What happens if I got injured and the insurance company denied my claim?
If an insurance company denies your claim, generally there are several steps. If you’re injured and you’re out more than five days, the employer has to file a first report of injury. They have seven days from that time to file it with the insurance company and the Department of Industrial Accidents. At that point, the insurance company has fourteen days to either decide to put you on benefits or deny your claim. If they deny your claim, then you have to have a workers’ compensation attorney file a claim for benefits. It’s a Form 110 and the form establishes that you’ve been denied, the benefits have been denied. If you’re filing a claim for either medical treatment, a weekly benefit, or both, you have to attach a relevant piece of medical evidence that causally relates that industrial accident to the disability.
Once you’re denied, it’s incumbent upon you if you don’t have a claim filed, then the insurance company isn’t going to reach out to you again to change their mind.
Is it possible to win an appeal if my claim was denied?
If you’re appealing a conference order, certainly. Conference orders are best described as temporary orders. They’re orders based on the evidence to give perhaps an individual either the insurance company or the employee an order at that time. If you are denied benefits at the conference, perhaps the court doctor’s opinion comes back in your favor. Perhaps the testimony to be taken is much more detailed than in your favor than the judge was able to see at the time of the conference, then certainly, you can win on the appeal. After the hearing, if there was an error of the application of law, then you can certainly prevail at a hearing in front of the reviewing board, either with a decision or getting it referred back down to that judge with some instruction by the reviewing board. Yes, it’s possible to win on an appeal if you get an adverse decision.
Do I have to go to my employer’s doctor or can I choose my own?
The employer has the right to have you initially seen by a doctor of their choosing. They do not have the right to have you treat with a doctor of their choosing. Under Massachusetts law, you can treat with whomever you want to. The burden is as long as that medical treatment is fair, reasonable, and medically necessary, you have the right to treat with a doctor of your choosing.
You have the right to receive medical treatment from a doctor of your choosing.
- As long as your medical treatment is reasonable and related to your work injury it will be covered.
- You have the right to be reimbursed for expenses related to your medical treatment, such as out of pocket expenses, mileage, parking and prescription expenses.
- The Workers Compensation Insurer has the right to have you evaluated, not treated, by a doctor of their choosing once every six (6) months.
What if I don’t know the name of my employer’s worker’s comp insurance company?
Employers are supposed to post the worker’s comp insurance information, but that doesn’t always happen. More often than not, people call us and they don’t know who the comp carrier is. In that case, we turn to a database with Department of Industrial Accidents. We would submit the employer information and try to establish who that comp carrier is for the time of the injury. If that information isn’t there, we petition the Division of Insurance in Massachusetts. They’re very good at helping run a search and they will identify, hopefully, the insurance company if the person does have a worker’s comp policy.
If you ask your employer the name of their insurance company, they are obligated to provide that information. However, when a lot of people get injured, they’re out of the workplace and they don’t want to talk their employer about it.
How long do I have to file a claim in Massachusetts after I’m injured?
The statute of limitations for worker’s comp in Massachusetts is four years. However, the sooner you communicate your injury, the better. There are some people that are injured but don’t say anything. They move on with their life with the intention of recovering, but that doesn’t always happen. Regardless, you have to get the report and file a claim within four years of the date of injury.’
Should I wait to file my claim?
It is in your best interest to make a report and file a claim as soon as possible. For example, say somebody has an injury and they come back two years later to file it. Certainly, the insurance company is going to raise the defense of late filing and lack of notice. A lot of times, when you go to the conference, they would request that the judge deny any order for medical treatment up until that point. They would argue that they have not had the benefit of any knowledge of the injury. Timeliness is in your best interest because it eliminates a lot of questions that somebody would have relative to an injury that’s sustained, and a large gap in time goes by before it’s reported.
My company doesn’t have worker’s comp insurance and I was injured, do I have options?
We’ve had many cases in the past where an employer will not have worker’s comp insurance. While we don’t the understand the reasons for a lack of insurance, but sometimes perhaps the employer will improperly label somebody as an independent contractor. In any event, in Massachusetts, when an employer doesn’t have worker’s comp, there is a Massachusetts Trust Fund that you can file the same claim as you would against the private insurance company. They step in and they act as the insurer. They will pay a percentage of the average weekly wage. They will pay the medical bills and the mileage and everything else.
