Doctor's opinion must address major contributing cause

In a combination injury case in Massachusetts, a causation determination must be grounded in competent medical evidence that satisfies the applicable "major cause" standard.

Case name: In re Claudette Stewart's Case, No. 08-P-919 (Mass. App. Ct. 08/04/09).

Ruling: The Massachusetts Court of Appeals remanded a decision of the Department of Industrial Accidents for the administrative judge to evaluate additional medical evidence.

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What it means: In a combination injury case in Massachusetts, a causation determination must be grounded in competent medical evidence that satisfies the applicable "major cause" standard. A finding of heightened causation must be supported by medical opinions that address -- in meaningful terms, if not the workers' compensation law's exact language -- the relative degree to which compensable and noncompensable causes brought about the employee's disability.

Summary: A practice assistant at a medical center injured her back and neck while transporting a patient on a stretcher. Despite extensive treatment, the employee developed a disabling neurological condition. The employee and employer submitted medical opinions from seven different doctors to the AJ. However, the AJ only relied on the report and opinion of one doctor. That doctor's opinion indicated the employee had a preexisting spinal condition, but ultimately concluded her disability was caused by the work injury. The Massachusetts Court of Appeals noted that the doctor never specified whether the work injury was a "major cause" of the employee's condition when considered in relation to her preexisting condition. It stated while there are no "magic words" a doctor must use, an opinion expressed in terms substantially equivalent to those in the workers' compensation will support the requisite finding.

The court pointed out that the flaw in the doctor's analysis was that nowhere in the report did he opine as to the relative significance of the incident-related causes of the employee's disability as compared with her significant preexisting condition. The AJ's determination that the injury, alone or in combination with the aggravation of the preexisting condition, was a major factor in causing her present disability was therefore not properly supported by the only opinion on which the AJ relied.

The Court of Appeals pointed out that even though the AJ's finding of causation could not properly be grounded solely doctor's opinion, there was other medical evidence that could add to the analysis and support the conclusion that the employee's work injury was the major contributing cause of the disability. It therefore vacated the finding and remanded the case for the AJ to consider the other medical opinions.

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September 14, 2009

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