Boston Workers’ Comp Claim Timeline

In Boston, employees who are hurt on the job can apply for workers’ compensation benefits. Workers’ comp provides payment of medical expenses and a portion of lost income while the employee is out of work.

Workers’ compensation in Massachusetts is a no-fault system. Employees are entitled to benefits regardless of who is to blame for the accident. In exchange for these benefits, workers typically cannot file a personal injury claim against the employer for negligence.

The advantage of the workers’ comp system is that payment comes more quickly than it would in a personal injury claim. But the workers’ compensation timeline will vary for each person, depending on the facts of the case and if appeals are appropriate and/or necessary.

Are you suffering from an occupational disease or workplace injury? Applying for benefits can be confusing for those who are unfamiliar with the process. Small errors could delay the payment of benefits or result in denials. Let an experienced Boston workers’ compensation attorney at Michael Kelly Injury Lawyers make the process smoother for you.

Call or contact us for a free consultation.

Massachusetts Workers’ Compensation Laws

All Boston employers are required to carry workers’ compensation insurance. If you are injured at work, you will go through your employer’s insurance company to pursue workers’ compensation benefits.

The amount of benefits a worker will receive depends on the nature of their injury and the extent of the disability suffered. A total and permanent disability refer to an injury that prevents a worker from ever returning to work. In these instances, an injured worker will receive more than they would if they sustained a temporary disability. This is because a temporary disability means the employee will be able to return to work in the future.

Boston’s worker compensation laws outline the maximum amounts disabled workers are entitled to after an injury.

  • Permanent and total incapacity: Workers are paid two-thirds of their average weekly wage (AWW) up to the maximum state annual weekly wage (SAWW) for as long as they are disabled.
  • Temporary total incapacity: Employees receive 60 percent of their average weekly wage for up to 156 weeks.
  • Partial incapacity: Workers can receive 60 percent of the difference between their average weekly wage before the injury and what they can earn post-injury for 260 weeks. This amount cannot exceed 75 percent of what they would get if they were totally disabled.
  • Permanent loss of function and disfigurement: Employees may receive a one-time payment for permanent loss of function of a body part or disfigurement caused by a workplace accident. Certain restrictions apply based on the location of the scarring and severity of the injury.

Other requirements include:

  • Waiting period: There is a five-day waiting period for disability claims. That means you won’t get paid if your injury keeps you out of work for five days or less. However, if you miss 12 or more days, you can receive back pay for that time.
  • Time limit: Workers have up to four years after becoming aware of their work-related injury or disease to file a claim. This deadline may be lengthened in certain cases. For example, occupational illnesses like mesothelioma may not be detected for decades.
  • Transparency: Employers in Boston are required to display the name and contact information of their workers’ compensation insurance carrier in a place where workers can see and access it.

When a workers’ compensation insurance company accepts a claim, workers should receive a benefits check within 14 days of reporting the injury. In the case that the insurance company denies the claim, workers can request a hearing with the Massachusetts Department of Industrial Accidents. Before doing so, it’s smart to consult with a knowledgeable workers’ compensation attorney. But schedule a free consultation promptly — there are strict deadlines that must be met.

Timeline Of A Workers’ Compensation Claim In Boston

The workers’ compensation claims process includes steps that must be taken by the worker, the employer, and the employer’s insurance carrier.

Here’s what to expect as part of the workers’ compensation claims process:

  • You must get medical treatment. Your health is the most important factor after any accident. Get the care you need to prevent your injuries from becoming worse or complicating your claim later.
  • Notify the employer as soon as the injury or illness is diagnosed. You must report the injury or illness within 30 days. The employer has seven days to notify its insurance company of the injury.
  • The insurance carrier has 14 days to make a decision. They may agree to pay the workers’ comp claim or reject it. If benefits are denied, you must receive a letter explaining the decision. The insurance company must also inform the Department of Industrial Accidents of its decision.
  • Benefits are paid on a schedule. If your claim is accepted, the insurance company must pay you lost wage benefits every two weeks. Your doctors and other healthcare providers will receive their benefits directly. The insurance company must notify the Department of Industrial Accidents if it stops paying you benefits, or if there is any change in the number of benefits you are receiving.

Benefits denied? Contact an experienced Boston workers’ compensation lawyer. A workers’ comp attorney can help with every stage of the claims process. It’s especially important to contact a lawyer if you have been denied workers’ comp benefits or received notice that the insurer is stopping or reducing payments. An attorney can evaluate your claim and discuss your options for appealing the decision.

What Can Lead To Workers’ Compensation Denials?

