For decades, Insurance Companies in Massachusetts and Self Insured’s have been finding any way possible to deny legitimate injury claims. They do this so they can either pay nothing or pay as little as possible to the injured victim. These companies do not answer to the victims. They only answer to their stockholder and owners who are looking to make as much profit as possible. In order to get accountability and justice, injured victims often have to litigate against these wealthy insurance companies for years. Many of these insurance companies use the ‘4 D’ strategy: Deny, Delay, Duck and Defend. In the case of self -insured entities, the matter is even more troubling.
Keep in mind, if the Insurance Company’s adjuster delays payment – the corporation gets to keep the reserve and gain interest off of the funds. It is all too easy to forget the battles that personal injury lawyers fought against greedy and ruthless insurance companies in the past.
Workers’ compensation in Massachusetts
Workers’ compensation in Massachusetts is a state-regulated insurance program designed to provide benefits to employees who are injured or become ill due to their work. Here are some key points about workers’ compensation claims in Massachusetts:
- Mandatory Coverage: In Massachusetts, most employers are required to carry workers’ compensation insurance. This includes businesses with one or more employees, full-time or part-time, regardless of the number of hours worked. There are some exceptions for specific types of employment.
- Benefits:
- Medical Benefits: Workers’ compensation covers all necessary medical treatment related to a work-related injury or illness.
- Temporary Total Disability Benefits: If the employee is unable to work due to the injury or illness, they may be eligible for weekly compensation payments equal to 60% of their average weekly wage.
- Partial Disability Benefits: If an employee can work but earns less due to the injury, they may receive partial disability benefits.
- Permanent and Total Disability Benefits: In cases where the injury results in permanent and total disability, an injured worker can receive benefits for life.
- Death Benefits: In cases of fatal workplace injuries, surviving dependents may be eligible for death benefits.
- Filing a Claim:
- Employees should report work-related injuries to their employer as soon as possible.
- Employers must then file a “First Report of Injury” with their workers’ compensation insurance carrier.
- If a claim is disputed, the Massachusetts Department of Industrial Accidents (DIA) may become involved to mediate or resolve the dispute.
- Statute of Limitations: In Massachusetts, there’s a four-year statute of limitations for filing a workers’ compensation claim. This means that an injured worker has up to four years from the date of the injury to file a claim.
- Choosing a Doctor: In Massachusetts, an injured worker has the right to choose their own doctor, as long as the doctor is part of the employer’s workers’ compensation insurance network.
- Dispute Resolution: If there are disputes or disagreements regarding the claim, the Massachusetts Department of Industrial Accidents (DIA) may schedule a conciliation, conference, or hearing to resolve the issue.
- Legal Representation: In some cases, it may be beneficial to consult with an attorney who specializes in workers’ compensation claims to ensure your rights are protected, especially if your claim is disputed or complex.
It’s important to keep in mind that workers’ compensation laws and regulations can change over time, so it’s advisable to check with the Massachusetts Department of Industrial Accidents or consult with a legal professional for the most up-to-date and specific information related to workers’ compensation claims in the state.
Troubling Workers Compensation Case: “MARY E. CANAVAN’S CASE”
The troubling 1974 Massachusetts workers compensation case “Mary E Canavan’s Case” is a classic example. This is a classic case of big government and insurance denying defending and ducking responsibility in an health care employment injury cause of action. Refer: MARY E. CANAVAN’S CASE, 364 Mass. 762 (1974)
- Mary Canavan was a health care employee / nurse working as an employee for the city of Boston trying to make ends meet. Id.
- She was a nurse at the Long Island Hospital in Boston. Id.
- The City of Boston was a self-insured entity. Id.
- At the time of the injury Ms. Canavan was injured living on hospital grounds. Id.
City of Boston tried to deny a claim
The reason this case is troubling is that the City of Boston tried to deny a claim in which a nurse on hospital grounds was injured while trying to help in an emergency situation. She did everything she could to prevent others from being killed in a boat accident on hospital grounds. She risked her own health and welfare to save others which is her responsibility as a nurse. Despite this the City of Boston forced her to litigate and refused to do what is just and right by paying her workers compensation claim!
What were the facts of this troubling workers compensation case?
The Massachusetts Supreme Judicial Court set forth the facts as follows: “About 11:30 P.M. on June 29, 1967, while returning in her car to the hospital after a day off, the employee saw two men lying on the Long Island bridge, “hollering” for help. The bridge is located on the hospital premises, and is about three and one-half miles from the public way leading to the entry to the premises. The employee stopped her car, went over to the men, observed a boat on fire in the water below them, and told them to stay there while she went for help. She drove back the three and one-half miles to the guardhouse at the entrance to the hospital grounds, told two guards on duty that there were two persons on the bridge, asked them to bring some blankets for the persons, and then drove back to the bridge with the guards following her in their car.”
“She waited on the bridge until the guards arrived and she then drove to the hospital and went to her room. About ten minutes later, while she was preparing for bed, she began to experience chest and stomach pains. The next day she called a doctor and was seen in his office. After an electrocardiogram was taken she was admitted to the Carney Hospital and confined there for one month, diagnosed as suffering from myocardial infarction. She did not return to work at the hospital until July 1, 1968, and claims total disability compensation for the period from June 29, 1967, to July 1, 1968.” Id.
Procedural history and findings
The issue of whether Ms. Canavan’s injury was caused by the incident was determined by the Industrial Accident Board. “After hearing, a single member of the Industrial Accident Board found in accord with an opinion rendered by an internist specializing in cardiology (called as a witness by the employee) that the employee’s heart condition and subsequent disability were causally related to the emotional strain brought on by the “incident” she observed on the bridge on June 29, 1967; he also found that at the time of this incident she was on the hospital premises.” Id.
Issue that The City of Boston litigated at Supreme judicial Court?
According to the Top Court in MA: “The principal issue raised before the single member and the reviewing board was whether the heart injury for which the employee claims compensation was one “arising out of and in the course of … [her] employment” as required by G.L.c. 152, § 26.”
What was the standard of review in effect at that time?
“On judicial review the findings and decision of the reviewing board must be accepted as final unless wholly lacking evidential support or tainted by error of law.” Id.
What was the Court reasoning in the Canavan’s case?
“Admittedly the employee was not on duty when she went to the aid of the men on the bridge and there was no showing that the men or the boat were in any way connected with the hospital. However, efforts to render assistance in case of emergency to people who might be injured are certainly consistent with the duties of a nurse. When such efforts are made, as in this case, by one regularly employed as a nurse while she is on her employer’s premises, we believe that an injury resulting from them could be considered as incidental to and “arising out of and in the course of” her employment, regardless of the fact that she was off duty at the time. “[T]he employee, in order to be entitled to compensation, need not necessarily be engaged in the actual performance of work at the moment of injury. It is enough if he is upon his employer’s premises occupying himself consistently with his contract of hire in some manner pertaining to or incidental to his employment.” Souza’s Case, 316 Mass. 332, 335 (1944). Horan’s Case, 346 Mass. 128, 129 (1963). See Peter’s Case, 362 Mass. 888 (1972).” Id.
“We also believe that the fact that the employee was not required to live at the hospital, but was on the premises at the time of the bridge incident because she voluntarily chose to live there, in itself is not dispositive of her right to compensation….Finally, in the circumstances of this case, the voluntary nature of the employee’s efforts to aid the men on the bridge does not make her injury non compensable as matter of law.” Id.
Did the Court decide the CASE?
No. Ms Canavan’s case was remanded to the lower tribunal for further factual findings. The appellate Court stated: “Since the evidence before the board in this case would warrant but not compel a finding that the employee’s injury arose out of and in the course of her employment, we must remand the case to the Industrial Accident Board to make a specific finding on this question
