If you get hurt on the job in Massachusetts, you may be able to get workers’ compensation benefits. These benefits can cover medical treatment, lost wages, and job training if you can’t return to your old job.
Three state agencies run the workers’ comp system in Massachusetts. The main one is the Department of Industrial Accidents (DIA). They handle disputes and make sure everyone follows the rules. The Division of Insurance (DOI) also oversees some parts. And the Executive Office of Health and Human Services (EOHHS) sets the fees that doctors and hospitals can charge for treating work injuries.
There’s also a Workers’ Compensation Advisory Council that watches how the system is working. They write up a yearly report with recommendations for improvements.
Most employees are covered by workers’ comp if they get hurt on the job or develop an illness from work. It doesn’t matter if you work full-time or part-time. The injury just needs to happen while you’re doing your job duties.
Some examples of work injuries that would probably be covered:
You can also get workers’ comp for emotional issues like PTSD if something traumatic happened at work. For example, a bank teller who develops anxiety after a robbery.
If your claim is approved, you can get several types of help:
Medical care – Workers’ comp covers all reasonable and necessary medical treatment related to your injury. This includes doctor visits, therapy, hospital stays, surgery, medication, medical equipment like crutches, and travel to appointments.
Lost wages – If you have to miss work due to the injury, you’ll get a portion of your usual wages until you can return. The exact amount depends on your wages and work status.
Job retraining – If you can’t go back to your old job due to permanent restrictions, you may qualify for vocational rehab. This can include skills assessments, job coaching, education programs, or placement services to find a new career.
Other smaller benefits may be available too, like home modifications if you now use a wheelchair.
Your employer’s workers’ comp insurance pays for all approved benefits. You should never see a bill. The only exception is if you choose a doctor outside of your employer’s preferred provider network. Even then, you just pay the copay.
As soon as you suffer a work-related injury or illness, tell your supervisor right away. Don’t delay reporting it. Your employer must file a First Report of Injury within 7 days. After that:
If your claim is denied, you can appeal to the DIA. A judge will review your case at a hearing and issue a final decision. The whole claim process can take weeks or even months in disputed cases.
EOHHS sets the maximum fees that doctors, hospitals, pharmacies, and other providers can charge for treating work injuries. However, employers and their insurance carriers often negotiate lower rates.
The regs with the reimbursement rates for workers’ comp include:
Hospitals are paid based on their individual Payment on Account Factor (PAF), which is a percentage of their full price. For doctors and other outpatient providers, EOHHS publishes a fee schedule with codes and rates for specific services. Prescription reimbursement uses the same rates as Medicaid.
If a service isn’t on the fee schedule, the insurer can negotiate a fair individual rate with the provider. Certain emergency and inpatient services are paid based on hospital charges instead of fixed rates.
Yes, you can generally choose your own providers for workers’ comp claims. The only exception is for the first visit. If your employer uses a preferred provider organization (PPO), you’ll have to see a doctor in that network first before you can switch.
For follow-up care, you can change doctors or use outside specialists if you prefer. Be aware that providers in other states will still need to accept Massachusetts’ fee rates for treating your work injury.
Disagreements happen frequently in the workers’ comp system between injured workers, employers, and insurers. Here are some common disputes:
Talk to an attorney if you have a complex dispute. For questions on your claim status or benefits, contact your employer’s insurance adjuster or the DIA helpline.
Hopefully this overview has helped explain Massachusetts’ workers’ compensation system. Our consultations are free if you would like to call us and ask questions on how we can help you or you can just fill out our contact form. To schedule a free consultation call 978-459-3085 or fill out the contact form on this site.
Here are some additional resources if you need to learn more:
You can also contact the DIA help line at 617-727-4900 or firstname.lastname@example.org. If you have a question on a specific issue, they can point you in the right direction. Workers’ comp can be complex, but following the proper steps from the start will get you the best outcome.
The worker’s comp system is quite complex. The easiest thing you can do is to hire an attorney. That way you do not need to worry about this call, that appointment, or try to navigate who to talk to and when while delaying your payment.
If you’ve suffered an injury at work in Massachusetts, you may be eligible for workers’ compensation benefits. This includes lost wages, medical treatment, and more. However, successfully filing a claim and getting the maximum benefits can be difficult without professional legal help. Here’s why it’s advisable to hire a workers’ comp attorney rather than go it alone:
There are many intricacies involved in proving your injury is work-related and merits compensation under Massachusetts law. An experienced local attorney will know how to gather convincing evidence and prove both legal and medical causation. This includes getting detailed witness statements, employer records, video surveillance, medical opinions linking the injury to your job duties, and more. They can then persuasively argue your case.
