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 existed before the employee’s time on the job. 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.
Our Boston workers’ compensation lawyers work hard to ensure that their clients understand Massachusetts’ workers’ compensation laws and strive to obtain the full benefits to which they are entitled. Call the Law Office of John J. Sheehan for a free consultation at (617) 295-7731.
The Complexity of Workers’ Compensation Claims in Boston
The terminology related to workers’ compensation claims processing is complex. When a lawyer does not work in workers’ compensation, the terminology is confusing even to them. The injured worker often does not understand the forms or claims process without help from an attorney. They may not know where or how to file a claim if the employer does not report the injury to its insurance company. They do not know what medical reports have to be filed with the claim to get it processed.
Our Boston workers’ compensation lawyer can guide you through this complicated process from start to finish. it is wise to hire an attorney as soon as you are injured rather than handle things independently. Not only is the process complicated, but insurance companies often look for any excuse to deny your claim. They may act even more aggressively if they know that they are dealing with a claimant that is unrepresented. Additionally, employers sometimes try to prevent you from reporting your claim because they are afraid it might negatively impact their business. You deserve the help of a knowledgeable Boston workers’ compensation lawyer to advocate on your behalf and get you compensation that your injuries require.
Employers’ and Workers’ Compensation Insurance in Boston
If you are unfamiliar with how workers’ compensation works, you might be wondering where exactly it comes from. Workers’ compensation is covered by insurance. Do not worry, you do not have to take out another insurance policy to be covered in case of a work accident. Your employer, however, must do exactly that.
Insurance coverage for workers’ compensation must come from your employer. Anyone considered an employer under the law in Massachusetts has a legal obligation to provide this coverage to the employee.
Like many states, Massachusetts does not allow waivers of workers’ compensation insurance. In other states that do allow waivers, the employee and employer may agree by contract when the employee is hired to forgo their workers’ compensation insurance. If the Department of Industrial Accidents (DIA) discovers that an employer does not have workers’ compensation insurance for its employees and has not obtained an exemption, they will issue a “Stop Work Order” until the employer comes into compliance with the law.
If you are injured in a workplace accident, you must report the accident and injuries to your employer. it is then your employer’s responsibility to contact their insurance provider and begin the workers’ compensation process. However, you may run into trouble if your employer refuses to report your accident to their insurance or claims the accident did not happen at work. In such a case, our Boston workers’ compensation attorney can fight for your claim.
When to Report a Workplace Accident in Boston
Any workplace accidents that result in an injury should be reported immediately. Even if your injuries are minimal, the sooner you report, the better.
Emergency care is usually covered, but the later workers’ compensation claim will not be approved automatically. Your employer’s insurance provider will want some proof of the accident and your injuries. This is often to prevent fraudulent claims and minimize the insurance company’s costs. If you delay reporting for whatever reason, the insurance company may question your claim.
A speedy report should be immediately followed up with additional doctor’s visits. Depending on your employer’s insurance, you may have to see a doctor chosen by your employer. Otherwise, you may select any doctor you wish. Your doctor’s visit will be used as evidence of your injuries. Delaying a report and medical treatment could result in less than accurate medical records, which will not bode well for your case. Call our Boston workers’ compensation lawyer to get your claim started right away.
Suing Your Employer for a Workplace Accident in Boston
If you are in a severe workplace accident and suffer injury, you might wonder if you can sue your boss. For the most part, the answer to this question is no. The law in Boston typically blocks injured workers from suing their employer for injuries. You are generally required to go through your employer’s insurance provider and claim worker’s compensation.
There is a major benefit to this system: when claiming worker’s compensation, you do not need to prove that anyone was at fault. The fact that the accident happened while you were on the job is enough for coverage. In contrast, a personal injury lawsuit requires proof of fault, which can be challenging. In the rare event that you actually can sue your employer for an accident, you would have to show that the accident was no accident at all.
Despite this, you can typically sue if your employer’s negligent, reckless, or willful misconduct caused the accident. For example, if your employer pushed you off a ladder, even if it was done “as a joke,” you could be entitled to sue. Workplace violence is surprisingly common, especially in certain industries. Call our Boston worker’s compensation lawyer to discuss your case.
