What Is Workers’ Compensation Insurance?

What is workers’ compensation insurance? It is a type of government-mandated insurance that is designed to protect workers who are injured while they are working. If you are injured at your job in Massachusetts, you have the right to file a workers’ compensation claim through your employer. Scroll down to better understand how this program works.

What Is Workers’ Compensation Insurance?

What is workers’ compensation insurance? To fully understand, it is important for you to learn how the system works. The Massachusetts government requires employers in the state to carry workers’ compensation coverage under the state’s statutory laws. Since injured workers have the right to file claims for benefits without having to prove that their employers were negligent, they do not have the right to file lawsuits against their employers. However, employees who are injured by the negligent actions of third parties at their job sites can pursue negligence claims against the third parties while also filing workers’ comp claims with their employers’ insurance carriers.

Types of Benefits Through Workers’ Compensation

Both injured workers and the close family members of workers who are killed in workplace accidents can file claims for benefits. Workers’ compensation provides benefits to pay for injured workers’ related health care costs, including doctor visits, hospital stays, prostheses, medications, rehabilitation costs, and others. These benefits are provided without copays, making it better for injured people to use workers’ compensation benefits for their medical treatment instead of their private health insurance policies. If workers suffer partial or total disabilities, they can also recover ongoing benefits to replace a percentage of their incomes while they are unable to return to work. The families of workers who are killed can recover death benefits to pay for their funeral and burial costs, any medical care their loved ones received before dying, and ongoing monthly benefits to replace a percentage of their loved ones’ lost income.

Why Some Workers’ Comp Claims Are Denied

Insurance companies and employers sometimes deny workers’ comp claims filed by injured workers. If your claim is denied, you should start by determining why. The insurance company will send a denial letter that should explain its reasoning for denying your claim. If you believe that the provided reason was made in error, you have a right to appeal the denial. Some of the common reasons why insurance companies deny workers’ comp claims include the following:

• Failing to report the injury on time
• Not filing a workers’ comp claim on time
• Claim by your employer that your injury didn’t happen at work
• Claim by your employer that your injury happened because of another disqualifying reason
• Non-compensable injuries
• Insufficient evidence to show that your injury happened at work
• Lack of medical treatment

Appealing a Denial

If you want to appeal a denial of your workers’ comp claim, you will need to pay attention to the deadline listed in your denial letter. In addition, working with an experienced workers’ compensation attorney is a good idea when you are appealing the denial of your workers’ compensation claim. The appeals process can be complex. Your attorney can evaluate your claim and help you find more evidence to support the basis for it. In many cases, the appeals process will require you to appear at a hearing before an administrative law judge. Having an attorney to represent you can help you better understand the process and avoid making critical mistakes.

Your attorney will ask you to bring all documentation to support your claim. This will include any medical records you have that address the reasons you were given for the denial of your claim. In some cases, your attorney may be able to negotiate with the insurance company and your employer to reverse the denial of your claim.

Contact Ellis & Associates for Help with Your Workers’ Compensation Claim

Working with an experienced attorney at Ellis & Associates might help you ensure that you receive all of the workers’ compensation benefits to which you should be entitled. If your claim has been denied, it is possible that you can successfully appeal the decision. Contact Ellis & Associates today to schedule a free consultation by calling 800-MR-ELLIS or sending us a message online.