What is Workers’ Compensation?

Were you hurt at work? If you were injured on the job, you may be eligible for workers’ compensation benefits. Workers’ compensation insurance, often referred to as “workers comp”, is a state-mandated program consisting of payments required by law to be made to an employee who is injured or disabled in connection with work. The federal government offers its own workers’ compensation insurance for federal employees, but every individual state has its own workers’ compensation insurance program. It is this insurance that pays for medical treatment regarding injury and illness. In the majority of situations, injured employees receive workers’ compensation insurance, regardless of who was at fault for the injury. Because these workers comp benefits act as a type of insurance, they prevent the employee from suing his or her employer for the injuries covered.

In the state of Massachusetts, the Department of Industrial Accidents (DIA) oversees worker’s compensation claims. The worker’s comp system is in place to ensure that workers are protected if they are injured on the job or contract a work-related illness. Under this system, the Massachusetts General Laws requires all employers to provide worker’s compensation insurance coverage to their employees. To learn more about workers’ comp in the state of Massachusetts, click this link!

Workers’ comp cases can be complicated. The attorneys and staff of Schulze Law can help you understand your worker’s compensation rights and bring a claim to the DIA. In some instances, employees are injured at work but that injury is not the fault of their employer. We can help you bring a new worker’s comp claim—as well as appeal a rejection of a previous claim—and also represent you in a third-party lawsuit if your situation supports it.

Let’s check out some of the top questions regarding workers’ comp to help you navigate this often confusing process. For up-to-date information on workers’ comp in your state, contact your state’s workers’ compensation office. You can also find links to the appropriate office in your state on the State Workers’ Compensation Officials page of the U.S. Department of Labor’s website.

  1. How do I know if I qualify for workers’ compensation?

If your injury occurred as a result of your employment, it’s very likely that you are eligible for workers’ compensation. In Massachusetts, any employee who suffers an on-the-job personal injury that causes him or her to miss five or more full or partial days of work is eligible for workers’ compensation. State law has specific definitions of employees and on-the-job injuries that qualify for benefits, which are stated in Massachusetts General Laws (MGL) Part 1 Title XXI Chapter 152 Section 1.

  1. What types of injuries does workers’ compensation cover?

According to GetLegal.com, the specific types of injuries for which benefits are available under state workers’ compensation laws varies slightly from state to state. As a general rule, states recognize the difference between temporary and permanent disability, and between partial and total disability. The types of injuries typically include:

  • Serious and catastrophic loss, such as broken bones, amputation or loss of limb, paralysis, traumatic brain or spinal cord injury, burns and permanent scarring or disfigurement
  • Repetitive stress or motion injuries, such as carpal tunnel syndrome, nerve damage, ligament, tendon and muscle injury
  • Joint and connective tissue injury, from foot, ankle, leg and hip trauma to hand, arm and shoulder injury
  • Occupational disease, such as mesothelioma, silicosis, cancer and heart disease, and
  • Mental health issues, including depression, stress and anxiety (varies by case)

3. Are all work-related injuries covered by workers’ compensation?

According to Nolo.com, workers’ compensation covers most work-related injuries—but not all. Generally, workers’ comp doesn’t cover injuries that happen because an employee is intoxicated or using illegal drugs. Coverage may also be denied in situations involving:

  • Self-inflicted injuries (including those caused by a person who starts a fight)
  • Injuries suffered while a worker was committing a serious crime
  • Injuries suffered while an employee was not on the job, and
  • Injuries suffered when an employee’s conduct violated company policy.
  1. What are the benefit amounts I’m entitled to?

The amount of money paid to an employee who is disabled depends upon the extent of that worker’s disability. Under Massachusetts workers’ compensation laws, the following are the benefit amounts a disabled worker is entitled to:

  • Total and permanent incapacity: Two-thirds of the worker’s average weekly wage
  • Total incapacity: 60 percent of the worker’s average weekly wage, up to 156 weeks
  • Partial incapacity: 60 percent of the difference between the worker’s weekly wage before the injury and after the injury
  1. What if I get denied?

