Dealing with a workplace accident claim can get very difficult. The Massachusetts Workers’ Compensation Guide was created by Lowell attorney Jeffrey Young to help injured residents navigate the system and obtain their maximum compensation.
The Comprehensive Guide to MA Workers’ Comp Benefits, Injuries, and Claims
Have you been seriously injured in a workplace accident? Attorney Jeffrey Young knows what struggles you are facing and wants to help you in any way he can. These are often traumatic events that can leave you in financial ruins. The insurance is not here to help when it comes to getting you the benefits you deserve. If you want workers’ compensation for your injuries, you found the right place.
Workers’ compensation benefits in Massachusetts are available for workers who are hurt on the job. It is a benefit that is provided to workers by employers at no cost. Most employers are required to provide these benefits under state law. No one really expects to get hurt on the job, but it happens every single day. While some workplace injuries are obvious, such as a broken bone, there are other injuries that take time to show symptoms. For example, repetitive stress injuries (such as carpal tunnel) and on-going exposure to harsh chemicals or toxins that cause asthma, cancer, or other long-term and often permanent health conditions.
Who Investigates Workers’ Compensation Claims?
The Department of Industrial Accidents (DIA) is a state agency that oversees the workers’ compensation program. They adjudicate disputed workers’ compensation claims. The DIA recommends that injured employees consult a qualified workers’ compensation lawyer because of how complicated these claims can be. However, the DIA cannot make referrals to lawyers.
What Benefits Are Available Through Massachusetts Workers’ Compensation Program?
There are several workers’ compensation benefits in Massachusetts. It’s important to remember that they are awarded based on the facts surrounding the claim. In general, they cover all of the medical expenses that are associated with the injury. Workers’ comp also provides wage replacement if the worker is temporarily or permanently disabled from the injury.
For disability benefits, the financial compensation awarded depends on the severity of the disability. In short, whether the worker is partially or totally disbaled and whether the disability is temporary or permanent. Permanent disability means that the worker is totally disabled and can never return to the workforce. A temporary disability means that the worker will eventually be able to return to work. Massachusetts law determines how much financial compensation a worker will receive if they are disabled:
- Workers who are totally and permanently disabled will receive 2/3 of their average weekly wage with a minimum 20% of the state average weekly wage at the time of your injury, and an annual cost of living adjustment for as long as you are disabled.
- Workers who are considered temporarily totally incapacitated will receive around 60% of their average weekly wage from the last year prior to the date of injury for up to 156 weeks. Payment begins on the sixth day of disability unless you cannot work for 21 days or more. Those days aren’t required to be consecutive.
- Workers who are considered partially incapacitated may receive up to 60% of the difference between their average weekly wage and what they can earn with their disability for up to 260 weeks.
The most common benefit associated with workers’ compensation is payment of medical expenses. Medical benefits are available for workers who suffer from either a work-related injury or illness that requires medical attention. The medical benefits are provided for as long as the worker needs them because of the injury or illness. However, it’s important to note that the insurance company can deny or end treatment if they don’t think that the treatment is reasonable or necessary. If this happens, a worker may appeal through the DIA. Medical benefits include:
- Medical care
- Reimbursement for what the worker spends out of pocket for prescriptions and treatment
- Reimbursement for mileage for injured workers who must travel to and from their medical appointments
The worker may choose their own medical provider. Additionally, the insurer has the right to have their doctor evaluate the worker.
There is a one-time payment for disfigurement or scarring. If it involves scars, they must be located on the face, neck, or hands. This benefit is in addition to other workers’ compensation benefits, such as medical or disability.
If a worker dies as a result of their injuries or illness, the spouse or child could be eligible for survivors’ and dependents’ benefits as well as having the funeral expenses covered. Children of the deceased worker are only eligible for benefits if they are minors, full time students, or have physical or mental disabilities that make them unable to support themselves. Benefits may include:
- Payment of up to 66% of the deceased worker’s average weekly wage, up to the maximum of the state average weekly wage at the time the injury or illness occurred for the surviving spouse
- A cost of living adjustment every two years for the surviving spouse
- Spouses who remarry will receive $60 a week paid for each eligible child. However, this amount may not exceed the total that the spouse received as a benefit before remarriage
- Funeral expenses up to eight times of the state average weekly wage at the time of death
Vocational rehabilitation is another workers’ compensation benefit that can really help injured workers and their families. The purpose is to help the worker be able to return to the workforce. To qualify, the worker must be medically stable, suffer from a permanent functional limitation, and liability must be accepted by the insurer.
Applying for Workers’ Compensation Benefits
If you were hurt on the job or are suffering from an illness because of your job, you must take steps to start the claims process. First, though, you should get immediate medical care. Even you think you only have a minor problem, you should get checked out. Otherwise, a small problem can get much worse. The worker should inform their employer in writing (and make a copy of the document) that they’ve been hurt. Injured workers have up to four years after they determine that their injury or disability was caused by their job to file a claim with the workers’ compensation insurance carrier.
Rights of an Injured Worker
In a perfect world, workers would always be safe on the job. But whether it’s the nature of the work, a freak accident, or a negligent coworker, work-related injuries happen. They are an unfortunate, but sometimes an unavoidable part of the working world.
Work-related injuries can be devastating for any worker, including those living or working in Massachusetts. If the injury is severe, it can lead to time lost at work, compounding the injury by adding financial difficulty to an already physically painful situation.
Luckily, there are laws and administrative procedures in place to ensure injured Massachusetts workers have some form of monetary recovery for their injuries. Depending on the facts surrounding the injury, as well as the applicable laws, this compensation can pay for medical bills, and lost wages.
The legal process for obtaining this type of recovery is usually quite complex and typically requires the advice of an experienced Massachusetts workers compensation attorney. The lawyer can explain the legal rights an injured worker may have and the steps they must take to take full advantage of those rights. In some situations, an injured worker will have two possible avenues of recovery: workers’ compensation and a personal injury lawsuit.
Workers’ Compensation in Massachusetts
If someone is injured as a result of his or her job, the first and primary source of recovery will be workers’ compensation. For those who are unfamiliar, workers’ compensation is a form of insurance for injured workers that provides two primary benefits.
The first is compensation for lost income due to missed work and the second is payment of medical bills. What makes workers’ compensation unique is that injured employees are entitled to these benefits regardless of who is responsible for the injury.
But there’s a catch. Subject to a few exceptions, injured employees are prohibited from suing their employer for the personal injuries that occur at work. This prohibition exists even if the employer is the cause of those injuries.
Another common issue with workers’ compensation is that it’s sometimes very difficult to obtain all the compensation the worker is entitled to under the law. Whether it’s an improper denial of the claim or requiring the worker to jump through a bunch of hoops, the workers’ compensation process does not always go smoothly.
Types of Workers’ Compensation Benefits
There are two main types of workers’ compensation benefits, with the first being income replacement. The exact amount as well as how long a worker may receive this benefit will depend largely on the extent of the injuries and when the worker is capable of returning to work.
Workers can receive 60 percent of their gross weekly wage for up to 156 weeks. And instances where the injury leads to a permanent disability, the workers’ compensation benefits are available for as long as the disability is present.
The second major benefit is the medical care coverage. This will pay for most, if not all, of the workers’ reasonable medical needs. This includes mileage reimbursement for travel and prescription drugs. The workers’ compensation insurance company must pay these medical bills as long as the medical care is reasonably necessary.
Personal Injury Lawsuits in Massachusetts
In addition to the workers’ compensation claim process, some injured workers sometimes have the option of filing a personal injury lawsuit. This pathway for recovery usually isn’t available to injured workers, but there are two main exceptions to this rule.
The first exception applies when the employer doesn’t have workers’ compensation insurance at the time of injury. Under Massachusetts’ law, almost every business that has employees will be required to have workers’ compensation insurance.
The second exception allowing workers to file a lawsuit is when the person or entity responsible for the worker’s injury is a third party. For example, imagine an employer hires an outside construction contractor to fix a ceiling light in the office. During the repair process, the employer’s own employee becomes injured from falling debris created by the construction company. In this scenario, the injured worker may be able to sue the construction contractor directly as well as make a claim for workers’ compensation.
However, much of the litigation that arises from a work-related injury is not the result of the worker filing a personal injury lawsuit. Rather, litigation takes place when the workers’ compensation insurance company denies the worker’s claim or otherwise pays less than what the worker is entitled to.
Due to the complexity of workers’ compensation law and the appeals process, the worker is almost always better off with an attorney. Not only will the attorney ensure the worker is able to present the best case possible, but they can help prevent the worker from forfeiting any legal rights they may have and make the appeals process go as smoothly as realistically possible.
