People who are injured on the job have the right to collect compensation. However, this does not mean they have the right to sue their employers in court.
Instead, all employers are required under Massachusetts law to obtain a workers’ compensation insurance policy. These policies pay the medical costs associated with treating the injury, can provide benefits to employees who miss at least five days of work, and in some situations even provide vocational rehabilitation.
Unfortunately, insurance companies sometimes try to find any excuse possible to deny a claim and save money. This can include arguing that an injury was not work-related or that the injury preexisted the employee’s time on the job. For more information on dealing with insurance companies during a claim, please see Meeting with Insurance Companies During a Workers’ Comp Claim.
All workers have the right to appeal any workers’ compensation denial, and a Boston workers’ compensation lawyer may be able to help them do that. Qualified personal injury attorneys work to ensure that their clients understand Massachusetts’ workers’ compensation laws and strive to obtain the full benefits to which they are entitled.
When an Injury is Covered by Workers’ Compensation
Defining “At Work”
Any injury or illness that happens while an employee is at work is covered by workers’ compensation. However, this is a more complex idea than it may appear, and it is important to understand what the law means when it uses the term “at work”. If an injury happens while “at work,” that means that the worker was injured while performing their usual work duties.
Official Working Hours
In addition, this injury must occur while the worker is on the clock—so if a worker is injured while driving to work, it may not be considered a work-related injury. Furthermore, if a worker is injured while walking in the parking lot during a lunch break, a workers’ compensation insurance agency may argue that this injury did not happen while the employee was on the clock.
Of course, there are nuances to this rule. For example, if a person’s job is to drive a delivery truck and they are injured in an accident, this is an injury directly related to that worker doing their job.
Illnesses & Sickness
Workers’ compensation insurance also covers illnesses as well as injuries. A classic example is a nurse or doctor, both of whom are exposed to diseases on a routine basis. If they contract an illness, and miss more than five days at work, they may file a Boston workers’ compensation claim if they can prove that it was connected with treating a patient.
For more information on workers’ comp eligibility and payments, please consult the following sources:
Appealing a Denied Claim
The DIA Form 110
All workers’ compensation disputes in Massachusetts are handled by the Department of Industrial Accidents, as outlined in Mass Gen. Law ch. 152 §2. If the workers’ compensation insurance company denies benefits or terminates or reduces benefits, the injured worker can file a workers’ comp claim by filing a DIA Form 110 with the Department of Industrial Accidents.
After filing a Form 110, the first session that the parties attend is a Conciliation. This is an informal meeting with a Conciliator at the Department of Industrial Accidents who makes sure there are sufficient medical records and doctor reports to support the claim being sent to the Administrative Judge for a Conference. The Conciliator also tries to see if the parties can resolve the dispute and reach an agreement that will end the current litigation but not settle the workers’ compensation claim.
Please read What You Need to Know About the Massachusetts DIA to learn more about the Department of Industrial Accidents.
The Administrative Judge
If this fails, the case is sent to an Administrative Judge for a Conference which is similar to a motion hearing in civil court where the lawyers submit medical records and reports and argue their case. The Administrative Judge then issues a Conference Order. Usually one and, in some case both, parties appeal the Conference Order. If there is a medical issue in dispute, an Impartial Physician will review the medical records and reports that were submitted at Conference and conduct a physical examination of the injured worker. The Impartial Physician will then file a report summarizing his or her findings and opinions as to the injured workers’ diagnoses and whether the diagnoses are related to the work accident. The Impartial Physician will also issue an opinion about the injured worker’s present work capacity, prognosis, and need for additional medical treatment or whether the injured worker has reached a medical endpoint.
Industrial Accidents Reviewing Board
In the rare case that this outcome is not acceptable to either party, they can ask the Industrial Accidents Reviewing Board to examine the case. This would involve a panel of judges examining the first judge’s decision and determining if it followed the law.
The MA Court of Appeals and Supreme Judicial Court
As a last resort, a worker may file an appeal with the Massachusetts Court of Appeals or in some cases, with the Massachusetts Supreme Judicial Court. A workers’ compensation attorney in Boston could help clients by guiding them through the entire appeals process.
For more information, please refer to the following sources:
- What You Should Know About Boston Workers’ Compensation Denials
- Determining the Validity of a Workers’ Comp Claim
- Steps to Take If Your Workers’ Comp Claim is Denied
- Appealing a Workers’ Comp Decision in Boston
Let a Boston Workers’ Compensation Attorney Help
All employees in Massachusetts are covered by workers’ compensation insurance. Ideally, this insurance should provide payments for medical treatment and supplemental income if a workplace illness or injury leaves you unable to work for five full or partial days.
However, insurance companies sometimes make their profits by denying valid claims. This can leave many injured employees without a way to support their families.
A Boston workers’ compensation lawyer could help you to fight back. They could work with you to file official appeals of workers’ compensation denials and represent your interests in court. After you become aware that an injury has affected your ability to work, there is a limited time of four years to file a claim, so call today to get to work on yours.
For more information on how a workers’ comp attorney can help you with your claim, please see: