If you can continue working (or have missed less than 5 days of work):

You may be eligible for payments for medical bills (but not weekly payments). It's the law: your employer has to notify the Workers' Compensation insurance company about what happened. Your doctor will need the name of the Workers' Compensation insurance company and the claim number. (Get this information from your employer.) Tell your doctor that your health problem is related to your job. Give your doctor your Workers' Compensation insurance company information. Your doctor will send your bill to the insurance company. You won't have to pay. Ask your doctor to use this Workers' Compensation insurance, not your regular health insurance. The Workers' Compensation insurance company is a different company from regular medical insurance or MassHealth, etc.

* Caution: If your employer asks you not to file a Workers' Compensation claim, you should consult an attorney.

If you cannot work for 5 days or more (these do not need to be consecutive):

• You may be eligible for up to 60% of your lost wages.

• Your employer must file a First Report of Injury (Form 101) with the Workers' Compensation insurance company and with the Department of Industrial Accidents (DIA). Your employer must fill out the form (Form 101) no later than 7 days after the days of work missed.

If your employer does not complete Form 101, you must make a report to your employer's Workers' Compensation insurance company. You will need an attorney to help you file Form 101 with the Department of Industrial Accidents (DIA). The Workers' Compensation insurance company must respond to the claim within 14 calendar days after receiving the First Report (Form 101).

The insurance company can

—Accept the demand and begin your weekly benefit checks or

—It will send you a certified letter indicating the rejection of your claim.

If the insurer agrees to pay the claim, they will send you an Insurer’s Notification of Payment (Form 103).

When Will The Benefits or Checks Start?

You should start getting a check within three to four weeks after your injury or illness. You will receive compensation for lost wages for any days you are disabled after the first five full or partial calendar days. You are not compensated for the first five days of incapacity unless you are disabled for 21 calendar days or more.

The first 180 days after your initial injury are considered a “Pay-Without-Prejudice” period. This means the insurer may pay benefits to you for up to 180 days without making a final decision on your case. Paying you during this period DOES NOT mean they have accepted liability. During this initial period, the insurer may stop or reduce your payments by giving you seven days written notice via an Insurer's Notification of Termination or Modification of Weekly Compensation During Payment-Without-Prejudice Period (Form 106). The insurer must give the reasons for taking this action. If the insurer continues paying you past this period, they will, in most cases, need permission from you or a judge to stop or reduce your benefits. If you receive a Form 106 and you receive notification of termination of benefits, be sure to consult an attorney to discuss your rights and responsibilities.

The insurer may ask you to extend the initial 180-day “Pay-Without-Prejudice” period for up to a year, with your written consent, on an Agreement To Extend 180 Day Payment-Without-Prejudice Period (Form 105). The DIA must approve the form. You should make sure you are aware of all your rights before giving your consent or signing any other document.

If the insurer decides to deny your claim, it must send you a Notice of Insurer Denial by certified mail; Form 104 (Insurer’s Notification of Denial), including the reasons for the denial and should inform you of your right to appeal. If you have hired an attorney, ask them to call the claims representative to find out about your claim. The claims representative cannot talk to you about the claim once you appoint an attorney. The attorney can help you file a claim for continued benefits and represent you in subsequent litigation.

If the insurer denies your claim, you have the right to file a claim with the DIA. If you wish to file a claim with the DIA, the court strongly recommends that you have legal representation at this point in the process. Completely and accurately complete an Employee Claim; Form 110 (Employee’s Claim) and submit it to the DIA. Do not submit this form to DIA unless you have received a Notice of Denial from the Insurer; Form 104 (Insurer’s Notification of Denial), or if 30 calendar days or more have passed since the date of your injury or illness and you have not heard from the insurer.

Once the DIA receives your completed Form 110, a Conciliation will be scheduled, which will take place in about two weeks. With this, the controversy process will begin. You will receive a notification indicating the date, time and place where said meeting will take place.

1. Conciliation

The first stage of the Dispute Resolution process is initiated when the DIA receives either of the following forms:

1. Employee's Claim (Form 110), which is filed by an injured employee or their legal counsel against the Workers’ Compensation insurance carrier.

2. Insurer’s Complaint for Modification, Discontinuance or Recoupment of Compensation (Form 108), which is filed when an insurance company requests permission to stop or change your benefits.

Upon receiving either of these forms, an informal meeting will be automatically scheduled between you (or your legal representative), the insurer’s attorney, and a conciliator from the DIA. This meeting, called a “Conciliation,” normally takes place within 12 business days of filing a Form 110 or Form 108. At the Conciliation, an effort is made to reach a voluntary agreement between you and the insurer. If a voluntary agreement cannot be reached, the status of your claim would remain the same as before, and your case could be referred to one of our judges for a Conference.

