section 34 benefits for a closed period, followed by ongoing section 35 partial disability benefits. The employee collected section 35 benefits until a claim was filed for section 34A permanent and total disability benefits on 4/1/11.

Ultimately, the claim for section 34A benefits was heard at hearing, and the Administrative Judge ordered permanent and total disability benefits in his decision. The Insurer appealed this decision on several grounds. One such ground was that the Insurer argued that the Employee failed to establish that he suffered a work-related worsening of his condition since the previous order of partial disability. The Reviewing Board agreed.

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