Frequently Asked Questions and Answers on Workers' Compensation in Massachusetts
Posted on behalf of Janet, Jenner & Suggs on Jun 06, 2017 in Workers' Compensation
Even if you have filed a workers' compensation claim in the past, you may have a lot of questions about the process.
That is why Janet, Jenner & Suggs has compiled a list of frequently asked questions and answers about filing a workers' compensation claim in Massachusetts.
Whether you have suffered an on-the-job injury or not, you should review the list to better prepare yourself in the event you ever need to file a claim.
If you are ever injured at work and think you may be entitled to workers' compensation, contact our Boston workers' compensation attorneys for a free consultation.
Who is Eligible for Workers’ Compensation Benefits?
In Massachusetts, any employee who suffers an on-the-job personal injury that causes him or her to miss five or more full or partial days of work is eligible for workers' compensation.
State law has specific definitions of employees and on-the-job injuries that qualify for benefits, which are stated in Massachusetts General Laws (MGL) Part 1 Title XXI Chapter 152 Section 1:
Anyone who provides services to another under an oral or written contract of hire, whether the contract is express or implied, is an employee. This excludes:
- People employed in professional athletics if their contracts provide for the payment of wages during any period of disability resulting from such employment
- Salespeople affiliated with a real estate broker, provided there is an agreement specifically providing for compensation in the form of commissions earned from the sale of rental or real property
- Salespeople who do not work in a retail establishment who are direct sellers of consumer products on a buy-sell or deposit-commission basis, provided their pay is directly related to sales and not hours worked and who provide services based on a written contract which says the seller will be treated as an employee for tax purposes
- Cab drivers operating vehicles leased from a taxicab company under an independent contract specifically providing for a rental fee or other payment to the owner of the taxicab that is not related to taxicab fares collected by the person, provided this individual is not treated as an employee for federal tax purposes
- People who are employed in jobs that are not in the usual course of business of the occupation of the employer
This covers any injury or medical issue caused by participation in activities inherent in the employee's job. This includes mental and emotional disabilities where the predominant cause is an event or series of events that occurred during employment.
Employees can also receive compensation for the worsening of a preexisting condition, provided the preexisting condition was made worse by an event or series of events during employment. However, compensation will only be provided for as long as the preexisting condition is made worse by an injury that occurred during employment.
The definition of a personal injury excludes mental or emotional disabilities arising from valid personnel actions, such as transfer, promotion, demotion or termination.
Do I Have to be Examined by a Doctor Chosen by My Employer's Workers' Compensation Insurer?
Your employer’s insurance company may request that you be evaluated by a doctor of its choice. If this request is made, you must comply, otherwise the insurance company can deny your workers’ compensation claim.
However, when your injury occurs, you are free to seek treatment from any doctor you choose. Unfortunately, doctors can refuse to provide treatment for a workplace injury if they do not want to accept the medical rates set by the state or are unwilling to negotiate a better rate. This may be ethically questionable but it is within the bounds of the law.
Does the Insurance Company Have to Pay Me the Work Time I Lose During the Medical Exam?
You can only receive compensation for lost work time if the appointment occurs during scheduled work hours.
How Long Do I Have to File a Workers' Compensation Claim?
The statute of limitations for Massachusetts workers' compensation claims is set forth in MGL Part 1 Title XXI Chapter 152 Section 41.
For workplace injuries occurring on or after Jan. 1, 1986, workers' compensation claims must be filed within four years of the date of the injury or the date the employee became aware of the injury.
If the injury caused the employee's death, claims must be filed within four years of the date of death.
If your injury occurred before Jan. 1, 1986, you must file a claim within one year of the date you gained knowledge connecting your injury to your job.
How Do I File a Workers' Compensation Claim in Massachusetts?
If you are injured at work, tell your employer about it as soon as possible. If you miss five or more days of work, your employer is required to file Form 101 – Employer's First Report of Injury/Fatality with the Massachusetts Department of Industrial Accidents (DIA) and the workers' compensation insurance company within seven days of the fifth missed day of work.
What if My Employer Does Not File a Claim?
Unfortunately, some employers do not file claims when they are required to do so. When this happens, you can initiate the workers' compensation process by reporting the injury to the insurance company yourself.
You should also submit Form 110 – Employee Claim to the DIA to notify them about your injury.
How Long Will It Take for My Workers' Compensation Claim to be Approved?
Once the insurance company receives a claim, it is required to investigate within 14 days and inform the employee about whether he or she will receive benefits. If your claim is approved, you will receive your first check at some point during those 14 days.
What are the Different Types of Workers' Compensation Benefits?
There are several types of workers' compensation benefits available in Massachusetts, including:
If your claim is approved, you will receive compensation for all adequate and reasonable medical care for your injury, no matter how long you need medical care. Once you no longer need medical care, benefits will cease.
