No. 02805997 (1999). EMPLOYEE: Thomas F. Chalifoux.
Case Date | August 19, 1999 |
Court | Massachusetts |
Massachusetts Workers Compensation
1999.
No. 02805997 (1999).
EMPLOYEE: Thomas F. Chalifoux
COMMONWEALTH OF MASSACHUSETTS
DEPARTMENT OF INDUSTRIAL ACCIDENTS EMPLOYEE: Thomas F. Chalifoux EMPLOYER: United
Parcel Service INSURER: Liberty Mutual Insurance Co.BOARD NO. 02805997REVIEWING BOARD DECISION (Judges Wilson, McCarthy and Smith)APPEARANCES
Michelle K. Manners, Esq., for the employee
Patricia M. Vachereau, Esq., for the insurer
WILSON, J. The employee, who appeals
from an administrative judge's denial of his claim for penalties under
§14(1), contends that the insurer unreasonably defended the claim. Finding
no error, we affirm the decision.
The case was submitted to the administrative judge on an agreed
statement of facts. Thomas Chalifoux, a package truck driver for UPS, reported
to his supervisor on July 31, 1997 that he had injured his hip. The employer
forwarded a First Report of Injury form to its insurer on August 1, 1997. That
same day the insurer's adjuster called the employee's home, but the employee
was unavailable, and the adjuster spoke with his wife about the claim. On
August 4, 1997, the insurer contacted the office of the employee's physician,
Dr. Lobovits, and was informed that on August 1 the doctor had seen the
employee but the dictation was not yet prepared. (Dec. 2.) The insurer
requested that the information be sent to it when complete. On August 5, an
insurer representative met with the employee and received a signed
authorization to obtain information. The insurer again contacted Dr. Lobovits'
office on August 7, but was unable to get any additional information. On or
about the same day, the insurer completed an Insurer's Notification of Denial
form and forwarded it to the employee. (Dec. 3) The denial specified:
No Personal Injury. Witnesses and documents dispute that the
employee sustained an injury.
No Injury Arising Out of and in the Course of Employment. Injury
was not caused by an incident of the employment.
No Disability. No medical reports have been received to
substantiate a disability.
No Causal Relation Between Personal Injury and Disability.
Disability, if any, was caused by a non-employment source.
(Joint Exhibit D.) The insurer once more contacted Dr. Lobovits'
office on August 11, 1997, and learned that the employee was to have a bone
scan that day. Three days later, the insurer again contacted Dr. Lobovits'
office in an attempt to obtain the results of the bone scan, but was told that
the report was not yet in. On September 9, 1997, the employee forwarded his
claim (Form 110) and the medical reports of his attending physician to the
insurer. About two days later, the insurer prepared an Insurer's Notification
of Denial (Form 104), listing the same defenses as in its original denial.
(Dec. 3, Joint Exhibit H.) The insurer received the results of the employee's
bone scan on September 16, 1997, and then scheduled the employee for a medical
examination by Dr. John Duff on September 30, 1997. As the employee requested
that the examination be rescheduled, it was not held until October 22, 1997.
Meanwhile, a conciliation was held on October 8, 1997. Upon receipt of the
report of Dr. Duff's examination, the insurer requested an addendum with
reference to his opinion on causal relationship, which it...
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