2. Conference

The Conference is an informal legal proceeding before an Administrative Judge, and usually will take place between 8 - 12 weeks from the date of the Conciliation. The judge learns about the case from presentations by both parties and the submission of documents, such as medical reports, wage statements and affidavits from witnesses. Witnesses are not called. You or your attorney indicates to the judge what the witnesses would have said.

At the Conference you need to show:

(A) you were disabled;

(B) the injury or illness was work related; and

(C) That any disputed medical bills were for necessary treatment.

After the Conference the judge issues an order, either telling the insurer to pay your benefits or ruling that they are not required to pay your benefits.

The Conference Order can be appealed by either party on an Appeal of a Conference Proceeding (Form 121). You have 14 days to appeal from the date of the order. There is a fee to appeal the Conference Order if your appeal is based on a medical issue. This fee pays for you to be evaluated by an impartial medical physician. This fee may be waived if you can prove you cannot afford to pay the fee by filing an Affidavit of Indigence and Request for Waiver of Sec. 11A (2) Fees (Form 136). If either party appeals the Conference Order, a formal hearing before the same judge will be scheduled.

3. Hearing

The Hearing is a formal legal proceeding. It is usually held before the same judge who presided at the Conference. Massachusetts Rules of Evidence will apply and sworn testimony is taken. Witnesses are called and cross-examined by the opposing party. A stenographer records the proceedings.

The judge will render a Hearing decision in which you will either be awarded benefits or not. The decision can be appealed to the Reviewing Board by either party on an Appeal to Reviewing Board (Form 112). This appeal can only be made if the party contends that the judge made an error of law in issuing their decision or during the Hearing. The appeal must be received within 30 days from the date of the Hearing decision. There is an appeal fee equal to 30 percent of the State Average Weekly Wage in place at the time of the appeal. The fee may be waived by filing an Affidavit in Support of Request for Waiver of Filing Fee Under Sec.11C (Form 112A).

4. The Industrial Accidents Reviewing Board

If one or both of the parties wishes to appeal the Hearing decision, that appeal is heard and decided by the Reviewing Board. This board is comprised of six Administrative Law Judges, three of whom will examine the hearing transcripts. They may ask for additional written legal briefs or oral arguments from the parties. The Reviewing Board can reverse or uphold the decision of the Administrative Judge, or can determine that more work needs to be done, and remand (send back) the case to the Administrative Judge for further finding. Either party may appeal Reviewing Board decisions to the Court of Appeals within 30 days of the Reviewing Board decision.

5. Further Appeals

If one or both of the parties wishes to appeal the decision of the Reviewing Board, the appeal is heard by the Massachusetts Court of Appeals.

Your benefits may be stopped or reduced for several reasons. Examples of those reasons are:

• Benefits are ordered to be stopped by an Administrative Judge, Reviewing Board, higher court, or arbitrator.

• You have returned to work. The insurer must resume benefits if you leave work again due to the same injury within 28 days, provided that the insurer has accepted or been assigned liability for your injury.

• The insurer has been given a medical report by your treating doctor or an impartial medical examiner stating that you are capable of returning to work, and your employer has reported in writing that a suitable position is available for you that your doctor has approved.

• You are requested to attend an evaluation by a DIA Vocational Rehabilitation Review Officer and you refuse to attend, or you refuse to cooperate with the provision of vocational rehabilitation services.

• You are asked to go to the insurer’s doctor for evaluation, and you fail to attend.

• You are imprisoned after conviction for either a misdemeanor or felony.

If you return to work for less than 28 calendar days and are forced to leave work again due to your injury, the workers' compensation insurer must resume payments to you, but only if the insurer has voluntarily accepted responsibility for the injury or has liability assigned by a judge.

However, you must report your renewed disability to the insurer, in writing, within 21 calendar days of your return. The insurer must resume these payments within 14 calendar days of receiving your notice. However, if liability has not been established, then the insurer would not be required to reinstate benefits. In that case, consult with an attorney to file a Form 110-Employee Claim with the court.

You can file a Workers' Compensation claim up to four years from the date of your injury or from the date you learned about your workplace health problem.

Boston

Lafayette City Center
2 Avenue de Lafayette
Boston, MA 02111-1750
(617) 727-4900, (800) 323-3249

Fall River

1 Father DeValles Boulevard, 3rd Floor
Fall River, MA 02723
(508) 676-3406

Lawrence

354 Merrimack Street
Entrance C, Suite 230
Lawrence, MA 01843
(978) 683-6420

Springfield

436 Dwight Street
Springfield, MA 01103
(413) 784-1133

Worcester

Mercantile Center
100 Front St., Suite 310
Worcester, MA 01608
(508) 753-2072