Unfortunately, workers’ compensation insurance companies can deny claims for almost any reason. About 50% of all workers compensation claims are denied. On the bright side, many of the most common reasons are also the easiest to avoid. You can often avoid denials and help make sure you receive prompt payment by making sure you see a doctor immediately, by reporting the injury to your employer as soon as possible and by calling Schulze Law to help assist you.

In Massachusetts, you have the right to file a claim with the DIA. The DIA recommends getting an attorney to help you with the dispute process. Firstly, you will have to complete an Employee’s Claim Form (Form 110), attaching any medical evidence of that supports your claim and a description of when and how your injury occurred. Once you send the completed form to the DIA, you will receive a date for a Conciliation meeting to try to reach a voluntary agreement with the insurer.  If no agreement can be made, you will have a Conference with an Administrative Judge, where you’ll be allowed to argue for your right to receive workers’ compensation benefits.  A decision as to whether to grant benefits will be made at the Conference, but can be appealed by either side at a subsequent Hearing.

  1. How long can I receive benefits?

For total incapacitation, you can receive benefits for up to three years. For partial incapacitation, you can receive benefits for up to five years. Workers who are permanently and totally incapacitated can receive benefits for as long as they are disabled.

7. Do I have to be injured at my workplace to be covered by workers’ comp?

No, not necessarily. Generally, if your injury is job-related, it’s covered. For example, you will be covered if you are injured while traveling on business, doing a work-related errand, or even attending a required business-related social function. You can learn more about what does and doesn’t count as a work-related injury or illness.

8. How long will it take for my workers’ compensation claim to be approved?

When an insurance company receives a claim, it is required to investigate within 14 days and inform the employee about whether he or she will receive benefits. If your claim is approved, you will receive your first check at some point during those 14 days.

  1. How do I start the workers’ compensation claims process?

According to Attorneys.com, the first thing you should do after suffering a workplace injury is get immediate medical attention. You will also need to inform your employer, preferably in writing, of your injury. This gets the ball rolling.

The sooner the better, but you have up to four years after you become aware of the connection between your disability and your employment to file a claim with your employer’s Massachusetts workers’ compensation insurance carrier. The insurance carrier will then process your claim and make a determination of whether to accept or deny benefits. Your employer is required by law to display the name and contact information of its workers’ compensation insurance carrier.

  1. Do I have to be treated by my employer’s doctor?

Some states give you the right to choose the doctor who will treat you for your injuries (called your “treating doctor”), while others give that right to your employer or its insurer. Other states have more complicated rules for selecting a treating doctor. In Massachusetts, your employer can require you to see a health care provider within its preferred provider arrangement (if it has one), but only for the first visit; after that, you can switch to your choice of treating doctor (Mass. Gen. Laws ch. 152, § 30 (2018)).

11. What if my employer doesn’t have workers’ comp insurance?

In some states, a failure to have workers’ compensation insurance means that the employer is open to liability in a regular court of law.

In Massachusetts, the employee will be paid from a trust fund set up by the Department of Industrial Accidents. The Workers’ Compensation Trust Fund has their own lawyers who will pay employees benefits when employers do not have workers’ compensation insurance. Afterwards, the Trust Fund tries to collect these funds directly from the employer. This collection process will likely cost the employer much more this way than it would have to just have workers’ comp insurance.

  1. How do I return to work after being on workers’ comp?

The insurer, the insurer’s examiner, or your employer—can’t tell you that you need to return to work. This decision is up to you and should be made with supervision from your doctor. The only exception to this rule is if the Department of Industrial Accidents orders an impartial physician and they determine that you are capable of returning to work.

Once you do go back to work, you are given a 28 day trial period to make sure that you are fully capable of meeting all of your job responsibilities. If you find that you can’t continue working, you must give your employer and the insurer notice within 21 days. If you report your inability to continue work under these rules, your benefits will start again without you having to file a new claim.

If you’ve been injured at work, contact Schulze Law today. The cases involving workers’ comp can be complex and challenging to navigate which is why our experienced attorneys can help. Each individual case is unique and it’s extremely important to have a member of our team review your case and discuss your legal rights and options. We will always fight for the justice you deserve.