Common Workplace Accidents
There are a variety of unexpected events that can occur at work. A birthday party or promotion might top the list of some of the more pleasant surprises. But one of the least expected and certainly the most hated surprises on the job are workplace accidents.
Having an accident at work is especially painful, not just because it can lead to a severe injury, but also because of the consequences it can have on the workers’ ability to earn a living. It can also lead to more serious problems later on.
For example, some of the highest numbers of workplace accidents occur in the construction industry. But tremendous pressure to keep costs down and projects completed on time means an injured construction worker may be pressured to continue working through a painful injury. In order to do this, they might start taking opioid painkillers.
Maybe the construction worker has a prescription for these pain medications or perhaps they obtain them illegally off the street. Either way, this individual is now at risk for suffering from an overdose, creating an addiction or causing another accident because they are under influence of prescription strength painkillers.
It’s easy to see how problematic accidents in the workplace can be, even in a state as progressive as Massachusetts. Luckily, workplace accidents only led to approximately 74 deaths in 2017. Should a worker be unfortunate enough to suffer from an accident at work, the employer will often do the right thing and ensure the worker receives any necessary medical care and compensation. But this doesn’t always happen. And sometimes, the employer is responsible for the accident occurring in the first place.
Types of Workplace Accidents
If there is the potential for a work-related accident, then it’s probably happened, at least once. However, some accidents tend to occur more often than others. Below is a list of some of the more common types of accidents seen in Massachusetts.
- Slip and fall
- Falls from a raised elevation (like a fall from a ladder or rooftop)
- Motor vehicle accident
- Exposure to harmful chemicals
- Building or structural collapse
- Falling objects
The Causes of Common Workplace Accidents
An accident that takes place at work can have any number of causes, many of which are the result of someone not paying attention. Most workplace accidents are usually caused by one or more of the following:
- Carelessness or negligence
- Intentional misconduct, such as horseplay or bullying
- Repetitive physical motion
- Failure to following safety rules or regulations
- Nonexistent safety rules or regulations
- Lifting or moving a large or heavy object
- Malfunction of equipment or tools
- Improper use of equipment or tools
- Failure of safety mechanisms
- Bad weather
What a Worker Should Do to Prevent an Accident at Work
When it comes to accidents that take place at work, the good news is that the majority of them are preventable. But the bad news is also that the majority of them are preventable. The trick is being able to anticipate the potential for an accident and being willing to take steps to prevent it.
While there’s no guaranteed way to prevent all workplace accidents, there are several things workers can do to reduce their chance of getting involved in an accident, such as:
- Following all safety rules and regulations
- Reporting a violation of a safety rule or regulation
- Identifying instances of where the modification or creation of a safety rule can address a specific risk at work
- Staying healthy; being in poor health has the potential of making a worker more likely to become involved in an accident
- Be knowledgeable about workplace safety; workers who don’t know the safety rules are not likely to follow them
What a Worker Can Do if Involved in a Workplace Accident
Should a worker be unlucky enough to have an accident at work, there are a few things they should promptly do. First, they need to report it to the employer. This will be necessary when filing a workers’ compensation claim. Ideally, the worker should report the accident in writing. Not only will it make it harder for an employer to potentially argue they never knew about the accident, but it will allow the worker to record details about the accident while the memories are still fresh.
Second, if the accident causes an injury, the worker should get medical help. This is important, not just because the worker should treat the injury, but any delay could hinder the worker’s ability to seek compensation at a later time.
Third, the worker should file a worker’s compensation claim. This is usually the only remedy available for the worker and will allow them to receive payments for lost wages and medical bills.
Fourth, consult with an attorney. Most likely, the worker won’t need legal representation as a result of the accident, but it’s a possibility. There may be other responsible parties involved or complications with the workers’ compensation claim. For most workers, this initial consultation will be free. In many cases the insurer has to pay most of the worker’s legal fees and expenses.
Common Workplace Injuries
Workplace injuries are an inevitable part of working, even in Massachusetts. Luckily, the number of injuries at work has been steadily dropping. For example, in 2004, there were 93,400 nonfatal occupational illnesses or injuries in Massachusetts. But in 2015, that number dropped to 65,300. Despite these seemingly high numbers, the rate of workplace injuries in Massachusetts is actually below the national average and has consistently been that way for several years.
Many of these injuries occur in traditionally dangerous jobs, such as mining and construction. But some of the highest rates are in areas someone might not expect, like education and health services. To get a better understanding of what causes Massachusetts workplace injuries, it helps to begin by looking at the common types of occupational injuries.
Types of Workplace Injuries
The human body is an amazing machine, but it’s not indestructible. Additionally, based on the body’s structure, some body parts are more susceptible to injury than others. No matter the job or workplace, any injury is potentially possible. However, the following is a list of injuries that tend to occur more often than others.
- Broken bones
- Nerve damage
- Brain injury
- Sprain and strain of a joint or muscle, especially the back or neck
- Cut, abrasion, or laceration
- Illness from exposure to toxic substances
Common Causes of Workplace Injuries
Most injuries that take place at work are avoidable. Despite this fact, they are still almost impossible to completely eliminate. Many of them are true accidents. But some of them are the result of the intentional acts of others. The vast majority of workplace injuries are the direct result of one or more of the following:
- Repetitive motion or stress on the body
- Entanglement in machines
- Bodily collisions, such as walking into objects
- Slip or trip
- Overexertion; for instance lifting an object that’s too heavy or trying to work with an existing injury
- Motor vehicle accidents
- Falling objects or debris
- Violation of safety rules and regulations
- Negligent co-workers
- Intentional misconduct by fellow co-workers
- Substance abuse
- Bad weather
- Defective equipment or tools
Hiring an Attorney Following a Workplace Injury
One of the first things an injured worker might wonder about is if they need to hire an attorney. Despite what many daytime television ads claim, hiring an attorney is not always necessary. Often times, an employer or workers’ compensation insurance company will do the right thing and ensure the worker receives necessary medical care and any other benefits they may require.
But should the workers’ compensation insurance company or employer take steps to deny workers’ compensation benefits, consulting with an experienced workers’ compensation attorney is probably a good idea. In situations where the workplace injury is particularly severe, it’s smart to double check with an attorney. This is true no matter how cooperative the employer and workers’ compensation insurance company are. The attorney can make sure the worker is getting everything he or she is entitled to and see that everyone responsible for the accident is held accountable.
Workers’ Compensation Claims
Practically all states have workers compensation laws in place. These laws allow injured workers to receive compensation for work-related injuries. Massachusetts is no different, and its workers enjoy protection through a well-established workers’ compensation system.
The best way for injured workers to receive the benefits they are entitled to under Massachusetts workers’ compensation law is to have as much knowledge as possible about the workers’ compensation process as possible. One way to do that is to speak with an experienced Massachusetts workers’ compensation attorney. But before contacting a lawyer, it’s good to have a basic understanding of how workers’ compensation works in Massachusetts.
What Exactly Is Workers’ Compensation?
Workers’ compensation is a type of insurance that provides income replacement and medical benefits to workers who receive work-related injuries. The benefits help replace the income a worker loses from missed work and provides medical treatment.
What makes workers’ compensation unique is that these benefits are available, even if the worker is responsible for causing his or her injuries. One exception to this rule is if the workers’ injury is the result of the worker taking illegal drugs.
What Kind of Injuries Are Covered by Workers’ Compensation Insurance?
In order to be eligible for workers’ compensation benefits, the injury must occur on the job. For example, if a worker gets injured in a car accident on his or her way to work, those injuries probably aren’t covered through workers’ compensation. But if that worker gets into a motor vehicle accident on the job, such as during a delivery, things can be very different. In this situation, injuries sustained in an accident while “on the clock,” will likely be covered by workers’ compensation insurance.
Workers’ compensation eligible injuries also include illnesses that relate to work. For instance, if a worker gets ill due to exposure to chemicals on the job, then that illness should be covered by workers’ compensation.
What Kind of Workers’ Compensation Benefits Are Available to Massachusetts Workers?
The most common significant benefits have to do with medical and lost income payments. Medical payments go towards paying the medical costs for treating the worker’s work-related injuries. This includes paying for prescription medications and mileage reimbursement when traveling to and from treatment. As long as the medical treatment is reasonable and necessary, the workers’ compensation insurance company should continue to pay for the worker’s medical care.
The second important workers’ compensation benefit is lost income replacement. If the worker is temporarily totally incapacitated, they may receive 60 percent of the worker’s gross average weekly wage (not to exceed the state average weekly wage). The worker will continue to receive these benefits for 156 weeks or until the worker is able to return to work, whichever is shorter.
If the injury permanently incapacitates the worker, then the worker may receive 2/3 of his or her gross average weekly wage (not to exceed the state average weekly wage). These payments will continue for as long as the worker remains permanently incapacitated.
