A Pre-existing Injury/Condition Will Not Automatically Bar an Injured Employee from Workers’ Compensation in Massachusetts

I recently handled a case in which a woman was hurt on the job in Massachusetts. Our client fell at her workplace in Newton, Massachusetts. The fall caused her to injure her hip as well as several other body parts. The workers’ compensation insurance company voluntarily paid the injured employee temporary total disability benefits and initially for all medical bills for treatment related to the injuries from the fall.

The main issue in this workers’ compensation case, however, became her hip. It was determined that this employee suffered from a pre-existing condition to the same hip prior to the fall at work. After all conservative non-surgical treatment for the hip failed to provide relief for this employee, our client’s doctor recommended a hip replacement. But, the workers’ compensation insurance company denied the authorization request for the hip replacement. Our office filed an Employee’s Claim for Benefits seeking a court order for the workers’ compensation insurance company to pay for the hip replacement. The workers’ compensation insurer cited a 1(7A) issue as a defense.

Pre-Existing Injury Issues In Workers’ Compensation Cases In Massachusetts

In Massachusetts, our workers’ compensation system requires employers to carry workers’ compensation insurance for their employees. This insurance covers and protects injured workers. The insurance policy offers certain benefits to cover the cost of reasonable and necessary medical treatment related to the work injury and provide disability benefits to employees whose injuries prevent them from working to earn their wages.

An employee that knowingly or unknowingly suffers from a pre-existing injury or condition may still be entitled to workers’ compensation in the event they are injured on the job. No worker forfeits workers’ compensation benefits because of a pre-existing condition. This is true even if the employee was injured in a prior accident.

The Massachusetts Workers’ Compensation Act (M.G.L. c 152) addresses pre-existing conditions or injuries and whether an aggravation of a pre-existing condition or injury is compensable.  Specifically, Chapter 152 §1(7A) states, in relevant part: “If a compensable injury or disease combines with a pre-existing condition, which resulted from an injury or disease not compensable under this chapter, to cause or prolong disability or a need for treatment, the resultant condition shall be compensable only to the extent such compensable injury or disease remains a major but not necessarily predominant cause of disability or need for treatment.”  

What this means is if a pre-existing condition is aggravated by a work accident, the injured worker may qualify for workers’ compensation benefits so long as the work injury is the major (not necessarily the predominant) cause of the employee’s disability or need for treatment.

A Workers’ Compensation Insurance Company May Still Deny Benefits Due To A Pre-Existing Injury

Even though Section 1(7A) provides that benefits may be available to an injured worker who aggravated a pre-existing injury or condition, a workers’ compensation insurance company may still deny benefits (either disability or medical) for the injured worker (and routinely do).

In the case of our injured client, her orthopedic hip surgeon was very specific in his medical notes that the injured worker suffered from osteoarthritis in her hip, but that the fall at work was the major (not necessarily the predominant) cause of her disability and need for a total hip arthroplasty. This client did not even know that she had arthritis in her hip as it never bothered her before the work accident. The insurance company disagreed with her doctor and refused to pay for the hip replacement and relied on 1(7A) claiming that the arthritis was the predominant and major cause of the hip replacement.

I filed an Employee’s Claim for Benefits immediately. The Claim followed the normal process of a workers’ compensation case and after a Conference before a judge, the employee was examined by an impartial doctor appointed by the Department of Industrial Accidents. The impartial doctor agreed that the fall at work was the major, not necessarily the predominant, cause of the need for a hip replacement. Based upon the impartial doctor’s conclusion, the workers’ compensation insurance company agreed to pay for the hip replacement. Ultimately, this case was settled by way of a lump sum settlement.

So, just because an employee may suffer from a pre-existing injury or condition does not mean that he or she will not be entitled to workers’ compensation benefits after a workplace accident.

Speak With An Experienced Workers’ Compensation Attorney Today

If you have been injured on the job and aggravated a pre-existing injury or condition you may still be entitled to workers’ compensation benefits in Massachusetts. Just because the insurance company may say that your pre-existing condition or injury bars you from workers’ compensation benefits doesn’t make it so. You should consult with an experienced Massachusetts workers’ compensation attorney. If you need to file a claim to fight for the benefits you deserve, the insurance company will have a lawyer arguing for them.  You should even the playing field and have a lawyer to fight for you. Find out how employee’s lawyers in Massachusetts are hired and paid in workers’ compensation cases.

To schedule a complimentary appointment and case evaluation call us at (508) 879-3500 or contact us online. We are happy to help and answer your questions. 

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