Identifying Fault for a Workplace Injury Lawsuit in Boston
It is typically easier to identify willful misconduct that caused your injuries, such as your employer pushing you off a ladder as a “joke.” However, you still may have the opportunity to sue a third party for damages from your injuries if they caused your injuries through an irresponsible act (or failure to act).
Massachusetts law provides that the sole remedy for a workplace injury is through workers’ compensation insurance. However, these limitations only apply in situations where there is no fault assigned for an accident or where the employer was at fault. But, if another entity that was not your employer negligently or recklessly caused your injuries, you still have the ability to sue them. For instance, if a contractor was responsible for building scaffolding on your site that was placed improperly and collapsed, you may have a case against the contractor. If the scaffolding collapsed because it was made of substandard materials, you may be able to target the manufacturing company in a lawsuit.
Simply filing a complaint for a violation that caused you injury will not get you the compensation that you deserve. Talk to your Boston workers’ compensation lawyer about what path best suits you for your own best interests.
Determining Whether to Sue a Third Party or File a Workers’ Compensation Claim in Boston
When considering whether to go through the courts or the insurance company, you should determine whether a third party was responsible for causing your workplace injury, as discussed above. If you believe that your employer’s negligent conduct was the cause of your injuries, you have a decision to make: file a lawsuit against the responsible third party, or file your claim under the workers’ compensation policy provided by your employer. In our view, the much stronger decision is to file a lawsuit.
Your workers’ compensation insurance is meant to provide for two general areas of your recovery: your medical care costs and the consequences of your injury’s impact on your ability to earn income. These calculations are covered in more detail in sections below.
However, a lawsuit could also get you compensation for your noneconomic damages, an area that doesn’t fall within workers’ compensation benefits. Noneconomic damages account for the injury victim’s pain and suffering experienced as a result of both their injuries and the ongoing care required to deal with them.
Some injuries may leave unsightly scars or disfigurements that can affect how the victim is perceived by others or serve as a reminder of the traumatic event. Disabling injuries may leave the victim unable to participate in recreational activities that they had previously enjoyed. Chronic pain from the injury or the surgery necessary to repair the damage may lead to the development of psychological disorders such as depression or anxiety, which may have an effect on the victim’s personal relationships or enjoyment of life. These and other factors may be considered by a court in a workplace injury lawsuit when determining the amount of compensation that you deserve.
Can Independent Contractors Use Workers’ Compensation in Boston?
People who are classified as independent contractors are outside of the employer-employee relationship in the eyes of the law. an independent contractor is technically “self-employed,” and they do business with the other company rather than work for it. Therefore, independent contractors do not benefit from the Commonwealth’s requirement of workers’ compensation insurance coverage.
Independent contractors typically make their own hours, do work with multiple companies, and do work that is considered different than their contracting company’s primary business. As an example, plumbers are almost always independent contractors. The easiest way to tell if you are classified as an independent contractor is if you file Form 1099 with the IRS as opposed to a W-2. Employers may often misclassify employees as independent contractors due to their own interests, so if you feel that you may have been misclassified as an independent contractor as opposed to an employee, it is imperative that you speak with a Boston workers’ compensation lawyer as soon as possible so that you don’t miss out on the insurance benefits that you are owed.
When is an Injury Covered by Workers’ Compensation in Boston?
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. There are also restrictions on who does and does not qualify as an employee for workers’ compensation. a person may be working for an employer, but they might not be considered an employee.
According to Mass Gen. Law ch. 152 §1, an employee is anyone who is working for another person under any contract for hire. The law carves out a few exceptions for people who are in service to another but are not considered “employees” for workers’ compensation. These people must take a different route to get compensation for their injuries.
Coverage for Employees Only
Employees do not include seamen or people working on ships or vessels engaged in interstate or foreign commerce. For example, someone working as a longshoreman would not be included.
Professional athletes may not be included if their contracts include being paid a salary when recovering from injuries. Sports are very physical and injuries are common. it is not unusual for professional sports contracts to include provisions for injuries and recovery time.
A real estate salesperson who works for a broker where their salary is paid exclusively on commission is excluded. This exclusion extends to salespeople who are direct sellers of goods on a buy-sell or deposit-commission basis. Salespeople who are paid based solely on sales and not on time worked may not be covered as an employee for workers’ compensation. This is especially so if they have a contract which states they are not an employee for federal tax purposes.
