Hurt on the job in Massachusetts? If you’re like most people, then you’re probably stressed out about keeping up with bills and worrying about whether or not you’ll have a job once you’re feeling better. If your injury was severe enough, you may even be concerned about your ability to work at all in the future.
Many people ask our firm: is workers’ comp required in Massachusetts? The good news is that yes, workers in Massachusetts have protections for on-the-job injuries. Your employer is required to hold workers’ compensation insurance just for this reason. Although there are a few exceptions, most employers legally have to cover their workers in case they get hurt on the clock.
We know you have questions, like when to hire a workers’ comp lawyer, how long does workers’ comp last in Massachusetts, and most importantly, how much does workers’ comp pay in Massachusetts? These are all important questions, and it can be hard to find clear answers without some help from the experts.
Obviously, the laws surrounding workers’ compensation or “workman’s comp” in Massachusetts are complicated and you may need the help of an attorney to get the compensation you deserve. But it’s important to know the basics before you file a claim, which is why we’ve put together this guide to everything you need to know about workers’ compensation in Massachusetts.
The Basics of Workers’ Compensation Laws in Massachusetts
So how does workman’s comp work in Massachusetts? Basically, employers have to carry insurance for workers’ compensation in case something happens while an employee is actively working, whether on or offsite.
If an accident or injury occurs and an employee is out of work for more than 5 days, the employer is required to file a claim with their insurance company and report the injury to the Massachusetts Department of Industrial Accidents (DIA) within 7 days.
Workers who are unable to get back to work within 21 days can also get back compensation for the first 5 days following the injury. Workers’ comp should pay for associated medical expenses and will provide partial disability compensation for missed time at work.
As a worker, it is pretty simple to get the ball rolling on a workers’ comp claim. The challenges tend to start popping up if the original claim is denied. This can happen for any number of reasons. The insurance company might say that your injury does not meet state guidelines for workers’ compensation. Or, they might argue that the injury did not actually occur on the job.
Straightforward claims might be processed without any formal legal proceedings, like a hearing. But if the claim is denied, then a hearing and potentially an appeals process may take place. If the case starts to get complicated, it is usually best to hire an attorney to help you.
Your Rights As An Employee: Can You Be Fired For Filing a Claim?
First off, it’s important to know that an employer cannot legally terminate your employment because you file for workers’ compensation benefits. If you’re dealing with a workplace injury that’s affecting your ability to come to work and do your job, it’s important to speak up right away.
With that said, your employer is not required to hold your job while you are out of work due to an injury. The law does mandate, however, that employers give preferential treatment during the rehiring process once you are ready to return to work. There are no guarantees, but there’s no downside to filing for workers’ comp if you’re injured and can’t work.
Medical Only Claims Without Disability
Although you have to be out of work for 5 days to qualify for workers’ compensation, you can file a “medical only” claim for injuries that don’t keep you off the job for more than a day or two but still have associated medical costs. It’s also important to note that the 5 days that must elapse before you can get workers’ compensation do not have to be consecutive. If an injury keeps you out of work, you can file a claim.
How Do I Get Proof of Workers’ Comp Insurance?
Not sure who insures your employer? Check your workplace for a “Notice to Employees” poster with information about your employer’s workers’ compensation insurer. This notice is required by law.
If you don’t see a poster, you can check your employer’s status online. Use your pay stub when searching for your employer to make sure you are using the correct name. Massachusetts workers’ compensation verification shouldn’t be difficult to find, and you can always ask for help from the DIA or an attorney if you need to.
Do You Have a Legitimate Claim?
To qualify for workers’ compensation, your injury must have occurred while on the job. In general, injuries that occur on your way to and from work are not covered under workers’ comp. However, if you are injured when driving on the clock, you may have grounds for a claim.
An injury that qualifies for compensation has to be more than your everyday cuts and bruises. If an injury can be treated with the help of a first aid kit, you probably can’t expect any compensation. However, if you develop a disease or injury over time as a result of your daily duties or exposure to chemicals, then you may have a legitimate claim. These are often known as “occupational diseases” and can be grounds for compensation.
Mental illness that is caused by workplace duties and conditions may also qualify an employee for workman’s comp in Massachusetts. An example of a mental illness claim would be PTSD that developed on the job and now makes it difficult or impossible to work.
Any injury or illness that is preventing you from working is grounds for a workers’ compensation claim, as long as it occurred on the job. Any witnesses to the accident will help to strengthen your case, should the insurance company deny your claim.
How Much Compensation Can You Collect?
Some of the most common questions about workers’ compensation understandably have to do with how much money you can expect to collect when you’re out of work. If you have a family to support, these questions become even more pressing.
Many clients want to know: do you get full pay on workman’s comp? The short answer is no. Workers’ comp is not designed to replace your wages, but it will provide some relief for people who are out of work during an injury.
