What percentage must a work injury contribute to establish a “compensable” injury under the Massachusetts Workers’ Comp Act?

Recently, the DIA Reviewing Board in Boston addressed in a recent opinion what percentage a work injury must contribute to establish a “compensable injury” under the Massachusetts Workers’ Compensation Act, where multiple, non-work-related factors are present.

In this most recent case, Jane Sullivan v. Centrus Premier Home Care, the Insurer appealed the decision of the Administrative Judge after Hearing. One of the points raised on appeal was that the requirements set for in Chapter 152 § 1(7A) were not met with respect to disability after 9/23/09, which was the date of the § 11A Impartial examination. Section 1(7A) states, in part, that where a work injury combines with a pre-existing condition, not compensable under the MA Workers’ Comp Act, the resultant condition shall only be compensable to the extent that the compensable/work-related injury remains “a major, but not necessarily predominant cause of disability and need for treatment.”

In laymen’s terms, § 1(7A) states that where a work injury combines with a pre-existing, non-work-related injury, you must show that the work injury remains “a major, but not necessarily predominant cause” of the resultant condition. The phrase “a major, but not necessarily predominant,” has thus become subject to extensive interpretation by the Judges at the DIA, as well as the Reviewing Board.

So, the question becomes, what constitutes “a major cause?” While every case is unique and presents an almost endless array of possibilities of interpretation, the Reviewing Board, in the present case, gives a nice summary of the well established case law pertaining to this question.

In the present case, Dr. Anas, the Board Impartial physician opined that the employee’s disability was 50% related to her underlying, pre-existing, non-work-related conditions, and the remaining 50% was attributable to her injury at work. So does a work injury which contributes only 50% to a resultant disability rise above the standard set forth in §1(7A)? Here, the Reviewing Board ruled that 50% does, in fact, satisfy the “a major” requirement of § 1(7A). Citing Goodwin’s Case, 82 Mass.App.Ct., 642 (2012), which stated that “a major cause need not be more than fifty percent.” (internal citations omitted).

Going further, they also cite a number of other cases. Durfee v. Baldwin Crain and Equip, 20 Mass. Workers’ Comp., Rep. 163 (2006), states, “In fact, a smaller percentage is capable of satisfying the “a major” standard.” Lesione v. Corcoran Mgt. Co., 22 Mass. Workers’ Comp. Rep. 153 (2008), states that “medical opinion that work injury was forty percent of cause satisfied” the 1(7A) standard. Finally, Abad v. Stacy’s PITA Chips Co., 25 Mass Workers’ Comp. Rep. 173 (2011), “in the proper circumstances a twenty percent contribution of a work injury to the disabling condition could satisfy the “a major” standard.”

As mentioned above, every case presents a unique set of facts and every case will likely give rise to their own unique interpretation of the 1(7A) standard. However, this case gives a good summary of some significant prior decisions in making the determination of what percentage a work injury must contribute to an underlying disability, in order to get beyond the 1(7A) standard.

Pre-existing conditions play a role in a large portion of the cases we, at the Troupe Law Office, handle on a daily basis. If you have sustained an injury at work, of any kind, it is crucial that you speak with an experienced workers’ compensation attorney as soon as possible. Please visit our web site at https://www.troupelawoffice.com for more information. Or, call us at (978) 531-7401, or email at atroupe@mac.com. We offer free consultations for all cases. We look forward to working with you.