Injured Workers' Frequently Asked Questions
1. After I am injured on the job how long does the insurance company have to start sending me my checks? When you have been unable to earn full wages for five (5) or more full or partial calendar days due to an injury on the job, your employer has seven (7) days, not including Sundays and legal holidays, from the fifth date of loss, to report the injury to its insurance company. The insurance company then has 14 calendar days from receipt of the first report of injury to mail you a check or, if it intends to contest the claim, to send you a form stating its reasons for denying compensation. An Employee Claim - Form 110 may be filed with the insurance company at any time, but the Department of Industrial Accidents (DIA) cannot accept it until at least 30 calendar days have passed since your first date of disability, or accompanied with an Insurer's Notification of Denial - Form 104. You can obtain claim forms from this website or call the Public Information Office at 617-727-4900, ext. 7470 to have one mailed to you. You may also e-mail the Public Information Office at Info2@massmail.state.ma.us and we can e-mail you the form.
2. I don't know the name of my employer's workers' compensation insurance company. What do I do?
Ask your employer. They are required by law to have a Notice To Employees poster displayed somewhere in the workplace, providing you with that information. Also, if you have been injured, and have been unable to earn full wages for five (5) or more full or partial calendar days, your employer must report your injury to their insurance company and to the DIA. They are required to give you a copy of this report, which contains the name and address of the insurer. If you have tried to get this information from your employer and failed, the Office of Insurance in Boston can assist you, 617-626-5480 or 617-626-5481.
You can also find the name of the insurance company by using the "Workers' Compensation Proof of Coverage and Verification Search" web tool which is located on the DIA landing page. This Proof of Coverage Application allows the public to search workers' compensation insurance coverage information for policies in the Voluntary Market and Assigned Risk Pool.
3. If I am injured on the job and have to go to the hospital for treatment, does my employer have to pay me for the entire day?
The only requirement under state law is that your employer needs to pay you for the hours you actually worked. If your employer does pay you for just the hours you worked, then the day you were injured would be considered the first day of disability. If your employer paid you for the entire day, or shift, then the next day would be considered the first day of disability.
4. The insurance company sent me a notice about having their doctor examine me. Do I have to go? Do they have to reimburse me for lost wages?
You are compensated for lost work time only if you are going for a medical evaluation at the insurer's request and the appointment conflicts with your normal, scheduled working hours.
5. My employer's insurance company wants me to be examined by another doctor in addition to my own. Is that routine or standard?
It is a standard operating procedure for your employer's workers' compensation carrier to send you to a doctor
of their choosing for an examination.
6. Am I required to have another exam in addition to the one conducted by my own doctor, if the insurance company wants me to have one?
Yes, otherwise your benefits can be terminated.
7. How long do I have to file a claim after I am injured?
Under MGL c. 152 В§ 41 for injuries on or after January 1, 1986, a claim must be filed with the insurer within four (4) years of the date an employee becomes aware of the causal connection between their disability and their employment. In the case of the death of an employee, the claim must be within four (4) years of death. If you receive a Notification of Denial - Form 104. you would have four (4) years from the date you received it to appeal the denial. For injuries prior to 1/1/86, the statute of limitations is one (1) year, regardless of the employee's knowledge of the causal connection, although it is the burden of the insurer to show prejudice by the employee's failure to file within one (1) year of injury.
8. I was hurt at work, and my employer does not have worker's compensation insurance. Can I get workers' compensation benefits? Can I sue my employer?
A Special Trust Fund has been set up to pay workers' comp benefits for those employees who are injured working for companies that do not have workers' compensation insurance. Employees of uninsured employers who were injured on or after December 12, 1985 can both sue their employer in a civil action and file a claim against the Worker's Compensation Trust Fund (WCTF), here at the DIA. If you were injured before that date you cannot file against the WCTF; you have the right to sue your employer.
9. I was injured working out of state, but I was hired originally here in Massachusetts; what state should I file a claim in?
The National Commission on State Workmen's Compensation Laws has recommended that an employee be given the choice of filing a claim in the state where the injury occurred, or where the employment was localized, or where the employee was hired. In the majority of states, jurisdiction will be found if one of these alternatives is satisfied. 9 Larson, В§ 143.01 (2000). In Massachusetts, it is settled law that either the place of injury or the place of hire will confer jurisdiction.