Taxi drivers may also be excluded if they rent their cab from a cab company, the contract provides a rental fee to the owner, and the fee is not based on fares collected by the driver.
Some people are included under the term “employee” even though they are not employees in the traditional sense. For example, students working under a school-work program may be considered employees. Also, people who are the sole proprietor of a business can be regarded as employees, but they must take steps to acquire the necessary insurance as an employer would.
This list of who is included as an employee for workers’ compensation is not exhaustive. Please speak with our Boston workers’ compensation lawyer for more information.
Accidents During 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. However, if that delivery driver was running personal errands during the workday while making deliveries, the line between “at work” and “not at work” becomes blurred.
Illnesses & Sickness
Workers’ compensation insurance also covers illnesses alongside injuries. a classic example is for nurses or doctors who 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 their job.
Contracting an illness outside of work and missing more than five days of work as a result would not be covered under workers’ compensation. The illness must have been picked up during on-the-job activities. it is not always easy to tell where an illness came from, as illnesses can be picked up from almost anywhere. If you can prove the illness came from workplace conditions, you may be covered by workers’ compensation. Exposure to toxic chemicals, asbestos, and other materials could cause cancer and other illnesses.
Coverage can also include mental health issues. Many employees will experience some level of stress or trauma in their jobs. When that stress causes your mental health to deteriorate to the point where you can no longer work or have difficulty working, you may be covered under workers’ compensation. Generally, you will need a serious mental health condition to be covered. Things like manageable anxiety or a general sense of employee burnout are probably not covered. However, things like post-traumatic stress disorders, severe depression, or crippling anxiety that stem from a work-related incident or series of incidents might be covered.
How Do Worker’s Compensation Benefits Work?
Workers’ compensation will look a little different depending on what kind of work you do and the extent of your injuries. Compensation may cover a complete inability to work or only a partial inability. Compensation may even become long-lasting if the recipient is unable ever to work again. Compensation usually covers medical bills and lost wages. The extent of your coverage will be based on your individual circumstances.
Payment of Medical Costs
The core of any workers’ compensation benefits package in Boston is the payment of medical costs. All policies must pay for an injured or ill employee to attend doctor’s appointments and rehabilitation visits that are necessary for them to make a maximum medical recovery. Hospitals and doctors will usually bill your employer’s insurance company directly. You will not have to pay anything yourself and then wait to be reimbursed.
In many cases, these appointments can bring the employee back to full health. In others, further medical treatment may not have any discernable benefit. When this is the case, an employee may be entitled to permanent incapacity benefits. In any event, workers’ compensation insurance should pay for all medical treatment in the immediate aftermath of the injury.
The insurance provider must cover medical costs. If your employer offers to pay for your medical expenses themselves because they do not want to get insurance companies involved, you must say no. In Massachusetts, employers are not allowed to pay their employees’ medical claims, even if the bills are relatively small and the employee misses little to no work.
Temporary Total Incapacity Benefits
The most common form of monetary payments issued in Boston workers’ compensation cases is temporary total incapacity benefits. to qualify for these payments, a worker must miss at least five days of work after the date of his or her injury. Total incapacity does not necessarily mean permanent incapacity. it simply means a person is totally unable to work for a certain period of time. See below to learn how permanent disabilities are handled differently.
These payments are issued at a rate of 60 percent of the gross weekly wage for 52 weeks prior to the injury. In other words, whatever an employee’s average weekly wage was over the previous year, they could receive 60 percent of that every week during recovery from their injury. Employees are eligible to collect these benefits for a total of 156 weeks or three years.
Total incapacity means you must be injured in a way that prevents you from returning to work at all. For example, suppose you broke both your arms in a work-related accident. In that case, you might receive total incapacity benefits because working with two broken arms in any job is probably impossible. However, broken bones are common injuries, and people tend to make a full recovery in a few weeks or months. You may be covered even though your injuries are only temporary.
Temporary Partial Incapacity Benefits
Other scenarios may involve an illness or injury that only partially affects a person’s ability to work. Any time a person can return to work after an injury but for fewer hours or lighter duty, he or she may be eligible to collect these payments. This means you can continue working, albeit less so than before, and also receive workers’ compensation.
