What Does Workers’ Compensation Without Prejudice Mean in Massachusetts?

According to the Department of Labor, nearly $80 million in compensation and medical bills have been paid out to Massachusetts workers injured on the job – in just the first 11 months of 2016. But the process of submitting a claim and getting paid can be very confusing. There are strange terms like “payment without prejudice;” Is that a good or bad thing?

Workers’ compensation without prejudice refers to a specific period of time where you receive workers’ compensation payments before the insurer has officially ruled on your case. In a sense, your case is still pending, but you are receiving payments anyway. This can be very beneficial to injured workers who cannot afford to wait for their payments. However, the insurer can very easily reduce or end these payments on relatively short notice.

If you have filed a workers’ compensation claim, you may be entering your period of compensation without prejudice very soon. You need to know what to do in the event the insurer tries to cease payments. Our Massachusetts workers’ compensation attorneys are here to help. Call The Law Office of John J. Sheehan at (617) 925-6407 to set up a consultation about your case.

Defining Workers’ Compensation Without Prejudice in Massachusetts

The period of the first 180 days after you are injured in Massachusetts is a “pay without prejudice” period. During this time, the insurer will pay benefits without actually having to rule on your case. It does not mean that your injury has been approved for workers’ compensation benefits, nor that your employer or the insurer is willing to accept liability for your injury. The law regarding the pay without prejudice period can be found under § 8 of chapter 152 under Title 11 of the Massachusetts General Laws.

The pay without prejudice period is a very precarious time for workers’ compensation claimants. On the one hand, you can begin receiving payments so that you can cover your medical expenses and make up for lost wages. Unfortunately, your insurer may put a stop to your payments at any time. However, they may only do so with a good reason. Usually, this reason must be based on your own income. If you are still earning money from work or have returned to work, your insurance company may try to cease payments.

At any time during these 180 days, the insurer can simply stop making payments to you, or reduce the amount you receive, by simply giving you a written notice of seven days. This is formally known as Form 106, or the “Insurer’s Notification of Termination or Modification of Weekly Compensation During Payment-Without-Prejudice Period.”

Termination or Extension of Workers’ Comp Benefits in Massachusetts

If the insurer opts to issue Form 106 during this period, they are required to give you the full reasons they are taking such an action. If you so choose, you may then file a claim challenging the insurer’s termination of your compensation payments. In your claim, you must address all the grounds asserted by the insurer and explain why you should continue receiving payments. Our Massachusetts workers’ compensation lawyers can help you through this process.

Now for the good news: if the insurer chooses to continue paying benefits after this period, they are then required to continue paying benefits unless either you or a judge give them permission to reduce or stop them. Their ability to reduce or stop payments becomes much more limited.

In some cases, the insurer might contact you to request an extension of that initial period. This requires you to give them written consent by filing Form 105, an “Agreement to Extend 180 Day Payment Without Prejudice Period.” Consult with an attorney before filing any paperwork regarding your case.

Grounds for Termination of Your Workers’ Compensation Payments in Massachusetts

Once your pay without prejudice period is over, your insurer may terminate or reduce your payments only in more limited circumstances. Restricting the insurer’s ability to alter your payments protects you from suddenly losing your support system when you need it the most.

The grounds for termination or altering compensation payments can be found under § 8(2)(a)-(l) of chapter 152 under title 11 of the Massachusetts General Laws. These grounds include:

  • Compensation is modified or terminated by an order from an arbitrator, administrative judge, a review board, or a court.
  • The recipient has agreed in writing to a change or termination of compensation payments.
  • The recipient has resumed working.
  • The insurer obtains a medical report from the recipient’s doctor or an impartial medical examiner stating the recipient can return to the job they had when they were injured or work that is similar.
  • The recipient underwent available vocational education or training in order to return to work, and the office of education and vocational rehabilitation informs the insurer that they may suspend or reduce payments because the recipient is capable of working again.
  • The recipient has exhausted the benefits available to them. This is likely to apply when a recipient is not entitled to indefinite or permanent compensation payments.
  • The recipient failed to respond to a request from the insurer for an earnings report, or there were past overpayments.
  • The insurer may request the recipient be examined by a doctor to determine if the recipient is still unable to work. Payments can be suspended or terminated if the recipient is found capable of working again.
  • The recipient is incarcerated for a misdemeanor or a felony and is therefore ineligible for compensation.
  • The recipient failed to file for workers’ compensation benefits in a timely manner and is therefore ineligible.
  • The recipient dies.

Remember, it is possible to attempt to return to work and still receive compensation payments. If the recipient leaves their employment within twenty-eight days of resuming work, and they notify their employer and insurer within twenty-one days of leaving that their injury or disability is the reason they left, compensation can be resumed. You should speak with our Massachusetts workers’ compensation lawyers about your case so we can help you if your payments are reduced or terminated.

Penalties for Insurers Who Try to Unjustly Terminate Compensation Payments in Massachusetts

Your insurer may attempt to terminate your compensation payments during your pay without prejudice period. Insurers have a lot of discretion during this time and very little stands in the way of them cutting you off from your workers’ compensation payments. To hopefully deter insurance companies from attempting to cut people off simply to save money or for other unjust reasons, a penalty system is in place.

According to § 8(5) of the law mentioned above, if an insurer terminated your compensation payments and it is later determined that your benefits should resume or should not have been terminated, the insurer must not only continue paying you, but they must also pay you a penalty fee. This fee is equal to 20% of the additional compensation owed to you on the date you are found to be entitled to payment.

Not only that, but this additional money paid to you as a penalty cannot be used to calculate things like premium rates for workers’ compensation insurance. This means that if the insurance company ends up paying you a penalty fee, they cannot attempt to recoup that loss by raising insurance premiums. If you believe you may be owed a penalty fee for unjust termination of compensation payments, contact our Massachusetts workers’ compensation attorneys.

How Long Before Workers’ Compensation Benefits Checks Arrive in Massachusetts?

Generally speaking, you should start getting checks for benefits within 3 or 4 weeks of your accident or injury. These checks will cover lost wages after the first five calendars (not work) days you are out of work. Workers in Massachusetts do not get compensation for the first five days unless they are disabled for at least three weeks. If you have been waiting for your workers’ compensation payments to begin, please speak to our Massachusetts workers’ compensation attorneys. We can help you figure out what the hold-up is and get you the money you need.

Call Our Massachusetts Workers’ Compensation Attorney If Your Claim Is Denied

Unfortunately, it is not unusual for a work-related disability claim to be denied following the workers’ compensation without prejudice period. When this happens, it is not the end of the world. You do have options and you can challenge a denial claim. Doing so requires experienced and knowledgeable representation. The best way to do this is with the help of a Massachusetts workers’ compensation attorney. Call the Law Office of John J. Sheehan at (617) 925-6407 to set up a consultation regarding your situation.