How to Claim Workers’ Compensation Benefits

Most employers in Massachusetts are mandated to carry workers’ compensation insurance coverage. People who are injured on the job can file claims for benefits to pay for all related medical expenses. If the workers are unable to return to work either temporarily or permanently, they might also recover temporary or permanent disability payments to replace a portion of their lost income. Obtaining workers’ compensation benefits is not automatic, however. Scroll down to learn how to file your claim.

How to File a Claim for Workers’ Compensation Benefits

To file a claim for benefits, you must be an employee and not an independent contractor. Your injury must also be compensable and have occurred during the scope and course of your employment. If you were injured while commuting to or from your job, you won’t be eligible for benefits.

Reporting Your Injury

As soon as possible after your injury, you are required to report it to your employer. If your injury forces you to stop working for five partial or whole days, your employer will be required to report your injury to the Department of Industrial Accidents and its workers’ comp insurer. The employer must make the report within seven calendar days of your accident. This report initiates your claim for workers’ compensation benefits.

Once the insurance company receives the claim, it will investigate your accident. A part of this investigation might involve interviewing people who saw what happened, talking to your employer, and reviewing your medical and accident reports. The company might then either approve your claim or deny it. If your claim is denied, you have a right to appeal the decision. If your claim is approved, you might still need to negotiate with the insurance company to secure a proper settlement.

Types of Workers’ Compensation Benefits

Under the law, injured workers can pursue several different benefits when they are injured and recovering, including the following:

• Medical treatment related to the injury or illness
• Temporary disability benefits when you are unable to return to work for six or more days, of up to 60 percent of your regular income
• Permanent partial disability benefits if you are left with partial disabilities but can still complete some work
• Permanent total disability benefits if you cannot return to work at all because of your injury

What Happens If You Are Denied?

You will receive a notice of denial if the insurance company denies your claim. From the date of the notice, you will have up to four years to file a workers’ compensation case against the insurance company. To do so, you will need to file a claim with the Department of Industrial Accidents together with your medical evidence and mail a copy to the insurance company.

After your claim is filed, a notice of conciliation will be sent to you. Conciliation is a meeting at which you will meet with the insurance company to try to negotiate a settlement. It is best for you to have legal representation for help with this. A conciliator will be present to try to help to resolve your case. If an agreement is reached, your case will be over. If you cannot reach an agreement, your case will be scheduled for a conference.

The conference is scheduled with an administrative law judge. During this informal proceeding, the judge will look at the evidence and issue an order. This order can be appealed by either party by filing an appeal form. It will then be scheduled for a formal hearing.

If your case goes to a hearing, it will be similar to a trial. You can call witnesses and present evidence. Your attorney can also cross-examine the witnesses called by your employer and the insurance company. Once all of the evidence has been presented, the judge will issue a written decision. If your claim is denied by the administrative law judge, you can appeal to the Review Board. However, appeals at this stage will only be successful if the three-judge panel finds that the administrative decision was beyond the judge’s authority, violated the law, or was not justified by the facts. If you want to appeal a decision from the Review Board, it must be filed with the Massachusetts Court of Appeals.

Get Help from an Experienced Attorney at Ellis & Associates

If you have been injured at work, you might be entitled to receive benefits through the workers’ compensation system. Schedule a free, no-obligation consultation with the workers’ compensation attorneys at Ellis & Associates by calling 800-MR-ELLIS or sending us a message online.