10. My check is late, or the insurer promised to pay, but I haven't received any money yet; what do I do?
How late is the check? Have you changed addresses lately? The insurance companies have high turnover rates with their claims adjusters, and sometimes checks that should be mailed out aren't. If you have been getting checks regularly and the most recent check is a week or more late, or it has been more than two weeks since the insurance company agreed to compensate you, contact your attorney. Should you not have an attorney, contact your insurer and ask to speak with the claims representative assigned to your case. Call the Information Office in Boston, 617-727-4900 ext. 7470, or e-mail Info2@massmail.state.ma.us to a have claim form sent out to you if you still do not receive your check after talking with your claims representative.
11. I collected WC benefits for several months, then tried to go back to work. After a week I had to leave work due to my injury; I notified the insurance company. Do they have to resume my benefits?
Under the worker' compensation law, В§8 (2)(c), in cases where liability has been established. if you return to work for less than 28 calendar days, and are forced to leave work again due to your injury, the insurer must resume payments to you. However, you are required to report your renewed disability to the insurer, in writing. within 21 calendar days of going back out. The insurer must resume these payments within 14 calendar days of receiving notice from you.
If, however, liability has not been established, then the insurer would not be required to reinstate benefits. In that instance, you would need to file an Employee Claim - Form 110 .
12. I came to an agreement for compensation with the insurance company (or a judge ordered the insurance company to pay me compensation). How soon do they have to pay me?
Compensation must be issued within 14 calendar days of knowledge from any source that payment is due. This means that the insurer can wait until the 14th day to issue payment. An exception is made for employees of the Commonwealth of Massachusetts, and for employees receiving benefits from the Workers' Compensation Trust Fund, whose checks may take a bit longer.
13. I was injured at my full-time job, and I'm going to be out for several weeks. I also have a part-time job, and I am able to continue working there. How does this second job affect my benefits?
You would be required to report your earnings from the second job to the insurer for your full-time job. The insurer would pay you partial benefits (В§ 35), compensating you for a percentage of your lost wages. This compensation would probably be less than what you would have received under В§ 34, temporary total benefits. (В§ 35 benefits are capped at 75% of what a person's В§ 34 benefits would be.) You would have to be covered by workers' compensation insurance under Massachusetts law at your second job for the income to be included in your average weekly wage (i.e. - if you had a second job with the federal government, that income would not count towards determining benefits under state law.)
14. Can the insurance company be fined for not paying my benefits on time? How much? Who gets the money?
Yes; if the DIA determines that an insurer has failed to pay or contest payment of a claim in a timely manner, under В§7 (1) of MGL c. 152, a $200 fine may be assessed, payable to the injured worker. Further delays in payment may result in additional fines, payable to the Workers' Comp Trust Fund.
15. I am back to work after receiving workers' compensation benefits. However, I am still undergoing treatment for my injury, and I must take time off from work to go for my therapy sessions. Does the insurance company, or my employer, have to pay me for the time that I'm out?
If you return to work, but continue medical treatment, your employer would NOT be required to pay you for the time you take off to go for medical visits. The employer is only required to let you have the time off from work, if these visits can not be scheduled outside your normal work hours. The insurer must reimburse you for reasonable travel expenses. You are compensated for lost work time only if you are going for a medical evaluation at the insurer's request and the appointment conflicts with your normal, scheduled working hours.
16. The insurance company paying me weekly benefits just told me that I was being overpaid, and they want to get the overpayment back from me; can they do this?
Under the Workers' Comp law, MGL c. 152, В§ 11D, insurers may recoup overpayments, but can reduce weekly checks by no more than 30%. If no future payments are due, the insurer may start an action in superior court.
17. I have a scar and a permanent loss of function due to a work-related injury. Do I get any additional compensation for this?
Yes, under MGL c. 152 В§ 36 you are entitled to a one-time payment for certain scars on the hand, neck or face, and permanent loss of function. Normally you would reach an agreement with the insurance company to settle this compensation anywhere between nine months and a (1) year from your date of injury. The delay is to let the scar or loss of function stabilize. If you can't reach an agreement with the insurer, you can file an Employee Claim - Form 110 to get an appointment to be evaluated by a conciliator.
18. How long do I have to appeal an order or decision by a judge?
Under 452 CMR (1.11) and 452 CMR (1.15)you must file the Appeal
Of A Conference Order - Form 121 within 14 calendar days of the date of the order, and an Appeal To The Reviewing Board - Form 112 within 30 calendar days of the date of the decision. 452 CMR (1.02) defines filed as: postmarked by midnight of the 14th or 30th calendar day.