Finally, if the worker has only a temporary partial incapacity, then they are eligible for 60 percent of the difference between their average weekly wage and what the employee is capable of earning after the injury. These benefits are capped at 75% of the temporary total disability rate. For example, if the average weekly wage was $600 and the worker could only earn $400 due to the injury, then they would be entitled to 60% of the $200 difference, or $120.
There are three other types of workers’ compensation benefits available. First, workers who suffer from a permanent loss of function, scarring, or disfigurement may receive a one-time payment.
Second, workers who die from their injuries will be able to have a child or spouse collect weekly benefits amounting to 66 percent of the deceased workers’ average weekly wage (but no more than the state average weekly wage). The surviving child or spouse will also be eligible to receive burial costs equal to eight times the state average weekly wage.
Finally, there are vocational services available for workers who have permanent functional limitations but are medically stable.
What Does a Worker Need to Do After Getting Injured?
If the idea that an injured worker is eligible to receive this wide array of workers’ compensation benefits sounds too easy, it isn’t. There are plenty of hurdles the employee must go through before getting his or her benefits and even after complying with these requirements, problems can still arise.
The first thing a worker should do after getting a work-related injury is report it to the employer. Ideally, this will be done in writing to avoid the possibility of the employer claiming they never knew the worker was injured.
The next thing the worker should do is obtain medical attention as quickly as possible. Waiting to get treatment is a problem because it can allow the injury to worsen and it will provide more reason for the workers’ compensation insurance company to deny the worker’s claim.
The third thing the worker should do is make sure the employer notifies its workers’ compensation insurer and the Massachusetts Department of Industrial Accidents. Some employers never report the injury because doing so may force the employer to pay higher workers’ compensation insurance rates or get into trouble with regulatory authorities.
If all of the above steps take place, the worker should receive all of the benefits they are entitled to under Massachusetts workers’ compensation law. But many times, things don’t work out as they should.
Sometimes, the employer refuses to file a claim. Other times, the workers’ claim is improperly denied or paid out in an amount that is far less than what the worker is entitled to. When this happens, the worker may need to file a claim themselves to the Department of Industrial Accidents or file an appeal of the workers’ compensation claim denial.
Workers’ Compensation Claim Process
Were you seriously hurt at work and are now confused about what you should do next? Perhaps you don’t know what your protections are. The State of Massachusetts has a workers’ compensation act that is put in place to help protect workers who are hurt, killed, or who are diagnosed with an illness because of their job. Workers’ compensation is a safety net for injured workers and their families. Most workers know that workers’ compensation exists. What they don’t know, however, is how to file claim if they need to do so and how that claim is processed.
Information Workers Need to File Their Claim
As an injured worker, there is certain information that you’ll need to file your claim. You may also need this information if your claim is denied. Keep track of:
- The date that your injury or illness happened. If you’re a family member filing because of an on-the-job death, write down the date the injury or illness happened and the date of death.
- The first day of work you missed and the fifth day of work you missed. These dates do not have to be consecutive.
- The name of the insurance carrier your employer uses for workers’ compensation.
- A list of your injuries and the parts of your body that are affected.
- The type of benefits you believe you need.
- The amount of time you’ll be out of work, if you know.
- The date you first went to the doctor.
- The name of your current treating doctor.
You’ll also want to have copies of unpaid medical bills, medical reports, accident reports, witness statements, and witness names.
The Massachusetts Workers’ Compensation Claims Process
The Massachusetts workers’ compensation claims process works a little differently when compared to filing other sorts of insurance claims. According to the State of Massachusetts, the employer must file Form 101 with the Department of Industrial Accidents and with their workers’ compensation insurance carrier. This is done within seven days after the worker is unable to earn their full wages for five or more calendar days.
When the workers’ compensation insurer receives the form, they are given 14 days to either begin paying benefits, or notify the employee as well as the DIA that they are contesting the claim. The insurance company can pay on a claim for up to 180 days and have seven days during that period to stop payment or reduce the payment just by giving notice to the worker and to the DIA. If the insurer continues to pay after the 180 day mark, they can only stop the payment for reasons listed in the workers’ compensation act and regulations.
If the payments are stopped or reduced, the worker can file Employee Claim Form 110 to request a hearing. However, this form may not be filed until after 30 days after the date of disability or denial of the claim. This gives the insurance company the time to do their investigation into the claim.
Claims Process Disagreements: Conciliation
If a worker and workers’ compensation insurer disagree about a claim, the Massachusetts Department of Industrial Accidents (DIA) has four steps available to try and reach an agreement among the parties: conciliation, conference, hearing, and Reviewing Board.
Conciliation consists of an informal meeting between the worker, the worker’s attorney (if he or she has one), an attorney for the workers’ compensation insurance company and the DIA conciliator. The conciliator serves as a neutral third party to try and help negotiate a settlement.
Conciliation meetings take place at the closest DIA regional office to the employee. If the worker is out-of-state, the conciliation will automatically take place in Boston. In some circumstances, the location of the conciliation meeting can be changed.
Before the conciliation, the worker should gather necessary medical documentation to support his or her position. It’s not required that the worker have an attorney for the conciliation process, but it’s a good idea that they have one. If the parties cannot resolve their disagreement during conciliation, the conference process is the next step.
Claims Process Disagreements: Conference
The second step is the conference (sometimes referred to as a proceeding). And while the worker still isn’t required to have an attorney, it’s strongly recommended they have one for this process. This is because even though a conference is an informal meeting between the workers’ compensation insurance company and the worker, instead of being before a conciliator, it’s in front of an Administrative Judge.
This Administrative Judge has much more power than the conciliator because the Administrative Judge can make a decision as to whether the workers’ compensation insurance company must pay benefits to the worker. If the worker or the workers’ compensation insurance company disagrees with the Administrative Judge’s order, they must file an appeal within 14 days. Appeals are decided at a hearing.
Claims Process Disagreements: Hearing
A hearing is a formal legal proceeding and is a lot like a trial. A hearing is held before an Administrative Judge and many rules from a regular courtroom apply, such as the Massachusetts rules of evidence.
At the hearing, both sides present evidence in support of their position and may call witnesses to testify. In certain situations, either side may be required to submit new evidence before the Administrative Judge issues a decision. If either side is unhappy with the Administrative Judge’s decision, they can appeal it to the Reviewing Board.
Claims Process Disagreements: Reviewing Board
At this level of the workers’ compensation settlement process, the parties may only present legal arguments in support of their position. Generally speaking, no new evidence may be presented to the Reviewing Board. If the Reviewing Board feels additional evidence is necessary, they will usually remand the case back to the Administrative Judge for further consideration of additional evidence.
No matter what, the parties must present legal briefs to the Reviewing Board. These legal briefs will explain the basis for their legal position. The Reviewing Board will sometimes ask for more from the parties, such as coming before the Reviewing Board to present their legal arguments in person.
If either side is still unhappy with the Reviewing Board’s decision, they may file another appeal with the Massachusetts Court of Appeals. A workers’ compensation appeal to the Massachusetts Court of Appeals is a fairly rare occurrence.
Workers’ Compensation Claim Denial
If the workers’ compensation insurance company makes a decision to deny the worker’s claim (and none of the above settlement steps are taken), the worker has the option of appealing the denial directly to the DIA by filing a claim.
The worker has two ways to file its claim: by mail or in person. Either way, the worker must get certain documents to the DIA’s Boston office. This includes the completion and submission of Form 110. Additionally, the worker must provide the following documents and information:
- Medical reports
- Unpaid medical bills
- Witness names and statements
- Anything else that explains how the injury occurred
After filing submitting Form 110 and relevant documentation to the DIA, the worker will need to give notice of the claim to the workers’ compensation insurance company by providing them a copy of all documents sent to the DIA. A common method of providing these documents is by sending them via Certified Mail.
The DIA will do one of two things after the worker files a claim. First, the DIA might reject the claim on procedural grounds due to the worker improperly completing Form 110. If this happens, the DIA will send everything back to the worker with an explanation of what is incorrect or incomplete. The worker can try and file the claim again.
Second, the DIA will accept the claim and set up a conciliation meeting. This is the same conciliation meeting that takes place during the claims dispute resolution process.
If You’re Hurt on the Job Get a Lawyer
While Massachusetts workers’ compensation laws are designed to help protect injured workers, insurance companies want to make a profit. It’s important that injured workers talk with an experienced workers’ compensation lawyer to make sure that their rights are protected and that they are treated fairly.
Workers’ Compensation Law in Massachusetts
Injuries at the workplace can happen to anyone and we offer our sympathies if it happened to you. If you or a loved one has been injured on the job, you may be eligible to receive workers’ compensation benefits for any losses you may have suffered. If this is the case, contact an experienced attorney who specializes in workers’ compensation claims. We will help you recover any lost wages, medical expenses, and disability costs while you focus on your recovery.
