When you get injured at work in Massachusetts, you’re entitled to benefits and healthcare.
What most people don’t know (or their employers don’t let on) is the circumstances don’t matter. If it was an accident, even if it was your fault, you’re entitled to worker’s compensation.
The workers compensation process differs drastically between states. Here’s how to apply for, and receive, the benefits you’re entitled in Massachusetts.
Phase one: Starting your claim by notifying your boss
Your first step to filing a worker’s comp claim is to notify your employer about your injury. This step sets off the claim process by getting your information in the government and your insurer’s systems.
What injuries count for worker’s compensation?
An injury or illness counts as work-related when an event or exposure at your workplace causes, contributes to, or aggravates a medical issue.
Note that this definition doesn’t specify who needs to be involved. Even in the case of an accident involving only you, you could still qualify for worker’s comp.
How do I file a worker’s comp claim in Massachusetts?
Your responsibility as an applicant is to let your employer know about your injury. Most of the claim filing process should happen on your employer and their insurer’s end.
Once you tell them about your injury, your employer will file a report to the state Department of Industrial Accidents (DIA) and their worker’s compensation insurance. You should get a completed copy of that form, too.
Your employer must file that form within seven days of the fifth day you lose work time from your injury. From there, the insurance has 14 days to decide if they will pay your claim.
If your employer doesn’t send their report and 30 days pass after your injury, you can report the injury to the insurance company yourself in writing. You can also send them Form 110, the DIA’s employee claim form.
When you need to file a claim yourself, a lawyer can help you provide the appropriate information to the insurer to improve your chances of a successful claim.
When and how should I let my employer know about my injury?
Tell your employer as soon as possible about your injury.
When you can, provide that notice in writing, such as through an email, letter, or text. Save a copy for your records.
These measures help you build a stronger case if your claim is denied. Letting your coworkers know about your injury when it happens can also create a better case if you end up needing witnesses.
What should I do if my claim is denied?
According to the DIA, half of worker’s comp claims in Massachusetts are denied by an employer or insurer. If this happens, the DIA highly recommends getting a lawyer.
Once you acquire a lawyer, they’ll work with you to file a claim with the DIA. You can also file one of these claims when you don’t get the benefits you think you’re entitled to.
The DIA starts this process with basic negotiations among you, your employer, and the worker’s comp insurance. If you don’t come to a resolution at that stage, the DIA will escalate the situation to informal legal proceedings and then a formal hearing.
Phase two: Getting active medical treatment
As you receive active medical care for your on-the-job illness or injury, your employer’s worker’s comp insurance will provide the benefits they consider appropriate.
The worker’s compensation insurer must give you an insurance card with your claim number on it. Give your doctor that claim number when you see them so you can receive the medical benefits owed to you.
What doctor can I see for worker’s comp?
In Massachusetts, you must go to your employer’s own medical clinic for your first appointment. If they don’t have a dedicated medical practice, you can choose your doctor.
Even if your employer sends you to their clinic for your first visit, however, you can go to your own doctor from the second visit onwards.
Throughout your treatment, your worker’s comp insurer may send you to one of their doctors to evaluate your condition.
Can I go back to work during treatment?
The duties you take on as you go back to work can affect how much money you receive from worker’s compensation.
Depending on the nature of your job, your employer may put you on light-duty work.
Working with light-duty responsibilities generally doesn’t interfere with your case. But, if you go back to your full responsibilities, you could receive fewer benefits due to your injury being perceived as not sufficiently severe.
For the same reason, taking a second job can also interfere with the total amount you end up gaining from workers’ comp.
In Massachusetts, worker’s comp will cover a set percentage of your wages that varies by how much your injury reduces your ability to work.
When will the worker’s compensation insurance stop covering my treatment?
Your employer’s worker’s compensation insurance covers as much treatment as the insurer considers themselves liable for.
While the worker’s comp insurer must make an initial decision on your case within 14 days, they will make a final choice within 180 days from your injury. During those 180 days, they can pay you benefits without deciding if they’re responsible yet.
If the insurer considers themselves not liable when you still need treatment, you have the right to work with a lawyer to appeal that decision.
Phase three: Reaching maximum medical improvement
You’ll reach a point in your treatment where you’ll figure out if you need long-term care. At this stage, you and your lawyer may have to negotiate the benefits owed to you for the rest of your life.
What is maximum medical improvement (MMI)?
Maximum medical improvement (MMI) is the point of care where your condition has improved as much as possible from medical treatment.
In many cases, this means the employee recovers and can go back to work.
Other cases involve an employee who has a chronic condition as a result of their injury. In this situation, they’ll want to get coverage for ongoing care that helps them manage their symptoms.
What am I entitled to after I reach MMI?
Once you reach MMI, your employer’s worker’s comp insurer will ideally cover any ongoing care you need to function. If they deny your claim at this point or don’t provide the benefits needed for your condition, you’ll need to work with your lawyer.
When your doctor determines you won’t recover further, they’ll use the AMA Guide to the Evaluation of Permanent Impairment to rate your condition. You and your lawyer will use this rating to negotiate the benefits owed to you. In some cases, the insurer will try to dispute this rating, making it especially important to have a lawyer to help.
It can take years for some people to get to MMI. Insurers in these cases may try to settle beforehand to minimize the ongoing benefits they need to cover.
Work with a worker’s comp lawyer in Massachusetts
A lawyer can help you get the highest payout possible from your worker’s comp claim in all stages of the process. They’ll ensure that your employer and their insurer provide the benefits due to you.
If you have a workplace injury and need assistance, contact Atticus today. We can give free legal advice on the early stages of your case, and can connect you to a lawyer if you need one. Our services are always free.