19. If I hire an attorney, who pays for him or her?
Generally you do not have to pay an attorney up front to handle your case. Some attorneys will take an injured workers case without requiring a retainer. You should discuss fees with the attorney you hire. If you get an attorney the law requires that the insurer pay the attorney's fee if you win your case. In certain cases the insurer can reduce your payments to help pay for your legal representation. If you lose, the attorney can charge you only for very specific expenses, for example, copies, travel expenses, subpoena costs, etc.
20. How can I get a copy of my DIA file?
All requests for records must be made in writing to the Keeper of Records Office, preferably on the DIA File Request Form. Please include as much information as possible: social security number, date of injury, employer, and workers' compensation insurance company. Please include your name and telephone number so that the Keeper of Records Office can contact you with questions.
The Keeper of Records Office (KOR) [also known as the Records Access Officer] responds to requests for records in compliance with Massachusetts Public Records Law [MGL c. 66]. A WRITTEN request must be sent to the KOR. All documents that are not considered public records, or considered exempt under the MGL c. 4, В§ 7(26), in whole or in part, shall be withheld. The Keeper of Records for the Department of Industrial Accidents is Bill Taupier, Director of Administration, 617-727-4900 ext. 7560, Bill.Taupier@massmail.state.ma.us .
- The Baker Administration has implemented standardized production costs in response to public records requests, and in the interest of cost savings and environmental purposes, fulfill requests electronically as able.
- Electronic Copies: No charge for duplication*
- 1-4 precisely defined documents: No charge**
- Black and White Hard Copies: 10 cents per page for single- and double-sided copies.
- Color Hard Copies: 50 cents per page
- To improve communications with the public, secretariats and agencies through their KOR will notify a requester within 5 days if the records they are seeking may take more than 10 days and/or $10 to produce. Requests should be fulfilled in no more than eight weeks, with any extension being explained to a requester in writing.
- DIA will regularly make available frequently requested information and/or records on their website and provide information as able, in electronic, searchable formats.
- The DIA will waive search and retrieval fees for standard public records requests. provide at no cost the first 4 hours of work required for more complex requests, and charge no more than $25 per hour for additional time required and notify the requester of those costs in advance.
*Costs for discs, thumb-drives or other storage devices necessary to transmit requested documents still apply.
**To be provided within 3-9 days of receipt of the request.
All files from 1967 and prior have been destroyed. Claims from 1968 - 1981 can be looked up via microfilm.
21. What information do I need to give you to locate an old file?
We need either the DIA Board File number, or the following four pieces of information:
Name of injured employee
Exact date of injury
Name of Employer
SSN# of injured employee
We also need a name and daytime phone number of a contact person.
All files prior to 1967 have been destroyed. Claims from 1968 - 1987 can be looked up via microfilm.
22. Is everything in my file a matter of public record?
No. Your Social Security Number, date of birth, nature of injury, body parts affected, medical records and employee telephone number are NOT public record. A signed authorization by you or a subpoena is required before this information is released to anyone NOT affiliated with your file
23. The insurance company sent me to their doctor for evaluation, and now they won't send me a copy of the report. Do I have a right to that report?
An injured worker may invoke MGL c. 152, В§ 20 or MGL c. 152 В§ 30A, which requires the insurer to provide a copy of the report. Also, the employee can invoke the Patient Bill of Rights.
24. I know someone who may be defrauding an insurance company. What do I do?
If it is an employer who does not have worker's comp insurance, speak to our Office of Investigations, 617-727-4900, ext. 7406; if it is an injured worker defrauding an insurer, you should contact the insurer directly, or notify the Insurance Fraud Bureau. at 1-800-32-FRAUD, or 617-439-0439.
25. Can I get a Cost Of Living (COLA) increase in my benefits?
You are eligible for a COLA increase if you are collecting benefits under MGL c. 152 В§ 34A (permanent and total disability), and your injury was more than two years ago, or if you were injured prior to December 23, 1991, and you are collecting partial disability benefits (В§ 35). You are not eligible if you are collecting under В§ 34 (temporary total disability). You need not apply for these benefits, they should be paid automatically if you are eligible. The amount of the increase is determined annually by the DIA, and goes into effect on October 1st of each year. These increases will be paid to the extent that they do not reduce benefits being paid under federal social security disability.
26. Under what circumstances, if any, can you collect vacation pay while collecting WC benefits? What happens to earned vacation pay if an employee is terminated while on WC?