Strict deadlines apply when reporting injuries to your employer and filing for workers’ compensation benefits. If you miss these deadlines, your claim may be denied. An attorney will advise you when and how to properly report the injury per Massachusetts statutes so your rights are protected.
Massachusetts workers’ comp laws contain many complexities that are hard for non-lawyers to understand. There are special rules for mental health injuries, occupational diseases, pre-existing conditions, and more. Detailed procedures must also be followed for filing claims, collecting benefits, choosing doctors, and resolving disputes through the Department of Industrial Accidents. An experienced local attorney will know how to comply with all requirements and navigate the bureaucratic system.
Many worthy claims are initially denied by insurance carriers. Your attorney can request an appeal hearing and represent you before the DIA to fight the denial. Having a skilled legal advocate greatly improves your odds of overturning the denial so you can finally obtain your entitled benefits.
There are many ways an attorney can get you more compensation. This includes proving you qualify for each benefit type, getting appropriate income replacement rates, fighting any premature benefit terminations, and securing the proper fee schedules for your medical care. They also know how to calculate and prove future lost earnings if you cannot return to your prior occupation.
Rather than endure years of litigation, most claims settle out of court. An experienced attorney will negotiate aggressively to get you the maximum settlement justified by the facts of your case. This requires sophisticated negotiation skills and knowledge of typical settlement ranges for your type of injury.
Insurers often delay payments to try to force a smaller settlement. Some even hire private investigators to try to claim you’re exaggerating your injuries. Your attorney can file complaints to recover unpaid benefits faster and protect you against harassment or other misconduct.
Dealing with adjusters, doctors, employers, and the DIA involves substantial paperwork and phone calls. Hiring a law firm gives you a team that can efficiently handle this administrative burden while you focus on recovery.
Most workers’ comp lawyers work on contingency, meaning they only collect a fee if they win your case. The fee comes out of your eventual settlement or award. This also motivates them to maximize your payout.
To further understand what a contingency structure looks like, here is a further explanation.
A contingency fee is a payment arrangement where the attorney only collects a percentage of the compensation awarded if they win the case. No upfront retainer or hourly fees are paid.
For workers’ compensation cases, the typical contingency fee is 20-25% of the final settlement or award amount. For example, if the attorney wins a $100,000 settlement for the injured worker’s claim, their fee may be $20,000 or $25,000 taken from the total award.
The main benefit of a contingency arrangement is it allows injured workers to pursue their claim without any upfront costs or fees. Attorneys are willing to work on contingency because they assume the risk – if they lose the case, they do not get paid at all for their time. This gives the attorney incentive to fight aggressively to maximize the final payout, so their percentage fee will be larger. It’s a mutual “pay if you win” system.
Contingency fees are very common for workers’ compensation cases since the injured worker is often unable to work and short on funds during the claims process. It allows them to secure experienced legal help without paying hourly legal fees they can’t afford. However, injured workers should still compare fee rates to find the best value.
Many attorneys choose to practice workers’ compensation law because they want to help injured people through difficult times, not just make money. Their passion shines through in their dedication to serving clients.
The bottom line is that an experienced local workers’ comp attorney levels the playing field against big insurance companies and employers. Their expertise and advocacy can make the difference between having your case denied or recovering the maximum benefits the law entitles. It’s an investment that pays off by reducing stress, work, risk, and delays in obtaining your due compensation.
Massachusetts workers’ compensation is intended to cover injuries workers sustain on the job. With very few exceptions, work-related injuries will be covered regardless of how they happened. It’s not necessary to prove that the employer was negligent.
Your return to work and any restrictions on the work you can do will be determined based on the doctor’s orders. If the treating physician determines that you are able to work but cannot perform all of your usual duties, they will give your employer restrictions. Then, the employer has the option of offering you light duty work that complies with your restrictions. If they don’t have work available that you can do with your restrictions, you will continue to receive temporary disability benefits.
Workers’ compensation is an exclusive remedy. So, if your employer or a co-worker caused your injury, Massachusetts workers’ compensation law prohibits you from suing. However, there may be situations in which a third party outside the company is responsible or partly responsible for your injury, such as when you are injured by a defective piece of equipment. In that case, you may have additional claims.
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