Failure to submit to independent medical exam justifies suspension of benefit payments

In Massachusetts, an employee who refuses to submit to an IME or in any way obstructs it may have his compensation suspended.

Case name: Kendrick's Case, No. 09-P-618 (Mass. Ct. App. 05/04/10, unpublished).

Ruling: In an unpublished decision, the Massachusetts Appeals Court partially upheld the reviewing board's decision permitting an insurer to suspend payment of workers' compensation benefits based on the worker's failure to submit to an independent medical examination. However, the insurer's suspension of payments based upon the worker's failure to submit an earnings statement to which the insurer was not entitled was improper.

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What it means: In Massachusetts, an employee who refuses to submit to an IME or in any way obstructs it may have his compensation suspended. In addition, while employers have the right to demand earnings statements from workers receiving benefits, the employee is not required to file an earnings report more often than once every six months. As a result, an insurer's suspension of benefits after not receiving a second statement within a month is improper.

Summary: The employee was injured on the job in December 2004. After several hearings, an administrative law judge determined that the employee had been partially disabled since March 2005. He received benefits of $300 per week, which was to be reduced by his actual demonstrated earnings. The ALJ ordered the employee to provide documentation of his earnings and stated that failure to do so would absolve the insurer of liability for any penalties for late payment. The employee initially complied but stopped after a week. He also failed to appear for an IME, and the insurer ceased making payments. The Appeals Court upheld the suspension of benefits based on the employee's failure to appear for the examination but determined that the suspension related to his failure to produce additional earnings reports was improper.

The court noted that under Massachusetts law workers who receive benefits must submit earnings reports, but no more often than once every six months. Because the employee submitted a report in October 2006, the employer could not demand another report until April 2007. As a result, the insurer improperly suspended payments in October.

However, Massachusetts law permits suspension of payments when the worker fails to attend or otherwise obstructs an IME. The employee refused to appear for the scheduled examination in December 2006, as well as the rescheduled examination several weeks later. The court concluded that the insurer could suspend benefits from the date of the first refusal until the employee attended a rescheduled examination.

Read more at the WorkersComp Forum homepage.

July 26, 2010

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