Accidental Disability Retirement cases in Massachusetts begin with an employee’s treating physician making a determination that the employee is unable to perform the essential duties of his position and that the disability is job-related and permanent. Once the physician makes this determination, he should be asked to complete a physician’s statement to document his findings.
Next, the disabled employee files an application for disability retirement along with the physician’s statement. In response to the application and supporting physician’s statement, a three-physician regional medical panel is appointed to examine the applicant. The panel then issues a certificate answering the following three questions: (1) whether the applicant is disabled; (2) whether the disability is permanent; and (3) whether the applicant sustained the disability in the performance of his duties. The medical panel’s certificate must be supported by a report which explains how the panel reached its conclusions. The certificate and narrative report serve two roles in the application process: (1) gatekeeping and (2) medical expertise. In both capacities, the purpose of the medical panel examination and certificate is to “vest in the medical panel the responsibility for determining medical questions which are beyond the common knowledge and experience of the members of the retirement board.”
In its gatekeeping role, the medical panel must answer in the affirmative all three of the certificate questions for the application to be approved by the retirement board. The application cannot move forward where the majority of the medical panel responds in the negative to any of the three certificate questions (disability, permanency, and causation.)
Where there is an affirmative certification, the medical panel has fulfilled its gatekeeper role and its findings serve as expert medical evidence, which the board takes into account along with all other evidence when making its determination of causation. An affirmative certification is not conclusive and the determination of the ultimate fact of causation is reserved to the appeal board.
Once a majority of the medical panel responds affirmatively to the three statutory questions, the burden of proving disability is on the applicant. This is true both of the issue of disability and, for accidental disability cases, the issue of the causal nexus between the disability and the job-related accident. There are some exceptions to this usual analysis of causation in certain accidental disability retirement cases, such as in cases involving statutory presumptions.