Benefits in Accordance with Massachusetts State Law
The law varies slightly from state to state. If you are injured on the job while working in the state of Massachusetts, it is important to know what benefits you may be entitled to under Massachusetts workers’ compensation laws.
All employers in the state of Massachusetts must carry workers’ compensation insurance. This coverage pays out the benefits received by injured employees, which ranges from full coverage of all medical costs to financial assistance based on degree of disability. Workers who are medically cleared to return to work at a future date will receive less compensation than an employee whose injury prohibits them from ever returning to work again, otherwise called Total and Permanent Incapacity.
Massachusetts workers’ compensation laws define three designations for disability, which are as follows: Total and Permanent Incapacity, Total Incapacity, and Partial Incapacity. Each designation is entitled to a different amount of compensation.
- Employees who suffer from Total and Permanent Incapacity are eligible for Total and Permanent Disability Benefits. This means that the injured worker is eligible to receive two-thirds of their average weekly wage (based on their yearly, 52-week income), along with increased compensation for higher cost-of-living expenses. These benefits may be paid for the remainder of the injured employee’s lifetime.
- Employees who suffer from Total Incapacity are eligible for Total Disability Benefits, which pays the injured worker 60% of their average weekly wage. However, workers can only receive these benefits for up to three years, or 156 weeks.
- Employees who suffer from Partial Incapacity are eligible for Partial Disability Benefits. This refers to workers who have been injured on the job and are now limited in the amount of work they can perform. Partial Disability Benefits allows them to receive 60% of the difference between their weekly wage before the injury and after.
How Do I Know If I Am Eligible for Workers’ Compensation?
There are a variety of different circumstances in which one can be injured at work. These include, but are not limited to:
- automotive accidents
- severe burns
- faulty machinery
- exposure to toxic chemicals and materials
- injuries sustained while lifting heavy objects
- workplace-induced emotional stress
An injury does not have to be caused by workplace negligence or an unsafe environment in order to qualify for compensation. Yet it is important to know what exactly constitutes the “workplace” before moving forward with a compensation claim. To help determine what is best for you, seek out a workers’ compensation attorney to assist with the claim process.
Moving Forward with a Claim
The first thing to do when injured at the job site is to seek immediate medical attention. Afterwards, you will want to inform your employer of the injury. Be sure to provide as much information as possible, making sure to note time and place of the accident, extent of the injury, and how exactly the accident occurred.
It is best to submit this notice in writing in order to kickstart the claims process, although verbal notification is also acceptable. Employers and insurance agencies are often skeptical of postponed or delayed claims, so it is important to turn in this information as quickly as possible. Insurance companies must approve or deny your compensation claim within 14 days of receiving injury notice.
Providing accurate information to your doctor is extremely important — not only is it vital for corroboration in the event your claim is denied, but it also aids in a quicker recovery.
How a Workers’ Compensation Attorney Can Help
Under Massachusetts state law, all employers are required to display the name and contact information of their workers’ compensation insurance provider. However, processing a claim and receiving the appropriate benefits is not as easy as it sounds. Claims can be denied for almost any reason, and it is often the simplest mistakes that are the easiest to avoid.
Hiring an attorney who specializes in workers’ compensation claims is only going to help you. Not only are you more likely to win your claim, but an experienced attorney can help you receive your benefits faster. Even if you decide to “go it alone,” our attorneys offer an initial consultation for free, providing you with direction and guidance.
Filling out all the necessary paperwork, making all the required phone calls, and meeting with insurance agents can quickly become tedious and stressful, so why not let a paid professional ease your burden and argue your claim for you? A workers’ compensation attorney manages your negotiations and provides the wherewithal for you to move forward.
Denied Workers’ Comp Claims
Workers’ compensation laws exist to protect employees who have been hurt on the job. But workers’ compensation insurance companies all too often would rather protect themselves. Unfortunately, many claims for workers’ comp benefits are denied, and the worker is put at a considerable disadvantage before the claim is even processed. Reaching out to a workers’ compensation attorney before making a claim is highly recommended. Not only will the likelihood of claim denial decrease, but if your claim is denied, an experienced attorney will help alleviate the process and fight for your case.
Common Reasons Why Workers’ Compensation Claims are Denied
An insurance company may deny a workers’ compensation claim for any number of reasons. They will try to poke holes in your case any way they can. To ensure that your claim is strong, you will need an experienced workers’ compensation attorney on your side.
- The injury is not reported immediately
The most common reasons that workers’ compensation claim get denied is often due to the simplest mistakes: the injury was not reported immediately.
When injured on the job, the first thing you should do is seek immediate medical attention. You should then notify your employer of the accident as soon as possible. Employers and insurance companies are far more likely to deny a claim that has been postponed or delayed. It is best to submit this notice in writing, although verbal notification is also acceptable. A written notice can serve as proof that you acted in a timely manner if an insurance company tries to argue against your claim.
Even more important than timeliness is accuracy. When informing your employer (and your doctor) of a workplace injury, provide as much detail as possible. This includes:
- Time and place of the injury
- Extent of the injury
- What you were doing when the accident occurred
- How and why the injury happened
- The names of any witnesses
Sometimes your employer will have you fill out an accident report. Once again, make sure to be accurate. Any inconsistencies can hurt your claim.
- The injury is a pre-existing condition
Many claims are denied because the injury or illness is deemed by the insurance companies to be a pre-existing condition, meaning that the injury originated before the accident. You cannot claim compensation for a pre-existing condition. However, some pre-existing conditions are further aggravated by duties on the job. If this is the case, you may be eligible to receive compensation for your injury.
Jobs that require repetitive movement can cause significant wear and tear on the body which builds up over time. Conditions such as arthritis and carpal tunnel syndrome cannot usually be linked to one specific incident, which means you can still receive compensation for your injury as long as you can prove it was work-related.
- The injury is not work-related
Another common reason that workers’ compensation claims are denied is because the injury is deemed to not be work-related. Therefore, it is important to know what exactly constitutes the “workplace.”
For example, injuring yourself on the way to work would not be considered an injury sustained on the job. However, if you were to injure yourself while performing an outside task specified by the job (not necessarily on the job site), this could be the grounds for a successful workers’ compensation claim. It is best to consult an attorney before moving forward.
A Workers’ Compensation Attorney Will Help with Your Claim
A workers’ compensation attorney will serve as your personal advocate when dealing with insurance companies and the DIA (Department of Industrial Accidents, the Massachusetts agency that overhears disputes between injured workers and insurers). A well-practiced attorney will help the claim process move along in a timely and efficient manner.
While it is possible to go through this process alone, it is highly recommended to hire or at least consult with an experienced attorney who specializes in workers’ compensation appeals. They will provide legal counsel and fight for your rights.
Massachusetts law provides workers’ compensation benefits when a worker sustains an injury or illness in the course and scope of their employment. The law also provides for workers’ compensation benefits in instances when an injured worker aggravates or exacerbates a pre-existing illness or injury. Simply put, a Massachusetts employer is said to “take their workers as they find them.” Notwithstanding this fact, it is essential that an injured worker retain a skilled and experienced workers’ compensation attorney when pre-existing injuries are at hand, as employers and their defense attorneys commonly attempt to dismiss or deny claims on the basis that the new injury or aggravation is a non-compensable pre-existing injury.
A pre-existing injury or illness is simply an illness or injury that the worker sustained prior to the current workplace accident or injury. Pre-existing injuries occur in many forms. For example, physicians may notice certain degenerative conditions that predated a new injury based on diagnostic studies such as x-rays, MRIs, and CT scans. Examples of conditions commonly noted through these diagnostic instruments include degenerative disc disease or spinal stenosis. Pre-existing conditions may affect the feet, ankles, knees, hips, hands, wrists, elbows, shoulders, and spine. Other pre-existing conditions or illnesses may be psychologically rooted, as is the case with depression, anxiety, and PTSD. They can also manifest in illnesses and diseases such as asthma, heart, and pulmonary conditions, and also include injuries such as hearing and vision loss.
An aggravation of a pre-existing condition can result in lost time from work, additional impairment, loss of function, earning capacity, as well as the need for costly medical treatments, hospitalizations, and medical prescriptions. Because of the costs associated with pre-existing injuries, employers routinely deny or seek to deny claims on the basis of a pre-existing injury defense. Thousands upon thousands of claims are initially denied by employers on this basis, notwithstanding the fact that the employee’s may have been symptom-free or pain-free from the pre-existing injury for months or even years prior to sustaining the new aggravation or progression of the workplace injury or illness.
