Massachusetts Workers' Compensation Benefits
Breaking down the basics
Workplaces in Massachusetts provide workers' compensation benefits to their employees, usually through a policy purchased through a private insurance company or, in some cases, with self-insurance. The workers' compensation system is set up to provide employees with a safety net in the case of injury or work-related illness. No matter what the job is, anyone from construction workers to receptionists can be at risk for an unfortunate incident, and getting compensation for the pain endured can be difficult.
The Law Offices of Deborah G. Kohl has vast experience dealing with workers' compensation cases for injured and ill people who need help. Legalese isn't everyone's primary language, which is why it's so important to have an attorney on your side who can make workers' compensation more user friendly. Simple and clean is the way that this process should be, and we can help with that.
- How are workers' compensation claims paid?
- What should I do after an injury?
- Filing a claim
- What kinds of compensation are there?
- What should you do if your claim is denied?
- Finalizing your settlement
A system set up to help the injured shouldn't cause further harm. Recovery shouldn't be interrupted or hindered by complicated legal proceedings; let us take care of that for you. If you've been injured, or are dealing with a work-related illness, contact us straight away. We'll assist you through the process, start to finish.
How are workers' compensation claims paid?
In cases of workers' compensation, the claim is administered through an employer's insurance company, the employer, or both. Workers' compensation is a no-fault system, which means that you don't need to prove that your employer was negligent in order to claim your benefits. In order for your injuries to be compensable, you only need to show that you were hurt on the job.
Workers' compensation includes two types of benefits: medical expenses and wage loss benefits. Your reasonable and necessary medical expenses related to the on-the-job injury must be paid in full by the workers' compensation insurance company. If you are unable to work, or need to work reduced hours or otherwise earn less as a result of your injury, you can claim a weekly check from the insurance company to compensate for your wage loss.
What should I do after an injury?
The moments after an injury can be ones fraught with panic and uncertainty. You've been hurt, or diagnosed with an illness that has the potential to change your life forever. Your quality of living may be an uncertain prospect at the moment. While these may be frantic times, there are a few actions that are critical to take following an injury.
- Report your Injury: Immediately alert your employer that you've been hurt. They'll have to file a claim with their insurance company, so time is of the essence. While you can make this notification verbally, we recommend doing so in writing, as it creates hard evidence of your report.
- See a doctor: As with any accident, you need to get medical attention immediately. A bump on the head can seem harmless, but you'll never know if it's an indicator of brain swelling or internal bleeding unless you see a doctor. Some symptoms of serious injuries take days to show up, and by then it may be too late to avoid catastrophic injury. In addition, having a medical examination on file bolsters your claim. The insurance company will likely attempt to dispute the extent of your injuries, and having that evidence will support your case.
- Contact a lawyer: Any case is hard to handle on your own. When your financial security and peace of mind are of concern, you need legal help. Insurance companies aren't always straightforward and simple, and they will do what they can to reduce or deny your claim for benefits. Remember, in Massachusetts, your employer and their insurance company are not required to provide you with information regarding your claim, so you're left to advocate for yourself - or have your lawyer advocate for you. Having an attorney on your side levels the playing field.
Once the claims process begins, it can be hard to see an end to it. That's why it's so important to have a lawyer on your side that knows the system inside and out. We're here for just that, to make life simpler for you so you can have an easier recovery. Contact us and we'll help you through the steps of filing a claim.
After you report your injury, you have four years to file your claim at the Department of Industrial Accidents (DIA) on the appropriate form. (Remember that notifying your employer or their insurance company does not count as filing the claim.) This may seem like a long time, but if you put off medical attention, you may not realize that an illness or disability you now suffer from was work related until after it's too late.
- Be sure to include when and where the accident happened, your symptoms, and how you were hurt. You may also be required to fill out an accident report, in which you should be incredibly specific about the incident.
- The insurance company will review your medical records, wages and work background, and may want a test of your functionality in order to proceed with figuring out your compensation.
What kinds of compensation are there?
In terms of workers' compensation, there are several types you can receive. Medical bills, wages lost from work days you've had to miss out on due to injury, even the cost of travel to medical appointments can add up rather quickly and must be addressed. In addition, an injury has the potential to result in differing levels of disability, which may impact how someone is given compensation. So, what might you be eligible for?
- Medical treatment: Any medical costs that are necessary and related to your on-the-job injury must be taken care of by the insurance company. Medical devices, tests, doctor's visits, any hospitalizations, and prescriptions should all be covered, along with reasonable reimbursement for related costs such as mileage to and from your appointments.
- Temporary total disability (TTD): This type of benefit applies when a disability renders someone unable to work for six or more days. In terms of wage reimbursement, the benefits include reimbursement 60% of your average weekly wages, up to a state maximum. You can collect this type of benefits for up to three years as long as you are unable to work.
- Temporary partial disability (TPD): This type of benefit applies if you are still able to work, but in a reduced earning capacity. For instance, you might need to work fewer hours or take on a "light duty" position for lower pay. TPD benefits are set by a judge at a rate that cannot exceed 75 percent of what you would have received for a total disability. You can continue to receive TPD benefits for up to four years as long as the disability persists.
- Permanent total disability (PTD): If your injury was expected to cause permanent damage and limit you, your doctor will perform an evaluation when you have healed, or gained back as much functionality as much as you are expected to. To qualify for permanent total disability, you don't need to completely lose your quality of life or ability to function, but you do have to be unable to continue working in your field. For example, if you worked in manufacturing, the injury would need to render you totally unable to work in the manual labor field.
What should you do if your claim is denied?
Don't panic. Insurance companies routinely deny workers' compensation claims, sometimes even before you have finished filing your claim with the Department of Industrial Accidents. Just because your claim was denied does not mean you can't receive your benefits. In fact, from the injured worker's perspective, a denial has very little effect on the process. You still need to go through with filing your claim at the DIA.
You'll need to complete an Employee's Claim Form and file it, along with all your medical records and anything that can support your claim. Once you have filed, the process proceeds as follows:
- You'll receive a notice of a conciliation, which is a meeting between yourself and the insurance company. If your claim is not resolved at this meeting, you'll have a conference as the next step.
- A conference is a meeting with an administrative judge who will review evidence and the case at hand. Note that going before a judge can take a long time - often three to four months. The judge will issue a compensation order, which either or both parties can appeal to a hearing.
- The judge will instruct you to see a doctor of his or her choosing for a medical evaluation.
- At the hearing, witnesses may accompany evidence, and the case proceeds in a trial-like fashion.
Remember, the insurance companies have gone through this process hundreds of times. If you try to represent yourself, you'll be at a significant disadvantage, and the deeper you get into the process, the more difficult it will be. We strongly recommend retaining an experienced workers' compensation attorney right away to build your best possible case for compensation.
Once a fair amount is agreed upon, you may get the option to be paid in a lump sum. These are often decided by the degree of injury, how long you've been disabled for, and your average weekly wage at the time of injury. Your attorney can advise as to whether a settlement is in your interest, and negotiate with the insurance company to find a solution that meets your needs. Note that in workers' compensation cases, all settlements need to be approved by a judge.
At the Law Offices of Deborah G. Kohl, we're dedicated to a personal approach that individualizes every client's case to give it the attention that it deserves. Contact us for a free case evaluation today and begin pursuing the justice you deserve.