Work injury early intervention is the key to a successful workers’ compensation claim. In a recent decision from the Massachusetts Appeals Court, Lamport’s Case, it was held that an Employee who settled her workers’ compensation case could only make a claim for future medical treatment for body parts specifically listed in the settlement paperwork.
Ms. Lamport worked in an assisted living facility. In April of 2016 she injured her neck and right shoulder lifting a resident. In February of 2017 she had surgery on her right shoulder. Prior to her right shoulder surgery, she complained to her doctor of pain in her left shoulder and an MRI of the left shoulder was done.
In February of 2018 Ms. Lamport settled her workers’ compensation case. The medical conditions listed in the settlement documents as being accepted as work related were: (1) a right shoulder rotator cuff tear and (2) a cervical sprain/strain. There was no mention in the documents of a left shoulder injury.
Two months after the settlement, in April of 2018, the Employee had a second MRI of her left shoulder and was diagnosed with a rotator cuff tear which required surgery. A request for payment of the left shoulder treatment was denied by the workers’ compensation insurance company. The insurance’s company’s position was that the left shoulder was not listed in the settlement documents as a body part accepted as work related. Therefore, medical treatment for the left shoulder was not covered.
The case was initially heard by an Administrative Judge at the Department of Industrial Accidents, who ruled in the Employee’s favor and ordered the workers’ compensation insurer to pay for treatment to Ms. Lamport’s left shoulder. The insurance company appealed this decision and won.
The Employee then appealed to the Massachusetts’s Court of Appeals. Unfortunately for Ms. La
mport, the workers’ compensation insurance company won again when the Court found medical treatment for the left shoulder was not covered under the terms of her settlement.
The Appeals Court decision hinged on the fact that the Employee knew she had a left sho
ulder problem before she settled her case in 2018. Because the Employee knew there might be an issue with her left shoulder, she would only be entitled to treatment for that body part if (1) it was specifically identified in the settlement paperwork or (2) language in the settlement papers retained the Employee’s right to bring a claim for left shoulder treatment in the future. Neither was done in this case.
Report All Injuries Comprehensively
The result in this case would have been different if Ms. Lamport did not have any knowledge or reason to believe that her left shoulder might have been injured when she settled her case in 2018. If the co
ndition was unknown and could not reasonably be expected to be known by the Employee at the time of settlement, a claim for the left shoulder treatment would likely have succeeded.
Usually, injured workers get medical treatment for the most pressing problems first. This means other areas of the body that may have been injured are not treated right away or in some cases at all. It is very important to try and identify any area of the body that may have been injured and to report this to a doctor as soon as possible so that it can be evaluated and treated.
Moral of the Story: Work Injury Early Intervention
The ultimate question will be whether the specific problem is a result of the work injury. This can be a very complicated issue. Seeking legal advice early in your case ensures that costly mistakes are not made, and the injured worker receives all the benefits that he/she is entitled to under the law.