What is Workers' Compensation?
By law, all employers in Massachusetts are required to carry workers’ compensation insurance for each employee. This insurance is in place to protect workers against on the job injuries and illnesses and will pay for reasonable and necessary medical treatment and possibly lost wages and retraining. Workers’ compensation claims are overseen by the Department of Industrial Accidents (DIA), the agency responsible for administrating workers’ compensation laws in Massachusetts.
How Do I File For Workers’ Compensation?
If you have a work related injury or illness that causes you to be out of work at least five full or partial days, your employer is required to file a report with the DIA, your insurer and yourself. If your employer does not report your injury, then you should file a claim with your workers’ compensation insurer yourself and send a copy to your employer. If your insurer does not dispute the claim, they will send you a notification of payment and you should start getting checks within 3-4 weeks.
The First 180 Days
The first 180 days after your initial injury are called the “Pay-Without-Prejudice” period. This means that your insurer may pay benefits to you during this time, without making a final decision on your claim, which also means that your insurer does not need to accept liability, even though they are continuing to pay you benefits. During this period, your insurer can reduce or stop your payments by giving you seven days written notice, in which they provide a reason for stopping or reducing your benefits. Conversely, they may ask to extend the pay-without-prejudice-prejudice for up to a year. In either case, you will want to discuss what your rights are with an attorney.
My Claim Was Denied by My Insurer
If you’ve received a notice from your workers’ compensation insurer that your claim was denied then you can file a claim with the DIA. The claim process involves several stages including an informal meeting with the insurer called conciliation, a conference with the insurer and the Administrate Law Judge assigned your case, and ultimately a hearing before that Administrative Law Judge. The Administrative Law Judge’s decision may then be appealed to the Industrial Accidents Review Board, which can either reverse, uphold, or remand the case for further proceedings. It is strongly advised that you contact an attorney if your claim was denied by your insurer.