Richard S. Higgins (employee) injured his back while working for the school department of Maynard. The employee filed a workers’ compensation claim with the Department of Industrial Accidents (department). In connection with that claim, the self-insurer, Massachusetts Education and Government Association (self-insurer), requested that the employee submit to a medical examination pursuant to G. L. c. 152, § 45. The employee sought to compel discovery of the medical report of that examination (§ 45 report), and also to use the report to cross-examine the impartial medical examiner (impartial physician) appointed pursuant to G. L. c. 152, § 11 A. The self-insurer appeals from the decision of the reviewing board (board) of the department, finding in favor of the employee on both issues.
1. Background. We summarize the procedural history as well as certain facts found by an administrative judge and the board. On July 12, 2004, the employee injured his back while lifting trash barrels as part of his job for the school department. The employee filed a claim pursuant to § 10 of G. L. c. 152, the workers’ compensation act (act). The self-insurer requested that the employee submit to a medical examination by Dr. William Shea, a physician it had selected, as the self-insurer was entitled to do under G. L. c. 152, § 45 (“if requested by the insurer . . . [the injured employee shall] submit to an examination by a registered physician, furnished and paid for by the insurer”). Dr. Shea examined the employee on May 2, 2005. The self-insurer did not file a copy of Dr. Shea’s report of his medical examination with the department, and neither Dr. Shea nor the self-insurer furnished a copy of it to the employee.
Following a conference conducted pursuant to G. L. c. 152, § 10A (1), the administrative judge ordered the self-insurer to pay the employee a closed period of total temporary disability benefits, an open period of partial disability benefits, and medical benefits. Disputing the cause of the employee’s medical condition, the self-insurer appealed from the conference order and sought a hearing pursuant to G. L. c. 152, § 10A (3). In advance of the hearing, the administrative judge appointed Dr. Nabil Basta as the impartial physician to examine the employee and render an opinion in the form of a report as to the cause and extent of the employee’s injury pursuant to G. L. c. 152, § 11A (§ 11A report).
On July 8, 2005, shortly before the impartial physician was
The administrative judge adopted the impartial physician’s opinion as set forth in the § 11A report, and found that the employee suffered from a preexisting chronic degenerative disc disease that had been aggravated by a work-related injury. The administrative judge also found, in accordance with the impartial physician’s opinion, that the impairment resulting from this injury had resolved by the date of the impartial physician’s § 11A examination on July 12, 2005, and therefore ordered discontinuance of the employee’s partial disability benefits as of that date.
In his appeal to the board pursuant to G. L. c. 152, § 11C, the employee argued in relevant part that he should have been permitted to discover Dr. Shea’s § 45 report and to use that report in cross-examining the impartial physician at deposition. The board agreed, concluding in essence that employees who are subject to examinations conducted pursuant to G. L. c. 152, § 45, are entitled to discovery and production of reports made in connection with such examinations. The board also concluded that due process concerns and the unique role of the § 11A
2. Standard of review. We review decisions of the board in accordance with the standards set forth in G. L. c. 30A, § 14 (7) (a)-(d), (f), and (g). Scheffer’s Case,
3. Discovery of the § 45 report. We agree with the board that
Section 20 of G. L. c. 152 provides in pertinent part:
“All medical records and reports of hospitals, clinics and physicians of the insurer, employer, or of the employee shall be filed with and open to the inspection of the division so far as relevant to any matter before it. Such reports shall be open to the inspection of any party.”
On its face, the requirement that “all” medical reports of physicians of the insurer must be filed and open to inspection appears to include the § 45 report.
The self-insurer asserts that G. L. c. 152, § 20, does not apply to nontreatment medical reports such as those created pursuant to G. L. c. 152, § 45. In support of this view, the self-insurer relies primarily on language in G. L. c. 152, § 45, which permits the insurer to require the employee to submit to ongoing medical examinations and requires “the insurer to file with the division a copy of the report of its examining physician or physicians if and when such report is to be used as the basis of any order by the division.”
Broad discovery by a party of medical reports procured by another party is consonant with the workers’ compensation scheme, which provides an alternative to traditional tort litigation by creating an insurance-based remedy for work-related injuries. See Saab v. Massachusetts CVS Pharmacy, LLC,
That the employee’s right of access and inspection translates to a right of compelled discovery also finds support in the liberal provisions for discovery of medical records and reports provided by the act and department regulations. General Laws c. 152, § 5, grants authority to the department to promulgate rules and regulations authorizing “a party, on or after the filing of any [workers’ compensation claim], to serve on any party, employer or medical provider rendering medical treatment to the claimant, a request to produce, and permit the party making such request to inspect and copy, any medical notes, treatment reports and employment records.” Of particular relevance is the regulation providing that on “written motion of an appropriate party, the administrative judge . . . may require . . . any request for discovery, including any request submitted under 452 [Code Mass. Regs. §] 1.12(1) or (2) [(2008)], be complied with.” 452
We therefore agree with the board that the employee was entitled to obtain a copy of the § 45 report through discovery.