In most cases, workers’ pre-existing injuries were completely asymptomatic and the new work-related injury permanently advanced, aggravated, or exacerbated the pre-existing injury creating new symptoms and at time, causing previous symptoms to arise. In spite of these clear facts, employers and workers’ compensation insurance carriers flat-out deny these claims and make it incredibly difficult for an injured worker to receive the benefits to which they are entitled under Massachusetts law.
For example, take the case of an injured worker who had a pre-existing herniated disc in his back that was surgically repaired and now has been asymptomatic for years. He begins a new warehouse position and while performing his job duties, bends over to lift something off a pallet and re-herniates that very same disc, experiencing new symptoms and pain that requires another costly surgery. Against this factual backdrop, an employer or workers’ comp insurance carrier will almost certainly deny this claim. However, given facts at hand, the worker clearly suffered a new injury within the course and scope of his employment that is the “major cause” of his symptoms and need for treatment. Thus, under the law and despite his pre-existing injury, his new injury would be compensable.
Employers, workers’ comp insurance carriers, and their defense lawyers frequently go out of their way to fight even the most compensable of workers’ compensation claims. Nowhere is the fight as prickly as when an employee with a pre-existing injury suffers a new workplace injury. Employers and their representatives defending your claim will thoroughly comb and sift through past medical records in search of what they think are pre-existing injuries in their unmitigated quest to deny a comp claim and save company money. In fact, not only will they attempt to initially deny the claim in its entirety, but they often use the pre-existing injury defense to deny certain prescription medications on claims that have already been accepted as compensable. In such cases, it is absolutely paramount that the injured worker retains a skilled and experienced workers’ compensation attorney to fight back and protect their statutory right to workers’ compensation benefits.
Under Massachusetts’ workers’ compensation statutes, the exacerbation or aggravation of a pre-existing injury is compensable. The law holds that a new injury sustained within the course and scope of a workers’ employment must be covered by workers’ compensation, so long as that injury is a “major cause” for the cause of the workers’ disability or need for treatment. Of course, this means that the injured worker is entitled to all of the medical, lost wages, permanent incapacity, and loss of function benefits that the Massachusetts workers’ compensation laws provide, just like any other compensable workplace injury or illness.
Other compensable pre-existing injury cases can become quite complicated, particularly when it comes to the apportionment of a workers’ permanent impairment or incapacity, as the parties attempt to determine what portion of an employee’s incapacity resulted from the new workplace injury, as opposed to the portion that pre-existed the new injury. Apportionment of incapacity is a very important issue during settlement negotiations and directly impacts the dollar value of the injured worker’s settlement. The workers’ compensation insurance carrier’s attorney will unquestionably try to apportion all of the new incapacity or impairment to the pre-existing injury to deny you your entitled share of benefits. An injured worker needs an attorney to counter this attack. It is imperative that an injured worker retain a seasoned and skilled workers’ compensation attorney navigate them through this process to ensure that they get the maximum possible permanent incapacity and/or loss of function award. An experienced attorney will know the proper questions to pose to the worker’s medical providers to assure the best possible outcome.
Workplace Neck & Back Injuries
Some of the most common workers’ compensation injuries happen to the neck and back. These injuries can be relatively minor or they can be serious enough to change how someone lives out the rest of their life. Massachusetts requires all employers to carry workers’ compensation insurance. With the exception of domestic employees, this coverage is available to workers regardless of how many hours they work in a week. For domestic employees, they must work a minimum of 16 hours to receive workers’ compensation benefits. If you’re a worker in Massachusetts and you’re suffering from a neck and back injury that happened on the job, make an appointment to speak with an experienced workers’ compensation lawyer.
Which Jobs Are Most Commonly Associated with Massachusetts Back & Neck Injuries at Work?
Back and neck injuries can have many causes. Some of the most common causes are falling, repetitive stress injuries, lifting heavy objects, and sudden motions that cause strains, sprains, or herniated disks. Jobs that see a high number of back and neck injuries include:
- The construction industry, including roofers
- Electricians and electrician apprentices
- Plumbers and plumber apprentices
- Metal workers and machinists
- Factory workers, including assembly line workers, warehouse workers, and fork life operators
- Medical professionals
- Office workers who have repetitive motions or improper workplace set-up that causes strain on the neck and back
- Mining and logging industry workers
- Agricultural workers
Why Massachusetts Workplace Back & Neck Injuries Are Dangerous
Your spine extends down through your neck and back. The nerves, muscles, ligaments, and bones play important roles. The first important role is protecting the spinal cord. If your spinal cord is injured, you could suffer from paralysis. It can also cause death. Injuries to the spinal cord aren’t always fixable. You may face a lifetime of needing intensive medical care, permanent help to handle every day tasks, and millions of dollars in medical expenses. You may or may not be able to work in the same capacity (or at all) after your injury.
Common Work Injuries That Affect the Back & Neck
The most common back and neck injuries that happen on the job include:
- Herniated disks
- Slipped disks
- Injuries to the lower back that result in chronic pain
- Spinal cord injuries that result in permanent paralysis or pain
- Torn ligaments
- Muscle strains and sprains
If you’re hurt on the job and experience a neck or back injury, it’s important that you get medical help right away. While the injury may not seem serious at the time, it’s important to remember that these injuries can be very serious. Minor injuries can quickly become a big problem. Get medical care immediately. You can choose your own doctor. Just make sure that they file through the workers’ compensation system instead of filing a claim on your health insurance.
Can Repetitive Stress Injury Affect the Neck and Back?
When most people think about repetitive stress injuries, they think about problems such as carpal tunnel syndrome. Yet, repetitive stress injury can affect the neck and back. Repetitive stress injuries are caused by performing the same movements over and over again for a long period of time. If you sit at a computer for most of the day, it can do more than affect your hands and wrists. It can also affect your neck and back. If your work station isn’t properly aligned or if your chair doesn’t properly support you, it can cause damage to your neck and back. Repetitive stress injuries to the neck and back may not seem serious, but they can make everyday tasks next to impossible.
Standing all day, regardless of whether you use heavy machinery or lift heavy objects, can also cause problems with your neck and back. Simply put, our bodies are made to move. Even if you follow the best possible practices to protect yourself by standing on special mats that absorb pressure or use safety shoes, you can still develop this painful condition.
Neck and back injuries are extremely common on-the-job injuries in the construction industry. Jack hammers, hauling concrete and wheelbarrows, constant use of a hammer, crushing injuries, falling from ladders, and faulty equipment can all cause serious damage to the neck and back. Sadly, these accidents are all too common. For serious neck and back injuries, workers may be unable to return to their profession and either can’t work at all or they have to find a new occupation.
What Benefits Are Available for Massachusetts On-the-Job Neck and Back Injuries?
When workers are hurt on the job, they have the right to file a workers’ compensation claim. Workers’ compensation provides several benefits for workers who are hurt on the job. However, the benefits that a hurt worker may receive depend largely on the injury and how it affects the worker. Benefits may include:
- Temporary total disability payments
- Partial disability payments
- Permanent and total disability payments
- Medical benefits
- Vocational rehabilitation
Carpal Tunnel Syndrome Workplace Injuries
Carpal tunnel syndrome, also known as repetitive stress syndrome, is one of the most common on-the-job injuries in Massachusetts. While it may seem minor, it can cause permanent disability. Workers who suffer from carpal tunnel syndrome injuries may not be able to return to their chosen occupation. Workers may also require multiple surgeries, wrist and hand braces, and medications for the rest of their lives.
What Is Carpal Tunnel Syndrome?
Carpal tunnel syndrome happens because the worker makes the same motions over and over again for a long period of time. The median nerve runs from the forearm into the fingers. It goes through a small tunnel within the area that is surrounded by bone. Carpal tunnel syndrome happens when the median nerve is compressed or pinched by swollen tendons.
What Are the Symptoms of Carpal Tunnel Syndrome?
Massachusetts carpal tunnel syndrome injuries at work can be extremely painful. Some of the symptoms of this condition include:
- Numbness or weakness in the hand or wrist
- Pain in the hand or wrist
- The numbness, weakness, or pain may get worse during use of the affected hand or wrist
- A dull aching pain in the forearm
- Stiff feeling in the fingers
- Inability to hold onto objects
- Inability to pinch objects with the thumb and index finger
How Is Carpal Tunnel Syndrome Diagnosed?
Diagnosis of carpal tunnel syndrome is done by medical professionals. There is no one standard test to determine if the condition exists. Instead, the medical professional looks at the symptoms and may use certain tests to confirm the diagnosis.
During the physical exam, the medical professional will examine sensitivity and how well the affected hand and wrist can operate. The injured worker may also be subjected to electrodiagnostic (EDX) testing or ultrasonography. However, EDX and ultrasonography cannot be used on their own for a diagnosis. While they can look at the internal area that is likely affected, they cannot look specifically at the sensitivity of the area or measure the ability of the worker to continue to use the hand and wrist.
