Massachusetts workers who while in the course of undertaking work related tasks become sick or are injured are typically covered by workers’ compensation, except in exceptional situations. Massachusetts state workers’ compensation laws make it mandatory for most employers to offer workers’ comp insurance. However there are some circumstances when a workers’ compensation claim may be denied. This could be because the insurer doesn’t consider that the circumstances leading to the sickness or the injury wasn’t related to work. All is not lost as this sort of workers’ comp denial can be challenged with the assistance of a workers’ comp. attorney. Workers’ Compensation Law in Massachusetts In Massachusetts if you are injured due to an accident in your workplace whether it was your fault or not your employer must under Massachusetts workers' compensation law ensure that you receive adequate benefits so that you are not financially disadvantaged by your injuries or illness. You have to inform your employer as soon as possible after the injury. If you don’t attend work for 5 or more days, your employer is required to report your work-related injury or illness to its insurance company and the Department of Industrial Accidents within seven days of the injury. This is the official start to your workers’ comp claim. The only employees that are not covered are some domestic workers. Most occupational diseases and physical injuries are covered. Mental injuries aren’t usually eligible for workers' compensation payments unless something intentionally was done to you at work that caused a mental trauma. The benefits provided include the cost of medical treatment, a percentage of your wages and benefits to cover vocational rehabilitation. Wage replacement if you are partially incapacitated is usually 260 weeks, but it could be doubled in certain cases. If you can’t work for 6 or more days due to your injury or illness you will be entitled to temporary total disability payments. These are 60% of the weekly wage you were receiving at the time of the accident and can last for 3 years if required. There are other categories of disability that attract payments too. Why Your Claim Could be Denied Unfortunately, being awarded a workers’ comp claim isn’t always as easy as you might think. Your claim could be denied by the insurer for several reasons. It could be that you were late filing your worker's comp claim or it might be claimed that the accident or sickness was not related to a work related incident. Sometimes, the claim form has not been clearly completed or some details omitted. These sorts of issues don’t usually take too long to solve and eventually favor you. However, there are reasons for a worker’ comp denial that are more difficult to solve easily, such as: Your employer says you didn’t use the allocated safety equipment designed to prevent injury or exposure to toxic substances. The injury was deliberately self inflicted so that you could take time off work with worker’s compensation. You were intoxicated when the accident took place so are responsible for your own injuries. The Massachusetts Workers' Comp Appeals Process If your workers’ comp claim is denied or the amount you have received in workers’ comp payments is not what you expected you must file an Employee Claim Form. This is a request for a hearing to be heard by an Administrative Law Judge. At the hearing, you or if you have an attorney working on your behalf will provide suitable evidence that supports your situation proving entitlement to workers’ compensation benefits from your employer’s insurer. A conciliator sent by the Department of Industrial Accidents will head the conciliation meeting and will try to reach a compromise between you and the insurer. If no agreement is reached a conference is called with an administrative judge. The evidence is assessed by the judge and a decision is reached called a Conference Order. The case then proceeds to a formal hearing involving the same administrative judge. If your claim is still denied you may choose to appeal to the Reviewing Board. The appeal must be filed within 30 days of the decision made by the administrative judge. This time 3 administrative judges will be assigned the job of reviewing your case but not new evidence is permitted. The Review Board will issue a decision in writing. This decision can be further appealed through the Massachusetts Court of Appeals. Why a Workers' Comp Attorney Can Help As you can see, appealing a decision regarding a denial of workers' compensation can be a time consuming affair. In order for the process to be completed as smoothly as possible it’s important to get a workers’ comp attorney to work on your behalf.
