In the Commonwealth of Massachusetts, all workers’ compensation claims are handled by the Executive Office for Labor and Workforce Development (EOWLD) and the Department of Industrial Accidents (DIA). When a workers’ compensation insurance company denies your benefits, a claim can be filed at the DIA to fight them.
It can be extremely challenging for an unrepresented injured worker to participate in the process, let alone receive a benefits award. Thus, the DIA highly recommends an injured employee seek legal representation as early as possible to aid with the complex requirements and maximize the chance for obtaining an appropriate benefits award.
As the legal team at the Jeffrey Glassman Injury Lawyers, can explain, the appeals process begins as soon as the insurance company denies your claim.
Why do Employers and Insurers Deny Workers’ Compensation Claims?Frequently, in denying a workers' compensation claim, an employer or its insurance carrier will argue that the worker didn't sustain the injury at work, the injury isn't as severe as the worker claims or the worker had a preexisting condition. Employers and insurers can also deny a claim if the worker waited too long to report the accident.
Other reasons employers and their insurance carriers deny workers’ compensation claims include such things as:
In Massachusetts, workers’ compensation is governed by G.L. c. 152. Information about workers’ compensation appeals can be found at G.L. c. 152, § 10A.
When an insurer denies your workers’ compensation benefits, you must file a claim with the DIA. You must include supporting evidence, such as medical documentation.
Acceptable documents that can help you win your appeal include:
Within a few weeks of receiving your on-the-job injury claim, the DIA will schedule a Conciliation. A Conciliation is an informal meeting with a court representative and a representative from the insurance company that starts the legal process. At this meeting, your experienced workers’ compensation attorney will try to negotiate an agreement with the insurance company in the presence of a Conciliator provided by the DIA. The Conciliator’s role is to help facilitate an agreement when possible. If an agreement is not possible, your workers’ compensation injury claim will be forwarded to the next stage, a Conference.
A Conference is a more formal legal proceeding that occurs before an Administrative Judge (AJ). The AJ will hear from the injured workers’ attorney as well as the insurance company’s attorney. Your attorney will make arguments about why you are entitled to workers' compensation benefits. The AJ will consider the evidence presented and make a preliminary decision on whether you are entitled to workers’ compensation benefits.
After a Conference Order, your attorney or the insurance company’s attorney typically files an appeal of the judge’s decision. Your case will then be sent forward for a Hearing.
At the hearing, the rules of evidence will apply. Your attorney will call witnesses, admit proof of your disability, and cross-examine your employer's witnesses. The Administrative Judge will make a formal ruling following this hearing. Either party can appeal the decision within 30 days of the final order.
The next level of appeal is before three of the six Administrative Law Judges (ALJ). These judges sit on the Industrial Accidents Review Board for the Commonwealth of Massachusetts. Information about appeals to the Reviewing Board can be found at G.L. c. 152, § 11C.
Three of the six ALJs will examine the transcripts and record from the formal hearing. The Review Board may also request the parties submit additional legal briefs on the matter. The Review Board can affirm or reverse the prior order or remand the case back to the original AJ for further proceedings.
If one or both parties wish to appeal a decision by the Massachusetts Industrial Accidents Review Board, they must file the appeal within 30 days of the board’s final decision. This appeal will be heard by the Massachusetts Court of Appeals, which is a state-level appellate court.
You can find more information about Massachusetts workers’ compensation and the appeals process on the state’s website.
Substantial evidence can help an employee win a workers' compensation appeal. Medical records can provide details on the cause and extent of your injuries. Witness testimony can give information on how the work incident specifically happened. A timesheet, accident report, or other documentation can show that you were at work when you were injured. All of these can help prove your case and show you are entitled to workers’ compensation benefits. Of course, your attorney will help collect evidence and build a strong case.
Our work injury lawyers are ready to help you with your workers’ compensation appeal. Contact Jeffrey Glassman Injury Lawyers today for a free and confidential consultation at (617) 777-7777 or using our online form.