Common physical tests include Phalen’s maneuver, Tinel’s sign, Durkan test, and the hand elevation test. The idea with some of these tests is for the medical professional to attempt to recreate the numbness and other sensory-based symptoms. Often, those symptoms are more severe than pain, although pain may be a presenting symptom.
How Is Carpal Tunnel Syndrome Treated?
There are several treatments available for carpal tunnel syndrome. The severity of the condition will determine how treatment will proceed. Treatment can be conservative and include simply splints or physically therapy. It can also include steroid injections or prescriptions, use of medication to receive symptoms, and surgery. The amount of time it may take for the worker to experience relief or full recovery depends on the type of treatment as well as the initial severity of the condition.
Which Work Activities Are Most Likely to Cause Carpal Tunnel Syndrome?
As mentioned earlier, carpal tunnel syndrome is caused by repetitive movements. It’s not a condition that is limited to those who work in an office in an administrative setting. The following work activities can cause carpal tunnel to develop:
- You work with rope, cloth, tape, or other material that you wrap or bind with;
- You spend most of your day typing, filing away physical documents, stocking shelves, or you make some sort of other repetitive motion every day;
- The work that you do affects wrist or hand posture (or both) in a way that causes stress on the joints;
- You use your hands in the same way for most or all of your work day;
- What you do requires you to rely on constrained movements such as a pinching motion or very small movements of the hands and wrists for accuracy;
- You fell on the job and fractured your wrist;
- Your job requires you to grip items for long periods of time;
- You use vibrating or oscillating tools;
- You extend and flex your hands and wrists for the majority of the day.
Massachusetts Carpal Tunnel Injuries at Work Are Covered by Workers’ Comp
If you notice any of the symptoms of carpal tunnel syndrome, it’s important that you file a claim with workers’ compensation to begin the process of getting medical care for your injuries. You can get the medical care that you need so that you can minimize future complications of the condition. The only qualifying factor is that the development of this condition must be caused by your work.
Before you get started, talk to a lawyer who is experienced with workers’ compensation claims. When it comes to carpal tunnel syndrome, you’re only allowed a certain amount of treatment. The treatment includes:
- Diagnosis activities: lab tests, traditional x-rays, electromyography to measure muscle response and nerve stimulation, and a nerve conduction study to measure how fast an electrical impulse moves through your nerve.
- Treatment activities: including a pre-operative visit and outpatient procedure for surgical correction if necessary.
- Post-operative treatment: visits to the doctor following your treatment and one of the following – chiropractor, physical therapy, occupational therapy, or acupuncture.
After your treatment, you may qualify to receive an ergonomic assessment to help improve your work area.
Depending on the amount of time that you miss from work because of the disorder, you may be eligible to receive weekly payments to compensate you for the time you miss from work. If you’re found to be totally or partially disabled, you may also be entitled to a one-time payment on top of the weekly payment.
If you’re able to work but you’re not able to return to your previous occupation, you may be entitled to vocational rehabilitation classes. These classes will help you learn a new skill so that you can re-enter the work force.
If you file a workers’ compensation claim for carpal tunnel syndrome, call a lawyer who is experienced in handling these claims. It’s important because it will help you protect your rights and make sure that you get all of the benefits that you need and deserve.
Vision and Hearing Loss
Massachusetts’ workers compensation laws provide benefits to workers who suffer work-related vision and hearing injuries. An injury is said to be work-related if it was sustained within the course and scope of employment. Simply put, workers’ compensation benefits are awarded to those employees who are injured while on the job without regard to proving fault or negligence on the part of their employer or themselves. Massachusetts’ law provides several categories of financial and medical benefits for the injured worker who suffers from work-related vision or hearing loss. Among them are Temporary Total Incapacity benefits, Partial Incapacity Benefits, Permanent and Total Incapacity Benefits, Permanent Loss of Function and Disfigurement Benefits and Medical Benefits.
Loss of Vision
Perhaps one of the most debilitating on-the-job injuries a worker can suffer is the loss of vision or eyesight. The loss of vision or eyesight can sideline a worker temporarily, permanently, and totally, and leave the worker with a permanent incapacity. Massachusetts workers’ compensation laws provide benefits for the loss of vision or eyesight in one or both eyes. The loss of vision or eye sight occurs in a variety of ways such as from chemical or light exposure, and from acute traumatic events directly to the eyes or head.
Given the magnitude of the impact that a vision loss injury is likely to have on an injured worker’s ability to work following the injury, it is essential for a worker who sustains a vision injury to consult a knowledgeable attorney who can protect their rights and ensure they receive all of the maximum possible benefits available to them, as they very well may be precluded from doing some or all work for the rest of their lives depending on the severity of the injury.
When most people think of work-related or on-the-job injuries, they conjure up images of a slip and fall, a torn rotator cuff, a back injury such as a herniated disc, lacerations, amputations, concussions, and burns. That is to say people tend to think of injuries that occur from one specific acute or traumatic workplace event. They do not tend to think of work-related hearing loss, which is generally gradual in nature. And while these one-time occupational injuries are commonplace due to the open and obvious nature of a one-time event, they may not be as prevalent as gradual occupational induced hearing loss, which impacts over twenty million workers every year! Perhaps this is due to the often times gradual onset of work-related noise-induced hearing loss, which often manifests gradually after repeated and continuous daily exposure to workplace noise. Workers are often unaware of the cause of their hearing loss as employers have little to no incentive to explain to their employees the devastating and permanent impact that industrial noise exposure has on their hearing.
The Mechanics of Noise-induced Hearing Loss
Occupational noise-induced hearing loss refers to permanent and irreversible loss or reduction in one’s ability to hear that is generally a result of continued and elongated exposure to loud noise in the workplace. Over time, loud noise damages tiny hair cells in the inner ear that conduct sound waves into the patterns of sound we then hear. While most cases of permanent work-related hearing loss are gradual in nature as a result of continuous and prolonged exposure to loud noises, some instances of permanent work-related hearing loss arise from single events such as loud blasts or explosions, or physical ear trauma.
Occupational noise is gauged in terms of decibels of sound. A soft whisper weighs in at about 40 decibels, typical conversation emits 60 decibels, a freight train resonates at 80 decibels, a boiler room resounds at 90 decibels, a typical construction site emits 100 decibels, heavy equipment operations resonate at 120 decibels, and a jet engine produces 130 decibels during take-off.
OSHA is the regulatory body that establishes rules and guidelines for the control of noise exposure in the workplace. Per OSHA, the acceptable exposure limit to 90 decibels is 8 hours per day. For every 5 decibel increase above 90 decibels an employee’s exposure period is halved. For example at 95 decibels an employee’s exposure should not exceed 4 hours; at 100 decibels an employee’s exposure should not exceed 2 hours; and at 105 decibels an employee’s exposure should not exceed 1 hour.
OSHA mandates that employers take safeguards to protect employees from hearing loss in the form of Hearing Conservation Programs that insist that employers accurately gauge noise levels on the job site, provide employees with free yearly hearing check-ups and distribute hearing protection and noise attenuating equipment such as earplugs and other hearing protection devices. Notwithstanding OSHA’s mandates, in actual practice very few employers notify employees of OSHA’s standards, nor do most maintain accurate job-site noise surveys, bother to monitor an individual’s noise exposure, or take the time to notify or inform employees of the permanent deleterious impact and destruction that the workplace noise will have on an employee’s hearing. Some of the most common occupations and positions where permanent noise-induced hearing loss is documented and occurs include: factory workers, machinists, pipe fitters, airplane maintenance workers, heavy equipment operators, miners, truckers, boilermakers, and fire-fighters.
Effects of Noise-induced Hearing Loss
The resulting damage from exposure to loud occupational or industrial noise is permanent and irreversible hearing loss, which cannot be repaired. Symptoms of work-related hearing loss may include the presence of a condition called tinnitus, whereby injured workers experience a ringing, buzzing, or muffling sound in their ears following exposure, which may be permanent. Those who suffer noise-induced hearing loss may experience profound short-term hearing loss upon leaving the job site at the end of the day. Many workers with noise-induced hearing loss report that noise levels were so loud on the job that they had to communicate with co-workers by yelling, using hand gestures or written words on a clipboard. Those workers who suffer permanent noise-induced hearing loss may experience difficulty with speech discrimination in the course of conversational speech. They may even have struggle hearing another’s voice on the telephone, or experience both psychological and physical stress, difficulty with concentration, anxiety, sleeplessness, and some even report vertigo-like symptoms or loss of the feeling of equilibrium.
