Opinion ID: 199579
Heading Depth: 4
Heading Rank: 2

Heading: St. Paul's workers' compensation obligations

Text: 35 We next turn to the question of whether the workers' compensation context increases St. Paul's burden beyond this showing of detrimental reliance. We first look to St. Paul's obligations under the workers' compensation laws. The existence of a second injury with a causal relationship to the accident at the Westford Regency Hotel is central to the issue of whether St. Paul was required to pay benefits to Formoso. Under Massachusetts workers' compensation law, when an employee suffers an accident that exacerbates a pre-existing injury or that causes a new injury at the same location as a prior injury, full responsibility for that injury rests with the insurer providing coverage for the second accident and not with the insurer who was responsible for the prior injury. Thus, [w]here an employee . . . has suffered a series of compensable injuries, he has a right to be paid compensation by the insurer on the risk at the time of the most recent injury shown to have a causal connection with his present incapacity. Falcione's Case, 26 N.E.2d 308, 309 (Mass. 1940); see also Tassone's Case, 116 N.E.2d 126, 127 (Mass. 1953); Evans's Case, 13 N.E.2d 27, 29 (Mass. 1938). Applying this principle to the present case, if Formoso was actually injured or if a prior injury was aggravated during the Westford Regency Hotel accident, then St. Paul would have been required to pay benefits despite its attempts to disclaim coverage. 36 It does not follow, however, that because St. Paul would have been required to pay benefits if there were a second injury, it also had the burden of proving the absence of such an injury. Indeed, Massachusetts law is squarely to the contrary. It has uniformly been held by this court that the burden of proof remains throughout the trial on the [employee] to establish his case on all the evidence where liability is denied, or the amount to be recovered is in issue. In re Ginley, 138 N.E. 719, 720 (Mass. 1923); see also In re Quigley, 10 Mass. Workers' Comp. Rep. 291, 1996 WL 143444 at  (Mass. Dept. Ind. Acc. March 27, 1996) (It is established law that the employee has the burden of proving medical causation and every other element of her claim.). This allocation of burdens remains the same whether an insurer has denied benefits outright or has filed a motion for discontinuance. In re Quigley, 1996 WL 143444 at  (The burden of proving benefit entitlement does not shift; in a discontinuance proceeding, it continues to rest on the employee.). Thus, whenever there is an issue of the assignment of causation for an injury to a specific accident, the employee bears the burden of establishing that causation. Id. 37 If St. Paul had discovered the fraud and contested Formoso's right to receive benefits, therefore, Formoso would have borne the burden of proving his entitlement to those benefits. We conclude that the Massachusetts courts would not shift this burden to the insurer in a later action alleging fraud. Indeed, Ellis has provided no argument explaining why the burden should shift and so increase the insurer's proof beyond a showing of detrimental reliance. Nor could he. Ellis's argument for burden shifting on the damages issue only arises once the insurer has demonstrated all of the other essential elements of a fraud that spared Formoso and Ellis the burden of proving the claim for benefits in a workers' compensation proceeding. Allowing the burden to shift to the insurer in this fraud action despite that avoidance would only serve to reward fraudulent wrongdoing. Given the striking similarities between the injuries alleged to have resulted from both the Victory Button and the Westford Regency Hotel accidents, along with the other facts of this case, that burden may have been a difficult one for Formoso and Ellis to surmount in a workers' compensation proceeding. We decline to reward such fraud by shifting this burden to St. Paul. Of course, it remains open to Ellis, if he chooses to do so, to shoulder the burden of proving, as a defense to the damages claim in this fraud case, that despite his wrongdoing, St. Paul would still have been required to pay the benefits it paid to Formoso. 10 Cf. Lorber v. Beebe, 407 F. Supp. 279, 289 (S.D.N.Y. 1976). 38 Our conclusion on this point is bolstered by the Massachusetts cases analyzing burdens of proof in case within a case attorney malpractice actions. In these actions, once some form of negligence has been shown on the part of the defendant attorney in the malpractice action, the issue of the defendant's ultimate liability for damages turns upon whether his or her negligence affected the result in the prior action. The burden of proof, however, does not shift between the prior action and the action for malpractice. The factual issues once involved in the underlying action are presented to the trier of fact in the [malpractice] case with the burden of proof placed precisely as it was in the underlying action itself. Glenn v. Aiken, 569 N.E.2d 783, 786, 787 (Mass. 1991). Thus, if a plaintiff in the malpractice action (the status comparable to St. Paul's in this case) would not have borne the burden of proof in the underlying action, that burden does not shift to it. Instead, the negligent defendant (the status comparable to Ellis's in this case) bears the burden of showing that its negligence produced no loss to the plaintiff because, even if there had been no negligence, the underlying action would have achieved the same result. Glidden v. Terranova, 427 N.E.2d 1169, 1171 (Mass. App. Ct. 1981) ([S]ince the client had no obligation 'to prove his case' in the underlying action (he could have simply required the plaintiff to prove his case), he should not shoulder the burden of proving a defense in the malpractice action. (quoting Nolan, Tort Law § 182 at 297)); see also Deerfield Plastics Co. v. Hartford Ins. Co., 536 N.E.2d 322, 324 (Mass. 1989) (reaching the same conclusion regarding burdens in a dispute over an insurer's unreasonable settlement of a workers' compensation claim). This principle is entirely consonant with our conclusion that the burden of proof regarding Formoso's legal entitlement to benefits did not shift to St. Paul when it filed this fraud action against Ellis.