Opinion
No. 15–P–1670.
10-21-2016
Michael OPARE'S CASE.
MEMORANDUM AND ORDER PURSUANT TO RULE 1:28
Michael Opare (employee) appeals from a decision of the reviewing board of the Department of Industrial Accidents (board). The board summarily affirmed a decision by an administrative judge that denied the employee's claim for medical expense benefits for back surgery. The employee argues that the administrative judge, in finding that the employee's back surgery was not causally related to his admitted industrial injury, lacked sufficient reasoning for adopting other physicians' opinions over that of the impartial physician. We disagree with the employee's contentions.
The employee's current claim derives from a prior appeal, Opare's Case, 77 Mass.App.Ct. 539 (2010) (Opare I ). In Opare I, an administrative judge approved a lump sum settlement between the employee and the insurer in spite of the employee's objections. The employee filed a complaint in Superior Court seeking a declaration that the lump sum settlement was and void. The Superior Court judge dismissed the complaint on the basis that the employee failed to exhaust his administrative remedies. We reversed the judgment of dismissal and remanded for a declaration that the lump sum settlement was and void and ordered the reinstatement of the employee's worker's compensation claim with the Department of Industrial Accidents. Id. at 544–545. The employee's new worker's compensation claim was settled by lump sum settlement in 2012. This case arises out of the employee's separate claim for medical expense benefits. See note 2, infra.
In 2010, the employee had back surgery for which the insurer refused to pay.
Discussion. We review the administrative judge's decision, as affirmed by the board, pursuant to the standards of the Administrative Procedure Act, G.L. c. 30A, § 14(7)(a )-(d ) and (f )-(g ), and determine if the decision is based on an error of law, arbitrary or capricious, an abuse of discretion, or otherwise not in accordance with law. See Wilson's Case, 89 Mass.App.Ct. 398, 400 (2016).
In accordance with G.L. c. 152, § 11A, an impartial medical examiner, Dr. Steven Silver, examined the employee and opined that the employee's “difficulties bear a causal relationship to his [2006] injury at work.” Dr. Silver further concluded that the employee had preexisting spinal stenosis but experienced “no prior symptoms for his difficulties.” The administrative judge found this report to be “adequate” and admitted it in evidence as required by statute. See G.L. c. 152, § 11A (administrative judge is statutorily required to accord findings of impartial physicians prima facie status). However, the administrative judge then appropriately, as is within his discretion, requested additional medical evidence due to the “complexity [of the case] in that the surgery was long ago as was the injury.” See Higgins's Case, 460 Mass. 50, 60 (2011), quoting from G.L. c. 152, § 11A(2) ( “[A]dditional medical evidence may be admitted only on a finding by the administrative judge that it is necessary ‘due to the complexity of the medical issues involved’ ”).
The employee does not contest the administrative judge's decision to allow additional medical evidence, sua sponte, nor does he contest the administrative judge's rationale for that decision. Instead, he argues that the administrative judge failed to provide adequate reasoning for adopting other physicians' opinions rather than that of the impartial physician. An administrative judge's findings must be “reasonably deduced from the evidence and the rational inferences of which it was susceptible.” Pilon's Case, 69 Mass.App.Ct. 167, 169 (2007). Here, the administrative judge explicitly stated that “after reviewing all of the medical evidence submitted,” he adopted the opinions of Dr. Richard Anderson and Dr. Kevin Sullivan. Based on these medical opinions, and specifically persuaded by Dr. Anderson's opinion, the administrative judge found that the employee's subsequent surgical treatment was a “result of the [employee's] preexisting condition[s] ... and not the reported work injury.” See ibid. (“Findings of fact, assessments of credibility, and determinations of the weight to be given the evidence are the exclusive function of the administrative judge”). We therefore conclude that the administrative judge's findings were not “wholly lacking in evidentiary support or ... tainted by errors of law.” Woolfall's Case, 13 Mass.App.Ct. 1070, 1070 (1982), quoting from Sweeney's Case, 3 Mass.App.Ct. 284, 286–287 (1975).
The administrative judge also stated that he considered “the testimony and evidence presented,” including his “observation of the [e]mployee, his demeanor and judging his veracity, as well [as] taking into account his education, training and work history.”
The employee's request for attorney's fees is denied.
Decision of reviewing board of Department of Industrial Accidents affirmed.