What Do You Think: Did Lump Sum for Right Shoulder Prevent Benefits for Left?

Boston, MA (WorkersCompensation.com) – What effect does a lump sum for one sore shoulder have on recovery for pain in the other shoulder?

As a recent Massachusetts case shows, the answer could be “plenty.”

A resident services assistant for an assisted living facility experienced pain in her right shoulder and neck while lifting a resident out of a wheelchair. She underwent surgery for these injuries. Prior to the procedure, the assistant began to experience pain in her left shoulder, which she continued to experience while recovering from the right shoulder surgery.

The insurer accepted liability for the right shoulder injuries and related treatment. About one year after the surgery, the parties entered into a lump sum agreement under which the insurer agreed to pay the assistant $24,500 plus an additional $5,500 for attorney’s fees.

The agreement stated that “the parties understand and agree that the herein proposed lump sum settlement closes out any claim that [the] [e]mployee may have.”

Following the settlement, the assistant continued to see her orthopedic surgeon. Eventually, she filled a second claim for coverage of medical expenses to treat and repair her left shoulder.

The insurer opposed the claim on the ground that the lump sum agreement barred recover for additional injuries arising out of the same accident.

An administrative judge found in the assistant’s favor and ordered the insurer to pay the assistant medical benefits for her left shoulder surgery and rehabilitation. On appeal, the reviewing board of the Department of Industrial Accidents reversed, holding that because the assistant was aware of her left shoulder injuries at the time she entered into the lump sum agreement, further recovery was not available.

The assistant appealed to court.

Under Massachusetts law, an employee is precluded from filing a claim for known but unspecified injured body parts stemming from an industrial accident known prior to a lump sum settlement. Once an administrative judge has approved an agreement, payment made by the insurer is a full settlement of all compensation due to the employee unless a benefit is specifically reserved in the settlement papers.

Did the lump sum agreement prevent the assistant from receiving benefits for her left shoulder?

A. Yes. The assistant knew about her left shoulder problems and did not reserve the right to claim benefits at a later date when entering into the lump sum agreement.

B. No. The agreement was silent about the assistant’s left shoulder injury, so she could pursue a new claim.

If you picked A, you agreed with the court In Re Lamport’s Case, No. 21-P-622 (Mass. App. Ct. 04/28/22), which held in the facility’s favor by determining that the assistant was not entitled to benefits for the left shoulder.

The court held that the reviewing board of the Department of Industrial Accidents correctly concluded that a lump sum agreement between the assistant and the insurer for injuries to the assistant’s right shoulder and neck arising from out of the accident barred further recovery for different known injuries arising out of the same accident. The court reached this conclusion because the assistant was aware of the different injuries she had at the time she entered into the lump sum agreement but failed to specifically reserve or exclude her left shoulder injuries from the agreement’s scope.

This feature does not provide legal advice.

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