Each year, the DIA determines the minimum and maximum weekly compensation rates. These are set according to average weekly wages for the state and generally go up every year. The minimum/maximum Massachusetts workers’ compensation fee schedule can be found here. These minimum and maximum rates won’t necessarily be what you’ll receive from your claim—they just set limits for the state as a whole.
So how much can you expect to receive? Within the limits of the minimum and maximum rates, you will receive up to two-thirds of your average weekly salary. While there isn’t an official workers’ comp calculator, Massachusetts workers can figure out how much they can expect to receive (at most) by figuring 60% of their weekly salary.
The amount you will receive will also depend on your injury. If you are totally, permanently incapacitated (unable to work), you will receive 66% of your average weekly wage, up to the state maximum. For full, but temporary inability to work, you will receive 60% of your average weekly wage. For partial incapacity (meaning you must work less or take a lower-paying job), you can receive 75% of the amount you’d get if you were unable to work.
How Long Does Workers’ Comp Last in Massachusetts?
Massachusetts workers’ compensation benefits don’t last forever unless you are totally and permanently unable to work as a result of your injury. If that’s the case, then as long as you are disabled, you will receive this compensation, with adjustments for cost of living.
If you are fully incapacitated but you are able to return to work eventually, you will receive 60% of your weekly wage for up to 156 weeks, or three years. Partial incapacitation benefits can be collected for up to 260 weeks, or five years.
What to Do if You’ve Been Injured
If you’ve been injured at work, then your first step should be to seek medical attention immediately. You should be able to see your regular doctor, but you may also have to attend medical appointments with a doctor chosen by the insurance company at some point during the process. Some companies require this during their claim investigation process. You have a right to a copy of the Independent Medical Exam (IME) report after the insurance company requests that you attend a medical appointment.
For occupational diseases that develop over a long period of time, you may need to work closely with your doctor to verify that the illness occurred while you were working. The insurance company will need that proof in order to accept your claim and provide you with compensation.
Filing a Claim
After you’ve been injured, it’s important to tell your employer right away. It’s best if you notify them in writing, as this can be used during the resolution process in case it is needed. Generally, your employer will file a claim and you will just need to provide information as requested.
There are some situations, however, that might require you to file a claim yourself. If your claim is denied, your employer will not file a claim, or you’re filing for an accident or injury that occurred a while ago, you will need to file directly with the DIA.
You’ll need to be able to supply basic information, like the date of the injury, the doctor who treated you and is currently seeing you, and your employer’s insurer. Make sure to collect all the information you need before you go to the DIA to file a claim.
If Your Employer Doesn’t Have Insurance
You’re not out of luck if your employer doesn’t have workers’ comp insurance. You can still file a claim with the DIA against the Workers’ Compensation Trust Fund (WCTF) and get benefits depending on the details of your case. You must file these claims either by mail or in person.
Do I Have to File Right Away?
You must wait at least 5 days after your injury to start receiving benefits (although you should definitely seek medical attention and let your employer know that you were injured immediately). Fortunately, you don’t have to file right away to receive benefits after your injury. In fact, you have up to four years to file after the injury occurs.
In some cases, it’s not immediately clear that an injury was caused by normal duties on the job. That grace period can be very important for people whose injuries develop slowly, like workers suffering from carpal tunnel. Repetitive motions often cause injuries that can interfere with a person’s ability to work.
It’s important to realize that it might be harder to prove your case if your injury is cumulative. You probably won’t have any clear witnesses to support your claim and you will need to provide more evidence with regards to how the injury occurred. But if you legitimately became injured on the job over time, then you have a valid workers’ compensation claim that you should pursue.
If Your Claim is Denied
You might not have to do anything more than file your claim and wait for a check to arrive. Many Massachusetts workers’ compensation claims do not go beyond this first stage. But if the insurance company denies your claim, then you may need to schedule a conciliation with the Department of Industrial Accidents.
Hiring a lawyer at this point might be a good idea. Not only will your attorney help you through the hearing process, but they will be able to answer all your questions and know the best ways to get you the compensation you deserve.
Why are Claims Denied?
An insurance company makes money by collecting premiums. The fewer claims they pay out, the more money they retain. For that reason, they will do their best to avoid accepting workers’ compensation claims as much as they possibly can—even if they know that the claims are legitimate.
Generally, claims are denied on the grounds that the injury did not actually occur during the employee’s work hours. If the accident occurred on a lunch break or a disease took years to develop on the job, the company might claim that it does not meet the qualifications for a workers’ comp claim.
It can be difficult to successfully argue your case without the help of an attorney. Insurance companies have their own representatives and legal counsel, and they are very familiar with all of the laws surrounding workman’s comp in Massachusetts. You need to have your own expert advisor to help walk you through the process and get your desired outcome.