For example, if you injure your back in a work-related accident, you may be able to return to work relatively soon. However, if the pain from your injuries is so great that you can only be standing for a few hours at a time, you might still be able to work with reduced hours or a chair to accommodate your injuries. This would be an example of partial incapacitation where you can still go to work, but not fully.
These Boston workers’ compensation benefits are paid at a rate of 75 percent of the payment that would be issued for total temporary disability. So, these payments would ultimately equate to 45 percent of an injured worker’s average weekly wage. This is in addition to any wages actually earned.
Permanent Disability Payments
More severe injuries may result in permanent incapacity. If this incapacity is only for a singular body part, or if it is due to severe burns, the treating doctor would refer to an impairment assessment chart to determine the impact that this injury could have on the employee’s ability to work. The insurance company would then use this assessment to provide a lump sum payment. This may include permanent disfigurements like burns or permanent losses like severed limbs.
In instances where a worker can never work again in any capacity, they may receive workers’ compensation benefits paid at a rate of 66 percent of the workers’ prior average weekly wage. In addition, these benefits are paid for the rest of the employee’s working life. There are also cost of living adjustments built into the program.
A permanent disability would be something like getting your arm caught in some machinery at work and losing the arm. Even if you can return to work with only one arm, you can still be compensated for the loss. The amount of compensation will be determined by how impaired you are by the loss. a more severe impairment will lead to more significant compensation.
Receiving Workers’ Compensation After Getting a New Job
Not everyone wants to live off of workers’ compensation benefits forever. Many people enjoy the feeling of purpose they get from having a job. However, getting a new job can affect your benefits under workers’ compensation.
It is possible to find new work after being approved for workers’ compensation without completely losing your benefits. However, the type and amount of benefits you will continue receiving may change. For example, after your accident, you might find yourself totally incapacitated and unable to return to work permanently. In this scenario, you might be receiving permanent disability payouts. However, if you feel the need to supplement your cash flow, or you simply wish to return to the workforce, you may do so while still receiving some benefits.
The amount of money you receive from workers’ compensation may be reduced in proportion to your new income. If you are making more money than you did before your accident, you might lose your worker’s compensation income entirely. However, if you are still receiving medical treatments for your work injuries, those treatments should still be covered. Call our Boston workers’ compensation attorney if you have found a new job but still need workers’ comp benefits.
Appealing a Workers’ Compensation Denied Claim in Boston
Not every workers’ compensation claim is approved. Many people have their claims denied every year and they may find themselves in financial trouble. If your claim was denied, you may appeal your case and hopefully get the workers’ compensation benefits you need. There is a step-by-step process for appealing that involves meetings, evidence, and a final hearing.
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 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.
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 or 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 the 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. You must file for this appeal within 30 days of the administrative judge’s decision.
The panel of judges will either affirm or overturn the previous decision to deny your claim. Reasons to overturn the previous decision include the decision being beyond the scope of the judge, unlawfully arbitrary, or contrary to the law. However, this does not mean that your claim is suddenly approved. Instead, you may have a chance to re-argue your claim and hopefully be successful the second time around.
The Massachusetts 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 help appealing your workers’ compensation claim, reach out to our Boston workers’ compensation attorney as soon as possible. The window of time for an appeal is not very large and we must work to file it quickly.
Time Limit for Filing a Workers’ Compensation Claim in Boston
Massachusetts law gives the injured worker four years from the date that they discovered their injury and its relationship to their employment to file their workers’ compensation claim. In many situations, the start date is the day that they actually suffered their injury. For instance, if you slipped and fell on a worksite, you have four years from that day to file your claim. However, many compensable workplace injuries, such as illnesses stemming from exposure to asbestos or other toxic substances, may take longer to identify, and even longer still to connect the illness with the victim’s place of work.
Just because you have four years to file does not mean that you should wait four years before contacting a Boston workers’ compensation attorney. First, preparing your case may take time, particularly if the injuries are severe. Second, evidence may dry up over time, making your claim harder to prove. Third, the sooner you file, the sooner you will see the compensation that you deserve. If you suspect that you may have a valid workers’ compensation claim, get in touch with the Law Office of John J. Sheehan as soon as you can.
Our Boston Workers’ Compensation Attorneys Can 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. For help getting the benefits you need, call the Boston workers’ compensation lawyers at the Law Office of John J. Sheehan. 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 at (617) 295-7731 to get to work on yours.