Temporary Total Incapacity
This is for any injury that prevents you from working for six or more full or partial calendar days. This benefit provides 60 percent of your gross average weekly wages for up to 156 weeks.
Partial Incapacity Benefits
These benefits are for workers who have an injury that limits the type or amount of work they can perform. Benefits are paid weekly for up to 260 weeks. The compensation rate is 75 percent of temporary total incapacity benefits.
This is for workers whose injury caused loss of a body part or permanent disfigurement. Workers receive a one-time payment along with compensation for other damages, such as medical expenses or lost wages.
Total and Permanent Incapacity Benefits
This is for workers who suffered a permanent injury that prevents them from working. They receive two-thirds of their average weekly pay, based on what they earned in the 52 weeks before the injury.
Spouses and children of workers who died from on-the-job injuries may be eligible for this form of compensation. Benefits are two-thirds of the deceased worker's average weekly wage. Survivors are eligible for cost of living increases two years after the date of the injury or illness.
Can My Employer Cancel My Health Insurance and Other Benefits While I Am Receiving Workers' Compensation?
Unfortunately, there are no clear rules on canceling an employee's benefits while he or she is receiving workers' compensation.
If you are fired while collecting benefits, your insurance will likely continue for 31 days after termination, under MGL c. 175, § 110D.
Under MGL c. 175, § 110G, most employers are required to offer continued coverage for 39 weeks, provided you do not become eligible for another plan.
Can My Employer Fire Me for Collecting Workers’ Compensation?
Employers are not required to hold your job for you while you cannot work due to a job-related injury or illness, unless you are under an employment contract that states otherwise.
However, employers must give injured workers preferential treatment when hiring, once the employee is capable of returning to work.
What if the Insurance Company Denies My Claim?
You will receive Form 104 – Insurer's Notification of Denial, which will include the reasons why your claim was denied. The form will also inform you of your right to appeal.
You can call the insurance company's claim representative to ask questions about the denial. The phone number for the claim representative will be in box number six.
If you want to appeal the denial, you must file Form 110 within 30 days of your injury or disability. If you submit the form on time, the DIA will schedule a meeting between you, a DIA conciliator, an attorney for the insurer and your attorney if you have one.
If the parties involved are unable to reach agreement, your appeal will be sent to an administrative law judge.
If the denial is not overturned at this stage, you have 14 days from that decision to file Form 121A – Agreement That No Impartial Physician Report is Required. Your appeal will be heard before the administrative law judge who heard the previous claim.
If your appeal is still unsuccessful, you can appeal to the Workers' Compensation Reviewing Board if you think the judge made an error during the hearing or with his or her decision. You will need to file Form 112 – Appeal to Reviewing Board.
If the board does not reverse the denial, your last option is to file an appeal with the Massachusetts Court of Appeals.
What if My Employer Does Not Have Workers' Compensation Insurance?
If you were injured on or after Dec. 12, 1985, and your employer does not have workers' compensation insurance, you can sue them in civil court. You can also file a claim against the Workers' Compensation Trust Fund (WCTF) to recover compensation.
If you were injured before Dec. 12, 1985, you cannot sue the WCTF, but you can still sue your employer.
Will My Benefits Resume After I Tried to Go Back to Work but Had to Leave Due to my Injury?
If you receive compensation then return to work for less than 28 days before being forced to stop working because of your injury, the insurer is required to resume paying benefits if it has voluntarily accepted responsibility for the injury or been assigned responsibility by a judge.
You must notify the insurer in writing of the return of your disability within 21 days of leaving work to resume benefits.
If the insurer has not been assigned responsibility, you will need to file Form 110 – Employee Claim to attempt to obtain benefits again.
Do I Need a Workers’ Compensation Attorney?
Filing a workers’ compensation claim can be tricky, especially if you must appeal. Insurers work to reduce their payouts, and will look for evidence to connect your job-related illness or injury to unrelated or prior events.
Attorneys know how to deal with workers’ compensation insurers and their questioning. Having an attorney on your side will allow you to navigate the process smoothly and smartly.
How Much Does an Attorney Cost?
Our workers’ compensation lawyers work on contingency. This means there are no upfront fees for us to take your case.
Massachusetts law requires that the insurer pay all legal fees should you win your case for workers’ compensation benefits. However, your benefits may be reduced to pay for legal fees. Should you lose your case, you may be required to pay specific fees associated with your case.
Contact Janet, Jenner & Suggs Today for a Free Consultation
The Boston workers’ compensation lawyers of Janet, Jenner & Suggs will help you pursue the workers’ compensation benefits you deserve.
We work on contingency and only get paid if we recover compensation for you.