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Q: AFTER I AM INJURED ON THE JOB HOW LONG DOES
THE INSURANCE COMPANY HAVE TO START SENDING ME MY CHECKS?
A: When you have been unable to earn full wages for five or more
days due to an injury on the job, your employer has seven days,
not including Sundays and legal holidays, to report the injury to
its insurance company. The insurance company then has 14 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 may be
filed with the insurance company at any time, but the DIA cannot
accept it until at least 30 days have passed since your first date
of disability.
Q: I DON'T KNOW THE NAME OF MY EMPLOYER'S WORKERS' COMPENSATION
INSURANCE COMPANY. WHAT DO I DO?
A: Ask your employer. They are required by law to have a notice
posted 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 or more 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.
Q: 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?
A: The only requirement under state law is that your employer needs
to pay you for the hours you actually worked. If you 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.
Q: 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?
A: Yes, you have to submit to reasonable requests for examination
by the insurance company's doctor. However, these examinations must
be at 'reasonable' intervals for each particular injury claimed.
The insurer must reimburse you for reasonable travel expenses, but
not for lost wages if you miss work due to the appointment.
Q: HOW LONG DO I HAVE TO FILE A CLAIM AFTER I AM INJURED?
A: Under §41 of Chapter 152, for injuries on or after January
1, 1986, a claim must be filed with the insurer within four 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 years of death. If
you recieve a notice of denial from the insurer (Form 104), you
would have four years from the date you received it to appeal the
denial. For injuries prior to 1/1/86, the statute of limitations
is one 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 year of injury.
Q: I WAS HURT AT WORK, AND MY EMPLOYER DOES NOT HAVE WORKER'S COMPENSATION
INSURANCE. CAN I SUE HIM? IS THERE A FUND TO PAY ME BENEFITS?
A: Employees of uninsured employers who are 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 at
the DIA. If you were injured before that date, you cannot file against
the trust fund. You have the right to sue your employer.
Q: I WAS INJURED WORKING OUT OF STATE, BUT I WAS HIRED ORIGINALLY
HERE IN MASSACHUSETTS; WHAT STATE SHOULD I FILE A CLAIM IN?
A; 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, § 143.01 (2000). In Massachusetts,
it is settled law that either the place of injury or the place of
hire will confer jurisdiction
Q: MY CHECK IS LATE, or THE INSURER PROMISED TO PAY, BUT I HAVEN'T
RECEIVED ANY MONEY YET; WHAT DO I DO?
A: How late is the check? Have you changed addresses lately? The
insurance companies have high turnover rates with their claims adjustors,
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, call the Information Office in
Boston, 617-727-4900, x470, or e-mail them at InfoDesk@dia.state.ma.us.
Q: 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?
A: Yes; under the worker' compensation law, §8 (2) (c), in
cases where liability has been established, if you return to work
for less than 28 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 days of going back out. The insurer must resume
these payments within 14 days of receiving notice from you.
Q: 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?
A: Compensation must be paid within two weeks of knowledge from
any source that payment is due. 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.
Q: 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?
A: 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 (§35), compensating you for a percentage
of your lost wages. This compensation would probably be less than
what you would have received under §34, temporary total benefits.
(§35 benefits are capped at 75% of what a person's §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.)
Q: CAN THE INSURANCE COMPANY BE FINED FOR NOT PAYING MY BENEFITS
ON TIME? HOW MUCH? WHO GETS THE MONEY?
A: Yes; if the DIA determines that an insurer has failed to pay
or contest payment of a claim in a timely manner, under §7
(1), 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.
Q: 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?
A: 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 medical evaluation at the insurer's request and
the appointment conflicts with your normal, scheduled working hours.
Q: 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?
A: Under the Workers' Comp law, M.G.L. 152, § 11D, Insurers
may recoup overpayments, but can reduce weekly checks by no more
than 30 percent. If no future payments are due, the insurer may
start an action in superior court.
Q: I HAVE A SCAR AND A PERMANENT LOSS OF FUNCTION, DUE TO A WORK
RELATED INJURY. DO I GET ANY ADDITIONAL COMPENSATION FOR THIS?
A: Yes, under §36 of the workers' comp law you are entitled
to a onetime 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 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, and
get an appointment to be evaluated by a conciliator.
Q: HOW LONG DO I HAVE TO APPEAL AN ORDER OR DECISION BY A JUDGE?
A: Under 452 CMR (1.11) and (1.15) you must file the appeal of a
conference order (Form 121) within 14 days of the date of the order,
and an appeal to the reviewing board (Form 112) within 30 days of
the date of the decision. 452 CMR (1.02) defines filed as: postmarked
by midnight of the 14th or 30th day.
Q: I HAD A CONFERENCE RECENTLY, AND JUST GOT THE JUDGE'S ORDER.
I UNDERSTAND THAT A PORTION OF MY FIRST MONTH'S BENEFITS MIGHT BE
DEDUCTED TO PAY FOR ATTORNEY FEES. IS THIS RIGHT?
