We are here to help you understand your Massachusetts workers’ compensation claim if it was denied due to a pre-existing condition or any other issues that you might be having with your workers compensation in Massachusetts. Under the Massachusetts Workers’ compensation statute, the comp insurer will often deny your claim for workers comp benefits if they have determined you have a pre-existing condition underlying your work related injury or illness. Pursuant to M.G.L. Ch. 152 sec 1(7A) 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 contributing cause of disability or need for treatment.
Establishing Proof of a Pre-Existing Condition
The burden of proof to establish a pre-existing condition not covered by the Massachusetts Workers’ Compensation statute is on the Insurer. It is a defense to your claim for benefits. If you have suffered a pre-existing injury or disease that is not covered by the Massachusetts workers’ compensation law or statute you must prove the current work injury is the major cause of your problems as the statute requires. So, how do you define “major cause”? Your work injury must be a serious and predominant cause of your disability or your need for treatment.
We look to establish this element two (2) ways.
- First, we request a narrative opinion from your treating physician asking them to address the major cause of your medical condition in light of the available medical evidence.
- Second, we present and argue facts that substantiate the major cause requirement. For example, was there an extended period of time between the need for treatment of the pre-existing condition and the work injury? Or, were you able to perform your job prior to the work injury without issue or impediment?
Is Aging a Pre-Existing Condition?
Getting older is not a pre-existing injury of disease! As we age our bodies change, resulting in degenerative and arthritic conditions over time. Many times an employee with no prior injuries will suffer a back injury for example, and subsequently the workers compensation insurer will have him or her evaluated by a doctor of their choosing. The doctor will state the employee sustained a back injury which resolved and their current disability is related to pre-existing degenerative disc disease. Based on this medical opinion the workers’ compensation insurer will deny a claim for benefits, or seek to terminate benefits being currently received by asserting 1(7A). The relevant case law establishes a purely degenerative condition which is not the result of injury or disease does not meet the first prong of the 1(7A) defense and, as a result, the defense must fail.