You are not left without recourse. If someone doesn’t have insurance, it doesn’t mean you don’t have a right to recover. You just simply get those benefits from the Massachusetts Trust Fund. The Massachusetts Trust Fund then will go and pursue those benefits back from the employer.
I was injured out of state, but my employer is in Massachusetts. What should I do/what state should I file in?
Being injured out of state while having a Massachusetts employer largely relates to where you live. If your employer is in Massachusetts and you live in Massachusetts, you were hired in Massachusetts, then you’re going to have essentially concurrent jurisdiction. We would recommend that you pursue the case in Massachusetts because when you go to court, it’s a lot easier for you to go to the regional court in Massachusetts than if you got hurt down in Florida. A lot of times there are questions of concurrent jurisdiction. If that jurisdiction lies in Massachusetts and that’s where you live, that’s where you would want to pursue the case.
How long do I have to wait to get my workers’ compensation check?
Under Massachusetts law, an agreement or a lump sum settlement, the insurer has to pay within fourteen days. They have two weeks to pay from the date of the approved agreement.
In rare cases, there are oversights, and the insurance company doesn’t pay your benefits in time. Sometimes, the payment isn’t made in a timely manner and the individual does have the right to file for a penalty. It’s an escalating penalty depending on the amount of time that the benefit isn’t paid under the worker’s comp statute, but fortunately, that’s not something that happens very often.
Can I get fired if I’m unable to work?
You can’t be fired because you sustained a worker’s comp injury and have availed yourself to that statute. If you’re fired for that purpose, it would be workplace discrimination and you may have a claim at the Massachusetts Commission Against Discrimination for that action. That being said, there are some individuals where their disability extends well into the future. Whereas an employee at will, the employer will say, “Look, I can’t hold this job open.” They fill that position. If that happens, under the statute, the obligation of the employer is to put you on a preferential rehiring list. If at some point in the future, you are no longer disabled and intend to return back to that job, you would be on a preferential rehiring list.
If I’m injured from daily wear and tear, not a specific accident, can I still get worker’s comp?
You can still get worker’s comp for a wear-and-tear injury (repetitive use injury), such as carpal tunnel syndrome. The symptoms develop and a doctor causally relates it to the work activities. Any kind of industrial accident or injury will come down to whether the doctor causally relates it to those work activities. For example, nurses often have back issues over periods of time, knee issues, shoulder injuries, etc. If they’re repetitive use injuries and the doctor causally relates it to those work activities, then certainly, it’s a legitimate claim for worker’s comp benefits.
The accident that happened at work that caused my injury was completely my fault, can I still receive worker’s comp benefits?
Under Massachusetts law, worker’s comp is a no fault system, so that even individuals that may have caused their own injury are entitled to benefits. Worker’s comp, being an administrative system, doesn’t have to establish somebody was negligent for you to be awarded these benefits. For a workers’ compensation laws to be valid, you must be doing something within the scope of your employment. and your injury arises out of those work activities. This is whether you hurt yourself, or it was the fault of someone else within the company, you’re still entitled to those benefits.
Additionally, you have a claim for pain and suffering if your injury was caused by the negligence of a third party.
If another party is responsible for the injuries you sustained at work a personal injury claim can be filed to recover for your pain and suffering caused by their negligence. This can result in another source of recovery for your injuries in addition to your Massachusetts Workers Compensation benefits.
Should I take a lump sum from the insurance company for my injury?
As far as lump sum goes, generally most cases may end up resulting in a lump sum, but there are different reasons for that. Perhaps somebody’s disability is such that the job has been filled, and there is no job to go back to. The other side of the coin is that individual’s injury is at the point of the end of medical treatment, or when they hit maximum medical improvement, the restrictions that have been placed on them by a doctor prevent them from going back to that job or that line of work. In those cases, it’s always the goal to negotiate a lump sum settlement that incorporates that exposure of payments that an insurance company would have to pay you under the worker’s comp statute.