In theory, workers’ compensation benefits should be easy to obtain. All employers are required to obtain workers’ compensation insurance policies that provide protections to workers who are injured while on the job. These benefits are designed to provide payment for medical treatment as well as weekly lost wage payments for the time that the employee misses at work.
Unfortunately, it is not uncommon for insurance companies to deny claims. They may argue that the injury did not happen at work, that the injury pre-existed the work injury, or that the employee’s own horseplay caused the injury.
Regardless of the reason for the denial, a worker has the right to appeal by filing a workers’ compensation claim. By knowing what steps to take if your workers’ compensation claim in Boston is denied, you could increase your chances of obtaining a benefits package that meets all your needs. En Español.
Examine the Denial Letter
Under Massachusetts state law, all workers’ compensation insurance companies are required to notify an injured employee of their decision to commence payment or deny their claim within 14 days of receiving notice of the injury. If the insurance company denies the claim, they must provide a copy of Form 104 to the employee.
This Insurer’s Notification of Denial must contain information as to why the insurance company denied the claim. Reasons can include:
- No personal injury occurred
- The injury was not caused by a work accident
- The claim was not filed on time
It is essential that claimants examine this form so that they can file a claim.
Initiate the Appeals Process
Regardless of the reason for a denial of the claim, employees have the right to appeal the denial. The Massachusetts Department of Industrial Accidents handles all disputes between employees and workers’ compensation insurance companies. To start an appeal, an employee must file a claim using DIA Form 110. Essential information to provide on this claim form includes:
- The date of injury
- The first and fifth days of work missed
- Doctor contact information
- Information about the injury
- The types of benefits you are seeking
This form must also be sent to the insurance company. A workers’ compensation attorney could help individuals gather necessary information, file the right paperwork, and ensure that the claim is successful by getting the insurance company to agree to pay or convincing a DIA Administrative Judge to order payment or workers compensation benefits.
Do Not Return to Work
One common trick used by insurance companies to avoid paying claims is to convince the employee to return to work before they are ready. If an employee is seen performing their previous job or any other occupation at full capacity while their case is in the appeals process, insurers can use this as evidence that the worker is not truly injured or has recovered from their work injury.
In addition, returning to work immediately after an injury may hinder a claimant’s case under the law. Massachusetts law requires an employee to miss at least five days of work after an injury to make a claim. If a worker returns to work, he or she may find themselves disqualified altogether.
Improve Your Worker’s Comp Claim Chances of Success With a Few Simple Steps
It is easy to become disheartened after a workers’ compensation denial. If you are unable to work because of an injury or illness suffered on the job, you are likely relying on these payments to provide for you and your family
Fortunately, all denials in Boston workers’ compensation cases may be appealed. To improve your chances of success, you should be sure to examine the denial notification, not return to work unless more than five days have passed, and prepare to file a claim with the Massachusetts Department of Industrial Accidents.
An attorney could help interested individuals with this process, as well as provide further clarification on these steps to take if your workers’ compensation claim in Boston is denied. Call today to learn more.