What type of an injury qualifies as a compensable injury?
A compensable injury can be a physical injury, a mental/emotional injury, or an injury brought about by exposure to poor indoor air quality. Regardless of the type of injury, the injury must arise in and out of the course of employment.
To be entitled to weekly disability benefits, a member must be unable to earn full wages for five or more calendar days. If the incapacity lasts for at least twenty-one days, then compensation is paid from the first date of incapacity.
If the incapacity extends more than five, but less than twenty-one days, then compensation is paid from the sixth day of incapacity. (See M.G.L. c.152, Sec. 29).
If an employee is unable to work for less than five days due to an industrial injury, he or she is not eligible for disability benefits, but the Workers’
Compensation insurer is responsible for paying for medical treatment related to the injury.
To have a compensable case, a member must satisfy the notice and claim provisions of M.G.L., c. 152. A claim for workers’ compensation benefits must be filed within four years from the date the member first becomes aware of the causal relationship between his/her disability and employment. Both the payment of Workers’ Compensation benefits and the filing of a claim tolls the statute of limitations. (See M.G.L. c. 152, Sec. 41). Notice of an industrial injury should be provided as soon as practicable and should be in writing indicating the time, place and cause of injury. (See M.G.L. c. 152, Sec. 41, 42, 43, 44).
1. Physical injuries
Ordinarily, a physical injury that arises out of and in the course of employment will be compensable under the worker’s compensation statute. However, there exists a line of cases in which workers’ compensation benefits have been denied for bodily wear and tear resulting from a long period of hard work. For example, benefits have been denied to a laborer whose back was weakened by years of hard labor, to a watchman whose heart failed from the aggravating effect of miles of nightly walking at work upon a preexisting heart condition, to a cigar roller who suffered a nerve disorder from years of sitting with poor posture to roll cigars, and a machinist whose hand was injured by years of handling tools.
The line between a compensable injury and "wear and tear" is a delicate one. To be compensable, the injury or illness must arise either from a specific incident or series of incidents at work, or from an identifiable condition that is not common and necessary to all or a great many occupations.
2. Pre-Existing Injuries
Pre-existing injuries that are aggravated by a work-related incident, accident or event are compensable under the Worker’s Compensation Act as long as the aggravation remains a major cause of the disability or need for treatment. In other words, if the Employee has an underlying condition or disease, and a work injury sets off an identifiable causal chain that would otherwise have remained inactive, the disability and medical treatment caused by the worsening of the underlying condition will be compensable.
3. Psychiatric injuries
Psychiatric or emotional injuries trigger a higher causation standard than do physical injuries; the predominant contributing cause of the disability must be an event or series of events occurring within the employment. (See M.G.L. c. 152, Sec, 1(7a)). In addition, employers utilize the bona fide personnel action defense in many mental/emotional cases. This means that there is no compensable injury if the mental/emotional injury results from good faith personnel actions such as an increased workload, transfer, promotion, demotion or termination. (See M.G.L. c. 152, Sections 1(7A) and 29.
4. Special Problems of Environmental Injuries
Environmental injuries caused by poor indoor air quality raise specific issues not involved in other claims. For instance, because environmental injuries generally occur and evolve over a long period of time, it is often difficult to pinpoint a date of injury. In that case, the date of the last exposure is considered the date of injury and the insurer covering the risk at the time of the most recent injury must assume all payments for the final disability.
In these cases, moreover, it is particularly important to exclude alternative causes for the symptoms and disability, such as allergies and animals, heating systems and chemicals in the home.
Lastly, some increasingly common diagnoses are troubling to the courts and the Department of Industrial Accidents due to the difficulty of proving the existence of the illness and its causal relationship to the work environment. The most challenging diagnosis is that of Multiple Chemical Sensitivity (“MCS”).