Claims for workers’ compensation are frequently denied. Some of the most common reasons given for workers’ comp denials include:

  • The claim was not filed on time. Workers’ compensation claims are time-sensitive, so it’s important to meet every deadline.
  • The employer disputes whether the claim is valid. For example, employers who suspect a worker intentionally injured him/herself or was drunk at the time of a workplace accident may argue that the employee is not eligible for workers’ comp benefits.
  • The insurance company says the injury or illness did not occur in the scope of the claimant’s employment. Injuries must be sustained while the worker was performing his/her job duties. For instance, getting in a car accident on the way to work is not compensable. However, if you drive a vehicle as part of your daily work, any injuries sustained in an accident could entitle you to workers’ compensation payments.
  • There is not enough evidence to substantiate the claim. Evidence is everything. You need to make sure that your claim provides the medical information needed for the insurance company to make a fair determination. A workers’ compensation attorney can evaluate your claim to make sure all relevant information is included.
  • The employee was not eligible to receive benefits (e.g., an independent contractor). Most Boston workers are entitled to workers’ comp benefits. However, employers sometimes misclassify workers as independent contractors to skirt the rules and avoid paying benefits to deserving workers. A sharp lawyer can recognize this tactic and help correct it.
  • The worker suffers from a pre-existing condition, not a workplace injury or illness. Even if you have a pre-existing condition, your injury should still be compensable if the condition was aggravated by a workplace accident.

Appeals May Lengthen The Workers’ Comp Timeline, But Can Pay Off

If you were denied workers’ compensation benefits, you can appeal the decision. If you haven’t hired an attorney during the early stages of the workers’ comp process, it is strongly recommended to do so before appealing.

There are multiple stages of the appeals process. It starts with an informal conciliation in the hopes of reaching an agreement without going before an administrative law judge. If no agreement can be reached, the case may go through increasingly formal stages and ultimately up to the Massachusetts Court of Appeals.

Naturally, appealing a decision will extend the workers’ compensation timeline. However, in some cases, it may be necessary in order to get the full and fair benefits you are entitled to.

Questions about whether to appeal your workers’ comp decision? A skilled lawyer at Michael Kelly can give you the answers. Arrange a free consultation today.

What If My Employer Didn’t Carry Workers’ Comp Insurance?

Although all Massachusetts employers are required to have workers’ compensation insurance, not all of them follow the rules. But you may still be able to receive payments for your injuries. The Department of Industrial Accidents has a trust fund set up for injured workers whose employers were negligent by not purchasing or maintaining their insurance coverage.

Employees who find themselves in this situation apply directly to the trust fund for benefits. It is managed by attorneys who are responsible for making payouts to approved applicants. Essentially, they’re the substitute for the employer’s insurance company. As such, your application for trust fund benefits may be rejected or accepted, and you can appeal if necessary.

Important note: The legal options for injured workers change if their employers failed to carry appropriate insurance. Normally, employees can’t sue employers under Massachusetts workers’ comp laws. But when employers neglect their obligations, they’re no longer protected by those laws. They can be held liable for negligence in a separate personal injury claim.

In the rare case that you suffered a Boston job injury and have an uninsured employer, seek a workers’ compensation attorney’s help immediately. A successful lawsuit means that may actually have the possibility of recovering twice — both workers’ compensation benefits from the trust fund, plus any money awarded if your personal injury claim is successful.

If you end up filing a lawsuit, you can expect the workers’ compensation timeline to be extended, at least when it comes to your separate legal claim. However, the payoff of a favorable outcome could mean more money in your pocket.

How To Protect Yourself On The Job

The best way to avoid the hassle of a workers’ compensation claim is to protect yourself at work. To prevent a workplace injury, you should:

  • Know the safety rules and follow them: Your employer should advise you of all safety regulations and provide you with the necessary equipment (e.g., harnesses, respiratory protection) to keep you safe from harm. Your responsibility is to follow them and not take shortcuts.
  • Report safety violations: Workers who violate the safety rules on the job put everyone at risk. Report any violations to your employer immediately. If your employer is the one violating safety rules, you can file an anonymous report with the Massachusetts Workplace Safety and Health Program or the Occupational Safety and Health Administration.
  • Identify risks: You may notice dangers on the job that have not been identified by your employer. If you identify any hazards, point them out to your employer and see that action is taken. If there is no response, file a complaint to initiate an investigation.
  • Know the emergency safety plan: Your employer should have a response plan in place in the event of an emergency. Make sure that you know it and follow it to lessen the likelihood of injury.

Even when all safety precautions are taken, accidents still happen. If you’re struggling to obtain workers’ compensation in Boston, speak to a qualified attorney for advice.

Hurt In A Boston Workplace Accident? Call Michael Kelly For Help

Many factors can contribute to workers’ compensation denials and delays. But if you’ve been injured, you need money to help with medical bills and other expenses as soon as possible. At Michael Kelly Injury Lawyers, our Boston workers’ compensation attorneys will work to ensure that your claim is filed properly and completely. We can also discuss other legal options that may apply in your case so that you obtain maximum results when you need them most.

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I would highly recommend Michael Kelly to anyone who is seeking a knowledgeable, experienced, and dedicated lawyer.

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Michael D. Kelly has a diverse background that provides a breadth of legal knowledge that he draws upon in serving his clients. Kelly compiled an excellent academic record during his three years at New England Law in Boston.