The workers' comp law does not address the continuation of any benefits - it's usually a matter of wage/hour law and/or collective bargaining agreements. Generally, an employer must pay an employee for any earned vacation time or other earned benefits due them, at the time of termination. Questions about vacation pay owed to an employee should be addressed to the Attorney General, Office of Fair Labor and Business Practices, 617-727-3465. Workers' compensation benefits are not paid for any period that a worker is receiving vacation pay.
27. How does collecting Social Security affect my workers' comp benefits?
Workers' Compensation insurance benefits are not affected by collecting Social Security benefits. If you are receiving social security disability benefits, that could affect any cost of living adjustments. More information on this is available from the Social Security Administration.
28. I filed a claim (or some other form) some weeks ago, and have not gotten a response from the DIA; what do I do?
Contact our Office of Claims Administration, 617-727-4900, ext.7321 or ext. 7332.
29. I injured my back on the job. When I went to a doctor for treatment he refused to handle my case, saying that he didn't accept workers' compensation cases; can he do this?
Yes, there is no requirement in the law for medical providers to accept workers' compensation cases. The DIA does NOT have a list of medical providers that accept workers compensation rates.
30. If a doctor is treating a patient for a condition, and the patient then determines the injury is related to their employment, can the doctor then refuse further treatment? Can the doctor balance-bill for past medical treatment?
While it might be ethically questionable, it would not be illegal for medical providers to refuse to continue treatment on workers compensation cases. However, if they do agree to continue, they must either accept the medical rates set by the state, or negotiate a better rate with the insurer. Balance billing of the employee is specifically prohibited by law.
31. Can my employer stop my health plan and other benefits while I am out of work due to an accident?
Apart from the anti-discrimination provisions of MGL c. 152, В§ 75B, there are no explicit provisions under the Massachusetts Workers' Compensation law preventing employers from stopping all benefits while a worker is missing work due to a work-related accident. But, MGL c. 175, В§ 110D, states that in most cases coverage will continue for 31 days following a termination, and MGL c. 175, В§ 110G requires most employers to offer continued coverage under the medical plan for additional 39 weeks (as long as the employee does not become eligible for another plan); the employee can be required to pay the entire (group rate) premium. Surviving spouses are also afforded the same coverage. Under applicable federal law (COBRA, Public Law 99-272), some employers are required to offer a continuation of whatever health plan the employee had prior to the termination or reduction in hours. This continuation period is usually 18 months; in some cases it is three (3) years. During this continuation period an employer can charge the employee the group rate, plus two percent (2%), for coverage. If you have any questions about what health care benefits, if any, your employer is required to offer you, contact your employer's Health Plan Administrator. If you can not afford the coverage offered by your employer, you should contact MassHealth, 1-888-665-9993. To get more information on the Federal COBRA law, call the U.S. Department of Labor, 617-565-9600.
32. What is MassHealth?
The MassHealth program provides comprehensive health insurance - or help in paying for private health insurance - to nearly one million Massachusetts children, families, seniors, and people with disabilities. MassHealth is the second largest health insurer in the state and is nationally recognized for providing high-quality care in an innovative and cost-effective manner.
33. My employer got a Stop-Work Order from your department, and has been closed down. Does my employer have to keep paying me?
An employee affected by a stop-work order must be paid for the first ten (10) days lost pursuant to such an order, under the workers' compensation law, MGL c. 152, В§ 25C, paragraph 4.
34. I was injured on the job, and I'm getting weekly checks. My employer has terminated me; are they allowed to do this?
Unless your union contract, or individual contract of hire, requires it, an employer does not have to hold your job open while you are unable to work due to an industrial accident. But, MGL c. 152 В§ 75 of the workers' compensation law does require employers to give preferential treatment in the rehiring of injured workers when they are ready to return to work.
35. There appears to be an unsafe condition where I work; is there anyone I can contact to investigate?
Suspected violations of safety and health provisions can be reported at any time by employees to the Attorney General's office, 617-727-3465. Employees or their unions can file a criminal complaint against an employer who violates safety and health standards established by the US Department of Labor.
36. I work with a substance that I think may be hazardous, and I'm not sure what it is; how can I find out?
Massachusetts has a "Right to Know" law, MGL c. 111F, dealing with hazardous material in the workplace. Employers must meet certain obligations, including labeling of containers, posting of information, and training of workers. Employees have the right to request from the employer a Material Safety Data Sheet, which will include the properties of the hazardous material and how to handle them. For more information on the Right to Know Law, hazardous chemicals, Asbestos, or general information on workplace safety, call the Department of Labor standards at 617-626-6975 or 508-616-0461.Source: www.mass.gov