Workers’ Compensation Process in Massachusetts

If you are an employee injured at work in Boston, the workers’ compensation process will be governed by the Workers’ Compensation Act (WCA), found in Chapter 152 of the Massachusetts General Laws (MGL).

Our dedicated attorneys are closely familiar with this process, having successfully secured benefits for many clients at each phase, including:

• Conciliations;
• Conferences;
• Hearings;
• Lump Sum Conferences.

While expediency is desired in this process, successful workers’ compensation claims often require long-term commitment and dedication. Where other injury law firms are content to quickly settle cases and move on, our legal team at Jeffrey Glassman Injury Lawyers are tireless in their pursuit of the best possible outcome for each client. We recognize this is your life, your future. Work-related injuries and illness can leave you reeling. We work at each procedural phase to help you pick up the pieces and regain your financial stability.

In the Commonwealth of Massachusetts, workers’ compensation benefits are available when an employee is injured on-the-job or suffers a work-related illness. Most workers’ compensation cases in Boston stem from injuries, as opposed to illnesses!

When an injury first occurs, even if it seems minor at the time, it is essential to let your employer know. If you have a supervisor or manager, tell that person, and make sure an incident report is generated.

If you are injured at work, you should seek prompt medical attention as soon as possible. You may need to take an ambulance, drive, or have a coworker transport you to a local hospital, urgent care clinic, or to your regular doctor.

Do not simply go back to work and pretend as if nothing is wrong. As our Boston workers’ compensation attorneys can explain, there are several reasons for this. The first and probably most important reason is that you want to make sure you get the proper evaluation and treatment as soon as possible. Seeking treatment as soon as you are injured will greatly increase the chances of obtaining a full and appropriate workers’ compensation benefits award.

Some injuries may not seem bad at first but worsen over time. If you do not seek treatment for the injury right away, and then you file a claim, the workers’ compensation insurance company may deny your Boston workers’ compensation claim on grounds that you were injured somewhere other than at work. This does not mean you won’t have a successful claim, but it may make things more difficult.

The best thing you can do for both your health and your work-related injury is to seek medical assistance as soon as possible and begin creating a record of your treatment. M.G.L. Chapter 152, Section 20, allows for your medical records and reports to be used as evidence in a workers’ compensation hearing.

If you are worried about your employer retaliating against you for filing a workers’ compensation claim or reporting a work injury, and this does happen, this retaliation would be grounds for filing another type of action that you should discuss with your experienced workers’ compensation attorney.

In Massachusetts workers’ compensation actions, the statute of limitations is four years. The clock on this four years starts to run when the injury first occurs. However, the Department of Industrial Accidents (DIA), which is the state agency under the Executive Office of Labor and Workforce Development, can (in limited circumstances) extend that four-year window in cases where a person would not reasonably know they were injured until much later. One example of an occupational illness not immediately apparent within the four-year period is mesothelioma caused by exposure to deadly asbestos fibers.

Once you notify your employer of your work-related injury or illness, your employer has seven days to notify the workers’ compensation company that an injury has occurred. At this point, the insurance company has 14 to 30 days to either send a notice to the injured employee accepting the claim and starting the payment of benefits or reject the claim and send a denial letter. If your claim has been rejected or your employer has failed to notify the workers’ compensation insurance company, you can file a claim with the Massachusetts Department of Industrial Accidents; however, there are several procedural requirements that you should discuss with your attorney.

Conciliation is a process typically scheduled a few weeks after the claim has first been filed with the DIA. It is a form of non-binding mediation with the goal of helping the insurance company and injured worker reach an agreement without having to go before a judge.

Conciliation is essentially a meeting with the injured worker, a claims adjuster or attorney from the employer’s workers’ compensation insurance company and a conciliator from the DIA. There is a good chance the employer will have a lawyer at the conciliation. It’s a smart idea for you to do the same. There are several conciliation centers around the Commonwealth, including locations in Boston, Lawrence, Fall River, Worcester, and Springfield.