Diagnosing Noise-induced Hearing Loss
Occupational noise-induced hearing loss can be diagnosed with an audiometric examination by an audiologist or a specialized physician called an otolaryngologist. By taking an employee’s anecdotal history of workplace noise exposure and reviewing their audiogram, a medical professional can not only arrive at the diagnosis of work-related hearing loss, but can also assess the degree of permanent impairment related to the damage. Additionally, certain audiometric patterns allow a specialist to distinguish noise-induced hearing loss from other types of loss, such as that resulting from the natural aging process. Prior hearing tests, known as historical audiograms, are also used by health care professionals to assist in measuring the severity of the hearing loss sustained during a set timeframe for a given employee. If the treating physician diagnoses work-related hearing loss, he or she may prescribe hearing aids that your employer is obligated to pay for the rest of the injured worker’s life. It is not uncommon for these hearing aids to cost upwards of $3,000 to $5,000 and necessitate replacement throughout the injured worker’s lifespan.
Importance of Hiring a Skilled Hearing Loss Attorney
Employers and workers’ compensation insurance carriers fight tooth and nail to prevent providing benefits and compensation to workers who suffer work-related hearing loss. Because in most cases, nearly all of their employees were exposed to injury levels of noise, they fear that if they pay out on one claim it will lead to a domino effect as it relates to other employees filing similar claims. As such, it is common practice for them to deny an injured worker’s claim for hearing loss benefits. They attempt to blame it on noise exposure outside the workplace or even attempt to blame it on the workers’ prior employers.
Because of the tenacity with which employers and workers comp insurance carriers fight and deny hearing loss claims, it is vital for the injured worker to procure a skilled Massachusetts workers’ compensation hearing loss attorney experienced in handling these tricky cases. An experienced attorney will protect all of your rights to make sure that your claim is not only properly and timely filed in accordance with the law, but will assure that the claim is made against the proper employer and that you get all of the maximum benefits available to you under the law. Additionally, a skilled and experienced hearing loss attorney will be able to protect you from the defenses and technicalities the employer or workers’ comp insurance carrier are sure to raise in an attempt to deny you the benefits, to which you are legally entitled.
Index | Massachusetts Workers’ Compensation Guide
At Fault Work Injury
In Massachusetts, if you’re injured on the job, it’s no fault. Even if the injury is your fault or it was caused by your actions, it’s still covered.
Most fees in the Massachusetts workers’ compensation system are paid by the insurance company. If you come to me and we have to file a claim, and we prevail, the insurance company pays my fee and they pay my expenses. The only thing that comes out of the client is if there is an order by a judge for ongoing weekly disability, the insurance company can hold 22% of those checks for four weeks only. The bulk of my fee is paid by the insurance company. The only other way I would get paid is if there were a lump sum settlement of the case. If there is a lump sum, my fee is set by the state; it’s either 15% of the lump sum or 20%, depending on the type of case it is. It really doesn’t cost a lot to have a workers’ compensation attorney in Massachusetts.
There’s no overall cap. Some benefits are limited in their time and what they pay, but there is no overall cap. If you’re on permanent total disability in Massachusetts, that can be paid for your lifetime. To get answers to your questions about what your benefits are, you should speak with a qualified workers’ compensation attorney.
Can Your Employer Tell You Who to Treat With?
Under Massachusetts workers’ compensation law, you don’t have to go to any particular doctor. There are some situations with unions where they’ll make an agreement as part of the union contract that you will see a company doctor first and then you can go to a doctor of your choosing. If you have a question about that situation, contact a workers’ compensation attorney and discuss it with them.
Essentially if a claim is denied, you can file a claim with the Department of Industrial Accidents in Massachusetts. It’s eventually heard by an administrative judge, and the judge decides whether or not the insurer has to pay. It’s best to have an attorney that handles workers’ compensation claims in Massachusetts, not just a general practice attorney, to file a claim on your behalf. Most of the attorney’s fees are actually paid by insurance companies, if you prevail.
Disability Retirement Benefits
If you’re covered by long-term disability or short-term disability, you can file for those in addition to your workers’ compensation. Usually, the workers’ compensation benefits will offset most of your long-term or short-term disability benefits. The other benefit you may be entitled to is Social Security Disability benefits. If you’re going to be out of work for more than a year, you can file for those benefits.
Again, there are formulas where they offset these other benefits based on your workers’ compensation that’s paid, but it is a situation that, if eventually you settle your workers’ compensation claim and you allocate that settlement over your life expectancy, then your offset for the Social Security may come off and you will be getting those benefits in full. It’s a complicated area and you need to seek the advice of a Massachusetts workers’ compensation attorney.
Do I Need a Workers’ Comp Attorney?
The answer is that workers’ compensation is a complicated area of the law. It involves statutes, regulations, and individual judges that have different personalities in the way they decided claims. You really need an attorney – not a general practice attorney that does everything, but one that specializes in workers’ compensation law – in order to have the best result for your case.
Employer Didn’t Report Injury
I met with a client the other day and his employer refused to give him a claim form to fill out when he was injured at work. If this happens, you want to seek the advice of an attorney. You can also file or contact the workers’ comp insurance company directly. That information is supposed to be posted visibly at your place of employment. If it’s not, you should contact an attorney that specializes in workers’ compensation in Massachusetts and have them handle it.
Employer Liability for At-Home Injuries
As long as the injury is in the course of and arising out of her job, she is covered by Massachusetts workers’ comp. If you have a question about whether or not your injury is covered, depending on where you are, you should contact a workers’ compensation lawyer and discuss it with them.
Fired While Out of Work on Workers’ Compensation
Unfortunately, in Massachusetts, there’s nothing in the workers’ comp law or other statutes that prevents that. The employer is entitled to replace an injured employer if they’re out for an extended period of time. There is a preference in rehiring, so if that employee was eventually able to go back to that job and the employer was hiring, they would have to give that employee preference over anyone else that hasn’t worked for them prior.
Forced Back to Work
A call I frequently get is that the insurance company doctor has said that they can go back to work after an independent medical exam, but their own treating doctor has said that they’re still disabled. You should listen to the advice of your own doctor. The insurance company may try to terminate or modify your benefits, in which case you need to speak to a workers’ compensation lawyer, if you don’t already have one, and find out what your rights are.
Going to Court for Workers’ Comp
You don’t have to go to court. Workers’ comp in Massachusetts is handled by the Department of Industrial Accidents which is an administrative body. They do have judges and there are proceedings, but they’re not formal court proceedings; it’s less formal. You probably will have to make an appearance at some point, depending on how far your case goes. If you speak to a qualified Massachusetts workers’ comp attorney, they can explain the whole process to you in detail.
IME Doctor Says I’m Not Disabled
A call I frequently get from my clients is about how the insurance company doctor has said that they can go back to work after an independent medical exam, but their own treating doctor has said that they’re still disabled. You should listen to the advice of your own doctor. The insurance company may try to terminate or modify your benefits, in which case you need to speak with a workers’ compensation lawyer, if you don’t already have one, and find out what your rights are.
I had an issue come up the other day. A client was injured at work; he hurt his knee. He had surgery on his knee, wasn’t happy with the results, and his question was, “Can I get another opinion with another doctor?” The answer is yes, you can. In Massachusetts, under the workers’ compensation law, you can actually go to three different doctors in the same practice area before the insurance company can object to that. Yes, second opinions are allowable in Massachusetts. Speak to a qualified workers’ compensation attorney and find out more about what your rights are.
Late Reporting an Injury
The insurance company can deny your claim, but that doesn’t mean you don’t have a claim. You can file a claim with the Department of Industrial Accidents and bring your claim before a judge. The judge will decide whether or not your claim needs to be paid. It’s best to contact a workers’ compensation lawyer and discuss with them what you need to do to get your claim filed.
Losing Health Insurance While on Workers’ Comp
I had a meeting with one of my clients the other day. He’d been out of work for a period of time and his employer notified him that they were terminating his health insurance. Unfortunately, in Massachusetts, there’s nothing that prevents that. Unless he were a union member, the average worker has no protection as far as losing benefits. He is entitled to COBRA under the federal law, but that’s paying the full cost out of his pocket expenses.
Loss of Function Benefits
I got a call the other day and they asked a question about whether or not scarring and loss of function was covered under Massachusetts workers’ comp. In fact, it is. It’s a specific benefit. Scarring is limited to your hands, neck, or face; disfigurement is not. Loss of function is basically calculated by a book with sets of amounts that they give you. Contact a workers’ compensation attorney to determine if, in fact, you’re entitled to any of those benefits.
In Massachusetts, under workers’ compensation, if you’re unable to earn what your average weekly wage was before the accident, you’re entitled to 60% of the difference between your average weekly wage prior to the injury and what you’re able to earn after the injury. You should definitely talk to an attorney to know what your rights are with regard to those benefits.
