In order to receive accidental disability benefits in Massachusetts, an applicant must establish by substantial evidence, including an affirmative medical panel certificate, that he or she is totally and permanently incapacitated from performing all of his duties as a result of an injury sustained or hazard undergone while in the performance of his duties. The regional medical panel’s function is to answer medical questions which are beyond the common knowledge and experience of retirement board members. The medical panel plays two important roles in the accidental disability retirement application screening process. First, it acts as a gatekeeper. Second, it provides medical expertise.
Unless the panel applies an erroneous standard or fails to follow proper procedures, or unless the certificate is “plainly wrong”, the local board may not ignore the panel’s medical findings.
A medical panel consists of three (3) physicians who examine the applicant either jointly or separately. The members of the medical panel will also review medical records and information including imaging studies such as MRIs and X-rays. It is impossible to get an accidental disability retirement in Massachusetts unless a majority of a three-member regional medical panel examines the pertinent medical facts and certifies that all of the conditions and requirements for accidental disability retirement are met.
In order to overturn an adverse decision made by a regional medical panel , the applicant must prove that the three-physician medical panel lacked pertinent medical facts or applied an erroneous standard in its conclusion. The panel doctors are not obligated to agree with opinions of other physicians and a conflict between the opinion of a regional medical panel and other physicians does not mean that the panel applied an erroneous standard.
In some cases, if the information provided by the medical panel does not provide sufficient information to the retirement board, the board has the option to submit a request for clarification to the panel. In such a situation the panel physicians will have an opportunity to further explain their opinions and conclusions by answering the board’s questions.
In situations where a two out of the three members of a properly constituted regional medical panel issue a negative certification, the application for accidental disability retirement benefits must be denied. Unless it can be shown that the panel lacked significant information or applied an incorrect standard, a retirement board cannot grant an accidental disability retirement. If the medical certification is proper, a board may not substitute its judgment for the opinion of the majority members of the panel, even if other doctors have issued contrary opinions.
ADR applicants in Massachusetts who are represented by lawyers have the legal right to have the applicant’s attorney attend the medical panel examination.