The Massachusetts Statutory Framework for Workers’ Compensation Benefits
In Massachusetts, an employee injured at work is entitled to file a claim for workers compensation benefits if it can be proven that the employee sustained an injury while in the course of employment. The injury may not be a new injury, but an aggravation of a prior injury. So long as the present condition is a major, and not necessarily predominant cause of the disability or need for treatment, it will be compensable.
Under the Massachusetts workers’ compensation statute (Massachusetts General Laws, Chapter 152), your employer is responsible to pay for all on-the-job accident-related medical care, which includes emergency care, hospital visits, follow-up doctor visits, testing, treatment and medication. This statute also entitles you to receive 60 percent of your average weekly pay, which includes regular overtime and salaries from any other jobs you might have. In other words, if you are hurt at one job, your average weekly wage is computed by looking at your earnings from all of your jobs combined.
Can I Sue My Employer?
An employee cannot sure their employer in Massachusetts. The employee’s only right of recourse against their employer is filing a claim for benefits pursuant to General Laws Chapter 152. There are several exceptions of which an injured employee should seek the advice of a lawyer to discuss.
What Are an Employer’s Obligations?
The Massachusetts General Laws require an employer to submit a First Report of Injury form to the insurance company when two conditions are met: 1) the employer has received proper notice that the employee was injured and 2) the employee was unable to earn his full wages for at least five calendar days (including weekends and holidays). Under the statute, the employer has seven days (excluding Sundays and legal holidays) after he receives proper notice of an injury to file the form. If the employer violates this Section three or more times in a year, a penalty of $100.00 will be imposed for each violation. If the fine is not paid within three days of receipt of the bill, it is considered a separate violation.
If your employer does not file the First Report of Injury when he is supposed to, you can contact the Office of Claims Administration at the Massachusetts Department of Industrial Accidents (“DIA”), telephone number (617) 727-4900. You can also consult with an attorney about filing a claim.
To be entitled to workers compensation benefits, an employee must be out of work for five consecutive days. The employer then has a period of time to investigate the matter, and determine whether or not to put an employee on benefits. Some employers will voluntarily place an employee on benefits. If not, then employee must file a claim.
Filing a Claim
If the insurance company does not begin paying you benefits after your injury, you can file a claim at the Massachusetts Department of Industrial Accidents. Depending on where you live, the claim may be assigned to one of the regional Departments: Boston, Lawrence, Fall River, Worcester, or Springfield. Your claim must be accompanied by medical records showing that you became disabled as the result of an injury at work. While some employees appear at the Department of Industrial Accidents without a lawyer, due to some of the nuances on the law, it is wise to consult an attorney to appear on your behalf.
The conciliation, which usually occurs approximately thirty (30) days after you file a claim, is an informal meeting between the attorney for the insurance company and you and/or your workers’ compensation attorney. The conciliator is not a lawyer and cannot grant your request for benefits. Rather, the conciliator’s job is to see if there is some way that the parties can reach an agreement. If an agreement cannot be reached, the conciliator will make sure that there is enough medical documentation to support your claim and will then forward it to the Division of Dispute Resolution.
A Conference is an opportunity for the parties to present their best evidence before an administrative judge. The time between Conciliation and Conference is different in each region and change frequently. At the conference, your lawyer and the insurance company’s lawyer will submit medical documentation and other information to the administrative judge and will make presentations regarding why you should, or should not, be awarded benefits. You will provide testimony, and the judge may ask you brief questions just to get clarification. After the Conference, the judge will issue temporary orders either awarding, or denying, your claim for benefits. A judge may also provide an Order awarding modified benefits.
The Impartial Medical Examination and the Hearing
If either side feels they were aggrieved by the judge’s order, it can file an appeal. If you are still disabled, you will usually be required to be examined by an impartial physician appointed by the Massachusetts DIA. Following the examination, the doctor will submit a report discussing his opinion about your disability. Your case will then be scheduled for a hearing before the same judge who presided over the conference. The hearing is a formal proceeding, like a trial.
In a Hearing, the rules of evidence apply and witnesses testify under oath. After the Hearing, the administrative judge again issues a decision awarding or denying your claim for benefits. Unlike the conference order, a hearing decision is usually fairly long and will let you know the reasons why the judge made his decision. There can be a number of months between the close of evidence in the hearing and receipt of the judge’s hearing decision. During this period, the terms of the conference order will remain in place.
After the hearing decision is filed, the parties have thirty days to file an appeal to the Reviewing Board at the Department of Industrial Accidents. Further appeals may be had to the Massachusetts Appeals Court and the Supreme Judicial Court.