Paying Bills While Waiting for Workers’ Comp
I get calls a lot from potential clients that are hurt, out of work, and the insurance company has refused to pay their claim right away, and that’s a common problem. One of the ways that you can try to pay your bills is, if you have short-term disability, you can file for these benefits. There are some state benefits that you can file for as well, including Mass Health, to cover medicals while the insurance company is delaying payment. You will want to seek an attorney that specializes in workers’ comp so you can get your claim filed, get it in front of a judge, and get your benefits coming as soon as possible.
Preexisting Medical Conditions
In Massachusetts, there are a couple of standards. If it’s a prior work-related injury that’s aggravated, even the slightest aggravation is a new claim. If it’s a non-work-related prior injury that’s aggravated, it’s a little bit different in that you have to prove that the new injury is at least one of the “major factors” in your need for treatment for disability; it doesn’t have to be the “predominant cause.”
Repetitive Motion Injuries
A lot of that depends on what your doctor says. If your doctor indicates that your repetitive injury and your disability that results there from is because of your work, then it’s probably covered.
Reporting Work Injuries
It’s best if you report the injury right away to your boss or a co-worker. Fill out an accident report if you can. If you don’t report it right away, do it as soon as you can thereafter. It’s very important that you report your injuries, so that your employer knows or is aware of the fact that you were injured on the job so that it’s not a problem later.
Seeing a Company Doctor
Under Massachusetts workers’ compensation law in most cases, you don’t have to go to a particular doctor or a company doctor. There are some situations where unions will make agreements that you see their doctor first, but that’s the exception to the rule. If you have questions, you should speak to a workers’ compensation attorney who handles workers’ comp in Massachusetts, to get the answers to those questions.
Serious Workplace Injury
The first thing you should do when you’re hurt at work is report it to your boss or a co-worker and file an incident report, if that’s required. Secondly, you should get treatment right away. Third thing you want to probably do is contact an attorney that specializes in workers’ comp claims. It’s a complicated area, there are a lot of benefits that people don’t know about, so it’s best to know your rights and get the information up front.
Settling a Workers’ Comp Case
You have to weigh the different scenarios. Does she want to collect a check weekly into the future or possibly for for the rest of her life, potentially? Does he want a lump sum of money now? What’s his financial situation? He’s also on Social Security Disability, so the question is, how does that affect the Social Security? It’s a very complicated area. You really need to speak to a qualified attorney to address all your possibilities and determine what’s best for you.
A question I get a lot from people who are out on workers’ compensation, they’re getting benefits, and the insurance company has approached them about settling their case. They want to know what that means. Essentially, in Massachusetts, if you settle a workers’ compensation case, the insurance company is paying you a lump sum of money to prevent having to pay you into the future. In Massachusetts, the workers’ comp insurers don’t have to pay a settlement if they don’t want to. If they do offer a settlement, what you want to do is look at what amount is being paid, what benefits you might be entitled to into the future, what the value of those benefits are, and that everything is included in the settlement. It’s best to speak to a qualified Massachusetts workers’ compensation lawyer, as settlement is a complicated area.
That varies greatly. It depends on your injury, how long you’re out, the extent of your disability, etc. It could take several months; it could take several years. I’ve had clients that were injured in 1967 and their case is still going today.
Social Security Disability
If you’re qualified for Social Security Disability and you’re going to be out for a year or more, you should apply for those benefits.
There are formulas that Social Security uses that may offset, meaning reduce, the benefits you get based on what you’re getting for workers’ compensation benefits. You need to speak to an attorney that specializes in workers’ compensation in Massachusetts because there are ways to settle your workers’ comp case, allocate that over your life expectancy, and then lower that payment amount that Social Security uses in order to determine whether you’re offset, so you may end up getting your full Social Security benefits back. Again, you should speak to a qualified Massachusetts workers’ comp attorney about this issue.
Statute of Limitations
In Massachusetts, there’s a four-year statute of limitations on filing workers’ comp claims, but it’s best to file it as soon as possible. The longer you wait, the staler the evidence is, and the harder it is to prove your case in front of a judge. You should file right away.
Suing Your Employer
The workers’ compensation law prevents you from suing your employer or co-workers in situations where there’s negligence involved. If a co-worker intentionally injured you, then you might be able to bring an action against that co-worker, but generally, you’re prohibited from suing in court over those types of work injuries. Your remedy is to file a claim with the Department of Industrial Accidents and benefits are available under the Massachusetts workers’ compensation laws. It’s best, though, to contact an attorney to discuss what your rights are.
Temporary Partial Disability
In Massachusetts, you’re entitled to 60% of the difference between what you’re able to make after the injury and what your average weekly wage was prior to the injury. That benefit can run for up to five years.
In Massachusetts, if you’re on total disability benefits, you can’t collect unemployment benefits because unemployment, in order to collect it, you need to agree that you can do some kind of work, and you can’t collect total disability workers’ comp if you’re able to do some kind of work. If you are on partial disability benefits in Massachusetts, and you want to collect unemployment, there’s a dollar-for-dollar offset of the workers’ compensation, and so usually it’s a wash and you don’t get any of your partial benefits. You probably don’t want to file for unemployment because where partial benefits are limited in time, you’re just eating up that time while you’re collecting unemployment. It’s best to speak to a Massachusetts workers’ compensation attorney to figure out what your situation is.
The state has what they call “vocational rehabilitation services”. You can meet with them and they can discuss with you what you’re entitled to. Essentially, they look to see whether or not you can go to a similar type of job. If you can’t do that, they look to see if you have transferable skills that can help you get to a different field and earn the same amount of money.
If you can’t do that, the last category is retraining, where they’ll assign a vocational counselor. You’ll meet with them, develop a plan for retraining to get into a different field, and then they execute that plan. The insurance company should pay for that. The goal of those benefits is to get you back to earning what your average weekly wage was prior to your injury in another field. If you have any questions, speak to a Massachusetts workers’ comp attorney about those benefits.
Volunteers Filing Workers’ Comp Claims
Generally, to be covered under workers’ compensation, you must be an employee who’s paid. There are some exceptions with volunteers in specific categories, so it’s important that you speak to a workers’ compensation specialist attorney in order to determine if, in fact, your injury while volunteering is covered.
When Does Workers’ Comp Benefits Start Paying?
Once you’ve notified your employer that you’re going to be out of work for at least five days, they have five business days to notify their insurance company. The insurance company then has 14 days to either pay or deny your case. If they do it within the 14 days, you’re in what they call a “pay-without-prejudice” period. What that means is, essentially, they can pay your claim for up to six months, potentially a year if you sign an extension, but they can cut your benefits off with just a week’s notice.
If they don’t pay your claim within the 14 days, which they don’t in a lot of cases, then you need to file a claim with the Industrial Accidents and bring it before a judge for a decision on whether or not the benefits should be paid. It’s very important early on in your case to contact a qualified workers’ compensation attorney and make sure the process is proceeding the way it should.
Work Injury Medical Expenses
Any medical treatment that’s reasonable, necessary, and related to your work injury should be paid by the workers’ compensation insurer, but they don’t always do that. If you have a problem with bills, you should contact an attorney that specializes in workers’ compensation and discuss that with them.
Workers’ Comp Nurse Case Manager
The insurance companies like to sometimes assign what they call a “nurse case manager”. It’s generally a nurse who works with or for the insurance company and they oversee the injured worker’s medical treatment. The question usually is, “Do I have to work with this nurse case manager?” The short answer is no, you don’t. Although, in some cases, I like to work with them because they help facilitate getting medical treatment through the workers’ comp insurance company, and that’s sometimes beneficial. The question always is, who are they working for? Are they working in the injured employee’s best interest or are the insurance company’s interest. We keep a close eye on that. Again, you can terminate those services anytime you want.
Workers’ Compensation Hearing
In Massachusetts, the first step is a conciliation, where the attorneys meet; the client doesn’t have to be present for that. If it isn’t resolved at that stage, then it’s moved on to an administrative law judge at a conference, an informal process where the attorneys present their side of the claim; the client has to be there, but doesn’t have to speak.
Once that process is done, a decision is given by the judge. If either side doesn’t like that decision, they’ll appeal to a hearing level. The hearing level is a little more formal; it’s kind of like a trial, where there are witnesses, testimony, and cross-examination. The client has to be there – in fact, probably will have to testify at that hearing – but your attorney will advise you along the way as to what you have to show up for and will prep you for what is going to happen.
Call Jeffery Young Law Offices Today
We want to help you with this difficult situation as best as we can. Don’t settle for anything less than what you deserve. Jeffery Young will be there to guide you through this whole process so that you can focus on your recovery. Contact our office today to set up a consultation.
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