Witness's statement provides insurer with plausible defense

In Massachusetts, if an insurer has adequate grounds for presenting an alternate version of events, the insurer will not be liable for penalties.

Case name: DiFronzo's Case, No. SJC-10785 (Mass. 04/12/11).

Ruling: The Massachusetts Supreme Judicial Court held that an insurer was not liable for a penalty of double back benefits and costs.

What it means: In Massachusetts, if an insurer has adequate grounds for presenting an alternate version of events, the insurer will not be liable for penalties.

Summary: A laborer on a construction project was injured when he was struck by a car while crossing the street soon after completing his shift. A witness said that the laborer told him he was crossing the street to catch his bus home while the laborer claimed he was crossing the street to use a two-way radio in one of the employer's trucks to contact his supervisor. The employer's insurer denied benefits, arguing that the laborer was on his commute home when he was injured. A workers' compensation judge ruled for the worker. The Massachusetts Supreme Judicial Court held that the insurer was not liable for penalties of double back benefits and costs.

In Massachusetts, penalties can be assessed on an insurer that brings a defense without reasonable grounds. The court concluded that the insurer had a plausible defense based on the witness's statement, which provided the insurer with an alternate version of events. The law regarding the compensability of a person injured while crossing a street from a work site to catch a bus home was unclear.

The court noted that penalties would have been appropriate if the laborer was entitled to benefits even if he had crossed the street to catch his bus.

The project was divided into "work zones" closed to the public. Workers regularly crossed public streets to move between work zones. At the time of the accident, the laborer had just finished putting away his tools and was proceeding in the direction of another work zone across the street where his employer's trucks were located.

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