Ouch. Massachusetts Worker Shoulders Burden of Injury Omitted From Lump Sum

A Massachusetts woman who signed a lump sum settlement with her workers’ compensation carrier over a right shoulder injury cannot later obtain benefits for a left shoulder injury linked to the same incident because she did not specifically mention the second injury in the settlement.

The Massachusetts Supreme Judicial Court has affirmed a workers’ compensation board decision siding with the insurer, Safety National Casualty Co., that overturned an administrative judge who ruled the plaintiff was entitled to a second claim.

The question for the high court was whether Safety National’s lump-sum settlement with Mary Lamport with respect to her right shoulder injuries foreclosed her ability to file a claim with respect to her left shoulder injuries arising out of the same occurrence.

Lamport worked at an assisted living facility. On April 10, 2016, while lifting a resident out of a wheelchair, she experienced severe pain in her right shoulder and neck. In early February 2017, she underwent arthroscopic surgery to repair her right rotator cuff and related right shoulder injuries.

Prior to this procedure, because Lamport was favoring her injured right shoulder, she began to experience pain in her left shoulder. One month before her right shoulder surgery, Lamport complained to her surgeon of persistent left shoulder pain. The surgeon ordered a magnetic resonance imaging (MRI) scan of the left shoulder. Lamport continued to experience left shoulder pain during and after recovery from the right shoulder surgery.

The insurer accepted liability for the right shoulder injuries and related treatment, and about one year after the surgery, on February 13, 2018, the parties entered into a lump-sum agreement.

About one year later, Lamport filed a second claim, this time for coverage of medical expenses to treat and repair her left shoulder. The insurer opposed the claim, arguing that the lump-sum agreement barred recovery for additional injuries arising out of the same accident.

The industrial accident administrative judge found that Lamport’s counsel and the insurer “had knowledge, or should have had knowledge, of the employee’s left shoulder pain and its potential causal relationship to the work injury of April 10, 2016,” at the time they finalized the lump-sum agreement. The administrative judge believed that the agreement’s silence with regard to the left shoulder injuries meant that Lamport could file a new claim.

However, the workers’ compensation board held that the omission compelled “the opposite conclusion.” Lamport appealed that board’s decision to no avail.

The state’s high court has now affirmed the long-standing policy that once an administrative judge has approved an agreement, payment made by the insurer is a “full settlement of all compensation” due to the employee under the state’s workers’ compensation law and if the parties intend to reserve the right to claim an injury, they must specifically state so in the lump sum settlement.

Such a lump-sum agreement precludes reopening of the case except upon a showing of fraud or mutual mistake, according to the court.