4. Use of § 45 report to cross-examine the impartial physician. The appointment of an impartial physician pursuant to
Appointment of an impartial physician is mandated when a workers’ compensation claim involving a disputed medical issue has advanced to the hearing stage of department proceedings. See G. L. c. 152, § 11A (2); Murphy v. Commissioner of the Dep’t of Indus. Accs., supra at 224. The impartial physician’s report, which must reflect determinations regarding both the cause and extent of disability,
Except in limited circumstances, the procedure set forth in G. L. c. 152, § 11A (2), does not contemplate direct admission
A procedure that limits the presentation of relevant evidence and relies on the impartial physician to provide prima facie evidence of the cause and extent of disability in the context of a workers’ compensation claim risks denying a party (and, in particular, an employee) the opportunity fairly to present that party’s position on the disputed medical issue, which, in the tort context, a party would do by offering his or her own medical evidence. Id. at 19-24. See Meley’s Case,
We are here concerned only with the deposition of the impartial
The self-insurer argues that an employee may not use a § 45 report in cross-examination of an impartial physician because, unless and until the self-insurer places such a report at issue, it constitutes inadmissible hearsay. We address this claim briefly, even though in the procedural posture of this case, we do not know what the report contains or what use the impartial physician will make of it. The self-insurer’s position rests on the principle that an expert’s opinion, including that of an impartial physician, must “be based solely on the expert’s ‘direct personal knowledge’ or [otherwise] admissible evidence,” Patterson v. Liberty Mut. Ins. Co.,
Even if we assume, without deciding, that a party who cross-examines the impartial physician is confined to independently admissible evidence, the argument still fails. Expert opinions, including those of an impartial physician, may be based “on facts or data not in evidence if the facts or data are independently admissible and are a permissible basis for an expert to consider in formulating an opinion.” Department of Youth Servs. v. A Juvenile,
Based on the foregoing, we conclude that, in the context of the workers’ compensation scheme, a report of a physician’s examination of an employee procured by the employer or insurer under § 45, that is related to the employee’s work-related injury, may be used by the employee to cross-examine the impartial physician, regardless of whether such a report has been admitted in evidence at a hearing or otherwise placed at issue by the employer or insurer.
5. Conclusion. The decision of the reviewing board is affirmed and the matter is remanded to the department for further proceedings consistent with this opinion.
So ordered.
Notes
As discussed in part 4, infra, G. L. c. 152, § 11A (2), provides for the appointment of an impartial medical examiner (impartial physician) when a workers’ compensation claim advances to the hearing stage of the proceedings and involves a disputed medical issue. The § 11A report constitutes prima facie evidence of the contested medical issue at the hearing. G. L. c. 152, § 11A (2).
The parties agree, and we proceed on the assumption, that the motion was filed on July 8, 2005, although the record before us does not include evidence of its filing.
The hearing before the administrative judge commenced on January 31, 2006. On that date, the employee testified and the impartial physician’s report was submitted in evidence. In addition to requesting permission to depose the impartial physician, the employee sought to admit additional medical evidence. The administrative judge deferred ruling on the motion for additional medical evidence until after the deposition, and the motion was subsequently denied.
The reviewing board (board) of the Department of Industrial Accidents (department) concluded that the employee should “be granted the opportunity to cross-examine the impartial physician, using the report of the [G. L. c. 152, § 45,] medical expert [(§ 45 report)],” and that the self-insurer should “bear the costs associated with the further deposition.” It is plain from the context of the board’s decision that the reference to “the further deposition of Dr. Shea” is an error and that the intended reference was to Dr. Basta, the impartial physician.
In Anzalone v. Massachusetts Bay Transp. Auth.,
The board does not assert that the § 45 report is subject to mandatory filing, and we have not discovered any statute or regulation that imposes sanctions for the failure to file, in contrast to G. L. c. 152, § 30A, which imposes the sanction of civil fines on a physician who fails to furnish to the employee “[a]ny medical report pertaining to an injury which appears to be compensable . . . .” See note 10, infra.
General Laws c. 152, § 45, reads, in pertinent part:
“After an employee has received an injury, and from time to time thereafter during the continuance of his disability he shall, if requested by the insurer or insured, submit to an examination by a registered physician, furnished and paid for by the insurer or the insured. The employee may have a physician provided and paid for by himself present at the examination. If a physician provided by the employee is not present at the examination, it shall be the duty of the insurer to file with the division a copy of the report of its examining physician or physicians if and when such report is to be used as the basis of any order by the division. If the employee refuses to submit to the examination or in any way obstructs it, his right to compensation shall be suspended, and his compensation during the period of suspension may be forfeited.”