A: Yes, if you were injured on or after December 24, 1991. The workers'
comp law, § 13A (10), states that "the insurer may reduce
the amount payable to the employee within the first month from the
date of the voluntary payment, order or decision, by the amount
owed the claimant's attorney." There is a cap of twenty-two
percent of the first month's payment on this reduction. For example,
an order issued May 1, 1995, for benefits due March 1, 1995 through
April 15, 1995, will not involve any employee monies. An order issued
May 1, 1995, for benefits due April 1, 1995 through May 15, 1995
might involve 22 percent of these monies for benefits due between
May 1 and May 15, 1995. Finally, an order issued May 1, 1995 for
benefits due May 1 and indefinitely into the future might involve
22% of those benefits due between May 1 and May 30, 1995, up to
a maximum of the actual attorney fee. If, for example, $1000 in
benefits were due between May 1 and May 30, up to $220 could be
deducted.
Q: HOW CAN I GET A COPY OF MY DIA FILE?
A: All requests for records must be made in writing to the Keeper
of Records. If the accident date is before 1990 the record will
probably be in the state archives. This process takes about two
weeks. Records of more recent injuries are kept on file in the record
room in the Boston office. Complete files are releasable to parties
to the cases only. Copies of documents are $.50 a page, payable
before copies of documents can be released. A name and phone number
must be included with every request, so that the claims office can
contact them with any questions. You do not need to use any specific
form for your request, however a Records Request Form is available
for you to use.
Q: WHAT INFORMATION DO I NEED TO GIVE YOU TO LOCATE AN OLD FILE?
A: 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.
Q: HOW CAN I GET A CERTIFIED COPY OF A FILE?
A: For parties in a case, the DIA certifies orders, decisions, and
memorandum of agreement (Lump Sums and Form 113), the procedure
is:
1. Request in writing from:
DIA
ATTN: Keeper of Records
600 Washington St., 7th Floor
Boston, MA 02111
2. Include a $10 check, per item requested, made out to "Commonwealth
of Massachusetts"
3. It takes about ten days.
Q: 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?
A: An injured worker may invoke Sec. 20 or 30A of the MA workers'
comp law, which requires the insurer to provide a copy of the report.
Also, the employee can invoke the Patient Bill of Rights.
Q: CAN I GET A COST OF LIVING INCREASE IN MY BENEFITS?
A: You are eligible for a COLA increase if you are collecting benefits
under §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 (§35).
You are not eligible if you are collecting under §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 go into effect on October
1 of each year. These increases will be paid to the extent that
they do not reduce benefits being paid under federal social security
disability.
Q: UNDER WHAT CIRCUMSTANCES, IF ANY, CAN YOU COLLECT VACATION PAY
WHILE COLLECTING W.C. BENEFITS? WHAT HAPPENS TO EARNED VACATION
PAY IF AN EMPLOYEE IS TERMINATED WHILE ON W.C.?
A: 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. Workers' compensation benefits
are not paid for any period that a worker is receiving vacation
pay.
Q: 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 availabe from the Social Security Administration.
Q: I FILED A CLAIM (or some other form) SOME WEEKS AGO, AND HAVE
NOT GOTTEN A RESPONSE FROM THE DIA; WHAT DO I DO?
A: Contact the Office of Claims Administration, 617-727-4900, exts:
201 or 209.
Q: 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?
A: Yes, there is no requirement in the law for medical providers
to accept workers' compensation cases.
Q: IF A DOCTOR IS TREATING A PATIENT FOR A CONDITION, AND THE PATIENT
THEN DETERMINES THAT THE INJURY IS RELATED TO THEIR EMPLOYMENT,
CAN THE DOCTOR THEN REFUSE FURTHER TREATMENT? CAN THE DOCTOR BALANCE-BILL
FOR PAST MEDICAL TREATMENT?
A: 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.
Q: CAN MY EMPLOYER STOP MY HEALTH PLAN AND OTHER BENEFITS WHILE
I AM OUT OF WORK DUE TO AN ACCIDENT?
A: Apart from the anti-discrimination provisions of §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, M.G.L. 175,
§110D, states that in most cases coverage will continue for
31 days following a termination, and §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
years. During this continuation period an employer can charge the
employee the group rate, plus two percent, 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.
Q: MY EMPLOYER GOT A STOP-WORK ORDER FROM YOUR DEPARTMENT, AND
HAS BEEN CLOSED DOWN. DOES MY EMPLOYER HAVE TO KEEP PAYING ME?
A: 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 Chapter 152, section 25C, paragraph 4.
Q: WHAT IS CommonHealth?
A: It is a health insurance plan offered by the Department of Transitional
Assistance, under the commonwealth's universal health care legislation.
The plan provides full or supplemental medical coverage to disabled
working adults and disabled children under the age of 18 who are
not eligible for Medicaid. Participants pay a monthly premium according
to a sliding fee scale, based on income and family size.
Q: I WAS INJURED ON THE JOB, AND I'M GETTING WEEKLY CHECKS. MY
EMPLOYER HAS TERMINATED ME; ARE THEY ALLOWED TO DO THIS?
A: 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, §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.
Q: THERE APPEARS TO BE AN UNSAFE CONDITION WHERE I WORK; IS THERE
ANYONE I CAN CONTACT TO INVESTIGATE?
A: Suspected violations of safety and health provisions can be reported
at any time by employees to the Attorney General's office. Employees
or their unions can file a criminal complaint against an employer
who violates safety and health standards established by the Department
of Labor and Workforce Development; however, employees are urged
to contact the AG before taking independent action.
Q: I WORK WITH A SUBSTANCE THAT I THINK MAY BE HAZARDOUS, AND I'M
NOT SURE WHAT IT IS; HOW CAN I FIND OUT?
A: Massachusetts has a "Right to Know" law, Chapter 111F
of the general laws, 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.
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