How to File for Workers' Compensation in Massachusetts

Suffering an injury at work is a stressful experience, but understanding how to file for workers' compensation in Massachusetts can make the process smoother. The state has strict guidelines that injured workers must follow to receive benefits, including medical coverage and lost wages. This guide breaks down the necessary steps, eligibility requirements, and key factors that impact a workers' compensation claim.

Who Qualifies for Workers' Compensation in Massachusetts?

Massachusetts law requires most employers to carry workers' compensation insurance. The coverage applies to nearly all employees, whether full-time, part-time, or seasonal. Workers are eligible if they suffer a job-related injury or illness, regardless of fault. However, independent contractors, volunteers, and certain domestic workers may not qualify for benefits.

Exceptions and Limitations

While most employees are covered, there are a few exceptions:

• Independent contractors are generally not eligible unless misclassified by an employer.
• Sole proprietors and business partners are not automatically covered but can opt into coverage.
• Employees who intentionally injure themselves or are under the influence of drugs or alcohol at the time of injury may be denied benefits.

Steps to File a Workers' Compensation Claim in Massachusetts

Filing for workers' compensation involves several steps. Acting quickly is essential to ensure benefits are not delayed or denied.

1. Report the Injury Immediately

The first step in any workers' compensation claim is reporting the injury to your employer. Massachusetts law requires employees to notify their employer as soon as possible after an accident or diagnosis of a work-related illness. Failure to report promptly can result in a denied claim.

Employers are then responsible for filing a Form 101 – Employer's First Report of Injury or Fatality with their insurance company if the injury causes:

• Five or more calendar days of lost work time
• A permanent disability
• Medical treatment beyond first aid

2. Seek Medical Attention

Injured employees should get medical care right away, even if the injury seems minor. Massachusetts allows employers to designate a preferred healthcare provider for the first visit. However, after the initial visit, employees may choose their own doctor.

It's essential to inform the doctor that the injury is work-related so that medical records reflect this. Documentation from a healthcare provider plays a significant role in the claims process and can impact whether benefits are approved.

3. Employer Reports the Injury to the Insurer

If an employee misses at least five days of work, the employer must submit an injury report to its workers' compensation insurance carrier. The insurer then has 14 days to either begin payments or issue a denial.

If the employer fails to report the injury, the worker can file directly with the Massachusetts Department of Industrial Accidents (DIA) by completing a Form 110 – Employee Claim.

4. Receiving Benefits

If the claim is approved, injured workers may receive:

• Medical benefits – Coverage for necessary and reasonable medical treatment.
• Temporary total disability benefits – 60% of the worker's average weekly wage if unable to work for more than five days.
• Temporary partial disability benefits – 75% of the worker's total disability rate if they return to work at a reduced capacity.
• Permanent disability benefits – Available for workers who suffer life-altering injuries.

Payments are based on the average weekly wage in Massachusetts, which is adjusted annually. As of 2024, the statewide average weekly wage (SAWW) is $1,780.26, affecting benefit calculations.

What to Do if a Claim is Denied?

Not all claims are approved. If a workers' compensation insurer denies benefits, employees have the right to appeal. The Massachusetts Department of Industrial Accidents (DIA) oversees the dispute resolution process, which involves:

1. Conciliation – An informal meeting between the injured worker, their attorney (if applicable), and the insurer to try to resolve the issue.
2. Conference – A judge reviews the case and issues a temporary order regarding benefits.
3. Hearing – If the dispute continues, a formal hearing takes place, similar to a trial.
4. Appeals Process – If necessary, workers can appeal further to the Reviewing Board or even the Massachusetts Appeals Court.

Common Reasons for Workers' Compensation Claim Denials

Understanding why claims get denied can help workers avoid setbacks. Some common reasons include:

• Failure to report the injury promptly – Delayed reporting can create suspicion.
• Discrepancies in medical records – If the medical records don't match the claim, insurers may argue the injury isn't work-related.
• Pre-existing conditions – Insurers may claim the injury was caused by a pre-existing condition rather than work.
• Lack of medical evidence – Insufficient documentation from healthcare providers can result in a denial.
• Missed deadlines – Massachusetts has strict filing deadlines, and missing them can jeopardize a claim.

Workers' Compensation Deadlines in Massachusetts

Timeliness is a critical factor in the workers' compensation process. Massachusetts law sets the following deadlines:

• Employee injury report – Must be made to the employer as soon as possible.
• Employer's report to the insurer – Must be filed within seven days of the fifth lost workday.
• Insurer's decision – Must be issued within 14 days of receiving the injury report.
• Filing an appeal – If a claim is denied, the injured worker has four years from the date of injury to file an appeal with the DIA.

How Legal Representation Can Help

While workers can file a claim independently, hiring an attorney can be beneficial, especially if:

• The claim is denied or delayed.
• The injury is severe and leads to permanent disability.
• The employer retaliates or disputes the injury.
• There are concerns about settlement offers being insufficient.

Workers' compensation attorneys typically work on a contingency fee basis, meaning they only receive payment if they win the case. Under Massachusetts law, attorney fees are regulated and often paid by the insurance company if the worker wins the case.

Conclusion?

Filing for workers' compensation in Massachusetts requires careful attention to deadlines, medical documentation, and communication with employers and insurers. While the system is designed to provide benefits for injured workers, denials and disputes are common. Knowing the process, understanding your rights, and seeking legal assistance when necessary can significantly improve the chances of a successful claim.

Injured? The Office of Brandon J. Broderick, Workers Compensation Lawyers, Can Help

If the unfortunate happens and you’ve been injured in an accident, don’t go it alone. An?experienced lawyer?can advocate for your best interest and pursue fair compensation for your damages. At Brandon J. Broderick, Attorney at Law, you can count on us to work tirelessly for your quality of life. Our long track record of success has helped people like you move forward after sustaining an injury caused by another’s negligence.?

Contact us now?for a free legal review.