See DaLomba’s Case,
See, e.g., G. L. c. 152, § 7G (authorizing department to “promulgate rules setting forth the required documentation to be attached to any claim [which] shall be a prerequisite for the acceptance of said claim”); 452 Code Mass. Regs. § 1.07 (2008) (listing various forms of medical documentation required to be filed with certain claims); 452 Code Mass. Regs. § 1.08(7) (2008) (requiring for all contested claims that claimant provide at conciliation “all relevant medical records completed and available to the claimant . . . which contain any history of the injury ... or which contain opinions by medical personnel as to the nature and causation of the injury or condition being treated”); G. L. c. 152, § 10A (1) (granting administrative judge broad authority to “require and receive reports of injury, signed statements of the employee and any witnesses, medical, hospital, and rehabilitation records, and other written and oral matter” for consideration at conference); 452 Code Mass. Regs. § 1.10 (3) (2008) (same); G. L. c. 152, § 20A (requiring insurer or employer who maintains a clinic, dispensary, or hospital for treatment of injured employees to furnish any employee attending such facility “with copies of all reports of all medical examinations . . . showing the history obtained, the nature of the treatment given or prescribed, the diagnosis and the prognosis”). See also G. L. c. 152, § 5; 452 Code Mass. Regs. § 1.12(2) and (4)(a) (2008), discussed in text.
General Laws c. 152, § 30A, provides in pertinent part: “Any medical report pertaining to an injury which appears to be compensable shall be furnished by the physician or other medical provider to the employee, the insurer, and the department. . . .” Department regulations interpreting G. L. c. 152, § 30A, require only that reports made following “an initial medical examination by an attending physician of an employee, or of any subsequent examination by such physician indicating a change in the capacity of an employee” must be so furnished. 452 Code Mass. Regs. § 1.13(1) (2008). See L.Y. Nason, C.W. Koziol, & R.A. Wall, Workers’ Compensation § 16.7, at 495 (3d ed. 2003). Cf. Young v. Evans Delivery, 23 Mass. Workers’ Comp. Rep. 391, 401 n.11 (2009) (noting “treating orthopedic surgeon,” who was not primary care physician, was required by G. L. c. 152, § 30A, and 452 Code Mass. Regs. § 1.13[1] [(2008)] to furnish medical reports to department and each party); L.Y. Nason, C.W. Koziol, & R.A. Wall, supra at § 16.7 (discussing “discovery procedure contained in” G. L. c. 152, § 30A).
Under 452 Code Mass. Regs. § 1.12(2), any party may, after the filing of a workers’ compensation claim, “serve on any other party, employer or medical provider rendering treatment to the claimant, a request to produce, and permit the party making the request to inspect and copy, any medical notes [and] treatment reports.”
Our decision is consistent with the legislatively indorsed public policy, expressed in other chapters of the General Laws, that individuals who are required to submit to medical examinations or evaluations at the request of other parties, particularly employers or insurers, have a right to obtain copies of reports and records generated by those examinations. See, e.g., G. L. c. 149, § 19A (employer requiring physical examination of employee obligated to furnish employee with copy of medical report on request); G. L. c. 175, § 111F (injured person entitled to copy of medical reports of examinations commissioned by insurer under liability policies); G. L. c. 175, § 113J (injured person entitled to copy of medical reports of examinations commissioned by motor vehicle liability insurer); G. L. c. 1751, § 8 (obligating insurance company in possession of individual’s personal information, including medical records, to provide same to individual on request); G. L. c. 112, § 12CC (health care provider shall on request provide to patient copies of provider’s medical examination records).
General Laws c. 152, § 11A (2), provides in pertinent part:
“The impartial medical examiner . . . shall examine the employee and make a report [which shall], where feasible, contain a determination of the following: (i) whether or not a disability exists, (ii) whether or not any such disability is total or partial and permanent or temporary in nature, and (iii) whether or not within a reasonable degree of medical certainty any such disability has as its major or predominant contributing cause a personal injury arising out of and in the course of the employee’s employment. Such report shall also indicate the examiner’s opinion as to whether or not a medical end result has been reached and what permanent impairments or losses of function have been discovered, if any. . . . Either party shall have the right to engage the impartial medical examiner to be deposed for purposes of cross examination.”
We agree with the board that the workers’ compensation scheme contemplates that medical records and reports submitted to the impartial physician may be brought into the record through their consideration by the impartial physician or by the impartial physician’s deposition. Such medical records and reports, whether submitted by the employee, the employer, or the insurer, are intended to contribute to formulation of the impartial physician’s opinion or to a showing that additional medical evidence is necessary. See G. L. c. 152, § 11A (2); O’Brien’s Case,
General Laws c. 152, § 11A (2), imposes an obligation on employees to “submit to such examiner all relevant medical records, medical reports, medical histories, and any other relevant information requested” but does not impose a corresponding duty on employers or insurers. Pursuant to 452 Code Mass. Regs. § 1.14(2) (2008), on the appointment of an impartial physician,
Section 79G of G. L. c. 233 states in pertinent part:
“In any proceeding commenced in any court, commission or agency . . . reports, including hospital medical records ... or any report of any examination of [an] injured person . . . shall be admissible as evidence of. . . the diagnosis of said physician or dentist, the prognosis of such physician or dentist, the opinion of such physician or dentist as to proximate cause of the condition so diagnosed, the opinion of such physician or dentist as to disability or incapacity, if any, proximately resulting from the condition so diagnosed . . . .”
The self-insurer cites Ramacorti v. Boston Redevelopment Auth.,
We question whether this common-law principle is applicable in a workers’ compensation proceeding because it would frustrate the intent of the impartial physician scheme that seeks to replace the use of dueling experts in tort litigation. See Scheffler’s Case,