The conciliation is conducted as an informal meeting between the parties with the hope of settling the matter without the need for a formal trial. At the conciliation, the DIA recommends you bring your complete medical records, so the conciliator can examine these records and ask the parties any questions he or she may have.

At this juncture, both sides submit their “last best offer” to reach a compromise. Consent of the parties is required for any settlement or agreement reached at this meeting.

One important thing to remember is that the conciliator does not have the power to order or deny compensation for the injured worker. If the parties cannot reach an agreement, the case will be scheduled “immediately” for a conference. Realistically, this could be anywhere from a few weeks to several months, depending on the DIA’s backlog of cases.

The conference is a formal process where both sides submit evidence to an Administrative Judge, the Administrative Judge (AJ) reviews the information, and questions the parties involved. The AJ assigned to oversee the conference works for the DIA and has the full authority to order or deny workers’ compensation benefits. After consideration of the evidence and testimony, the AJ will issue a temporary order awarding or denying benefits. Typically, the AJ will weigh the “last best offer” made by involved parties and choose between them.

If one or both parties disagree with the order, they have 14 days to appeal and request a hearing before the AJ. Almost without exception, the assistance of an experienced workers’ compensation lawyer in Boston will ensure compliance with the DIA appeal requirements and will improve your odds of success.

The workers’ compensation hearing will take place a few months after the conference. The hearing is treated as a trial and will be much more formal than the previous court proceedings. Although claimants are permitted to represent themselves during these proceedings, doing so is generally considered unwise.

The hearing mirrors what you might expect with a formal civil trial as you sometimes see on TV and in the movies. There are specific procedural requirements for hearings which are outlined in M.G.L. c. 152 Section 11. The Massachusetts Rules of Evidence apply to the hearing, and the insurance company will be represented by their own attorneys. It is important to have your own attorney representing you during this proceeding to ensure compliance with the evidence rules. For example, while statements made outside of court are typically not admissible under the hearsay rule, an experienced attorney will know that statements made by the opposing party can be used against that party under an exception to the hearsay rule. Having a workers’ compensation lawyer to assist with your claim will ensure you respond appropriately and properly object when necessary during the Hearing.

The administrative judge who presided over the conference will usually be the same one to preside over the hearing. The proceeding begins with opening statements by each side followed by the calling of witnesses. Each witness testifies under oath, answering questions presented to him or her by the parties. The witnesses may be cross-examined and physical evidence, such as diagnostic studies and medical records, may be presented. Each side is provided with the opportunity to refute potentially damaging evidence before finally giving their closing arguments. Then it will be up to the judge to make a final determination. The judge’s decision could take months, but once complete, you will be notified by mail of the final decision.

If you lose at the hearing, you can appeal to the Reviewing Board – a panel of three administrative judges – within 30 days of the decision.

It is highly recommended that you have a lawyer during the hearing phase because hearings are procedurally complex, and representing yourself is difficult even under the best of circumstances. Plus, chances are if your claim has gotten to this phase, your employer’s insurer is not backing down.

Insurers or employers may at any point in this process propose a lump sum settlement to resolve your case.

As noted by the state Executive Office of Labor and Workforce Development, a lump sum settlement is a contract between you (the injured worker), the insurer and in some cases your employer. A lump sum settlement is a one-time payment that releases the insurer of the obligation to continue payment on your claim. It may also result in a forfeiture of other benefits.

Your employer cannot tell you that signing a lump sum agreement means you agree to forgo a return to your job. However, there is a lawful presumption that if you accept a lump sum, you are incapable of returning to work for one month for every $1,500 you receive. For example, if you received a $3,000 lump sum, you would be presumed incapable of returning to work for two months. This is outlined in M.G.L. c. 152, Section 48.

Lump sum settlements may be to your advantage, but they are not agreements into which you should enter lightly or without careful review from your Boston workers’ compensation lawyer.

Contact Jeffrey Glassman Injury Lawyers today for a free and confidential consultation.

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