Hiring Representation For Your Workers’ Compensation Claim in Massachusetts
Do You Need a Lawyer? What Does a Workman’s Comp Lawyer Do?
For many people who have been injured, the biggest question is: when should I hire a workers’ comp attorney?
Simple workers’ compensation claims can be settled without the need for legal representation. If the insurance company doesn’t dispute the claim and sends a check, there is usually no need to hire an attorney.
If your claim is denied, however, it’s a good idea to seek legal counsel right away. A Massachusetts workers’ compensation guide for injured workers can help you understand the basics, but legal counsel can help you get the best outcome for your case. Workers’ compensation laws can be difficult to understand, which is why it’s important not only to hire a lawyer, but to hire a lawyer with expertise in workman’s comp in Massachusetts.
So, what does a workers’ compensation defense attorney do? They will help you with your case, offering counsel and advice about what types of evidence to present, how to proceed with your case, and what your rights are. They will also represent you during legal proceedings like the conciliation and hearing.
The Legal Process
Whether you start working with a workers’ compensation lawyer or not, you should know that there is a several-step process involved with resolving a workers’ compensation claim in Massachusetts. If your claim is denied, you will begin more formal legal proceedings with the Department of Industrial Accidents.
Once you file with the DIA, you will be contacted to set up conciliation with a representative from the insurance company. A conciliation is an informal meeting with a DIA representative that is intended to resolve the case by bringing the parties to an agreement, if possible. It’s recommended that you bring an attorney to this meeting, and to any other legal proceedings in your case. If an agreement is not reached, the claim will be referred to a judge for a conference.
The conference is another informal meeting, but a judge takes part and will issue an order, whether in your favor or in favor of the insurance company. If you’re unhappy with the outcome of the conference, you can submit an appeal within 14 days. This will result in a hearing.
A hearing is very similar to a trial. You or the insurance company may present evidence and call witnesses. Your attorney will help you gather the information you need for the hearing and represent you at the hearing itself.
If the outcome of the hearing is not in your favor, the final step in the process is sending an appeal to the Reviewing Board. Some cases are even taken up by the Massachusetts Court of Appeals if further appeals are filed after the reviewing board makes a decision. Fortunately, very few cases get to this point.
How Much Does a Workers’ Comp Lawyer Cost?
When you’re strapped for cash and trying to get some compensation while you’re out of work, it can be difficult to think about hiring a lawyer. But the good news is that a workers’ compensation attorney salary gets paid on a contingent fee basis regulated by the Massachusetts workers’ compensation statute. That means that your lawyer only gets paid if they get you the workers’ comp benefits that were denied by the insurance company or if they settle your workers’ compensation claim. You never have to pay your workers’ comp lawyer out of your own pocket.
Under Massachusetts General Laws Chapter 152, Section 13A, a workers’ comp attorneys representing an injured worker is paid a fee and reimbursed their out-of-pocket legal expenses in two ways: Event Fees and Lump Sum Settlement Fees.
Whenever an injured worker’s lawyer has to appear at the Department of Industrial Accidents on behalf of their client and negotiates an agreement to pay workers’ compensation benefits or wins an Order from an Administrative Judge mandating payment of workers’ compensation benefits, the lawyer is paid a fee by the insurance company. The amount of the event fee depends on where the claim is in the litigation process. The event fees are set each year by the Massachusetts Department of Industrial Accidents.
When a workers’ comp claim is settled, the injured worker’s lawyer is paid a percentage of the settlement. If the workers’ comp claim settles with liability accepted, the fee is twenty percent. If the claim settles without liability, the fee is fifteen percent. In addition to being paid a fee, the injured worker’s lawyer will be reimbursed for their documented out-of-pocket legal expenses. The attorney’s fee and reimbursement of legal expenses are deducted from the settlement.
What’s important to remember about the cost of workers’ compensation lawyer fees is that you’re compensating your counsel to help you get paid. Without the help of a lawyer, you might not get any compensation at all. Putting that into perspective can help when you’re asking yourself: do I need a lawyer for a workers’ comp claim?
How Do I Find a Workers’ Comp Attorney?
If you think it’s time to hire an attorney to help with your case, then you may be wondering how to find someone you can trust. Unfortunately, there are bad workers’ comp lawyers out there and it’s very important to avoid them.
You might start by searching for “workers’ comp lawyers near me” or something similar and checking out the options in your area. Years of experience, successful outcomes in other workers’ compensation claims, transparency when you ask questions, and responsiveness are all attributes to look for in a Boston workers’ compensation lawyer.
At the law office of John J. Sheehan, we’re dedicated to serving injured workers. If you need help with a workers’ compensation claim in Boston, Wakefield, or surrounding communities, our firm is standing by. Call us at 617-213-1360 so we can help you get the compensation you deserve.