FAQ-Workers' Compensation

Pulgini & Norton, LLP — Braintree, Massachusetts

1.) WHAT IS WORKERS COMPENSATION?

If an Employee is injured performing work-related duties, the employee may be entitled to workers compensation benefits. These benefits are established by the Workers Compensation Act (M.G.L. c. I52). This statute is governed by the Department Industrial Accidents.

2.) WHERE IS THE DEPARTMENT OF INDUSTRIAL ACCIDENTS LOCATED?

Main Office:

Dept. of Industrial Accidents
600 Washington Street, 7th Floor
Boston, Massachusetts

Other locations:

Fall River
Worcester
Springfield
Lawrence

Where you live determines which office administers your claim. For more information or locations, you may call the Department of Industrial Accidents at (617) 727-4900.

3.) WHAT DO I DO IF I AM INJURED AT WORK?

Immediately report the injury to your employer and complete an accident report as soon as possible. Seek medical attention at a medical facility of your choosing as soon as possible. Be sure to inform your medical facility as to how and where your accident occurred. Secure the names of any witnesses to your accident, along with contact information for these individuals. Please note, never sign any documents that you do not understand, and never give a recorded statement without first consulting with an attorney.

4.) IF I AM INJURED AT WORK, HOW LONG WILL IT BE BEFORE I BEGIN RECEIVING BENEFITS?

You must be unable to receive full wages for five or more days as a result of your work injury before your employer has an obligation to report your injury to the insurer and to the Department of Industrial Accidents (Employers First Report of Injury). The insurer then has 14 days from receipt of the employers first report, to investigate your claim, and to make a decision as to whether they will pay or deny you benefits. The insurer must notify you of their decision in writing. However, even if the insurer decides to make payments to you at this point in time, they may still terminate your benefits at any time within the first 180 days of your disability, as long as they give you seven days notice of termination.

5.) WHAT DO I DO IF THE INSURER DENIES MY CLAIM, OR TERMINATES MY BENEFITS WITHIN THE 180-DAY PERIOD?

You should consult with an attorney who has experience handling workers compensation claims to determine what your rights and remedies are under the Workers Compensation Act. There is no charge for a consultation with an attorney relative to a workers compensation claim, as attorney fees are set forth under the Workers Compensation Act.

6.) IF I AM ENTITLED TO WORKERS COMPENSATION HOW MUCH WILL I BE PAID IN WEEKLY BENEFITS?

If you are found to be totally disabled, you are entitled to 60% of your average weekly wage. If you are found to be partially disabled, an Administrative Judge will determine what your benefit rate will be by determining how much you can earn post injury, versus your pre-injury average weekly wage. Your weekly benefit will be 60 % of the difference between the earning capacity and your average weekly wage. If you are found to be totally and permanently disabled, your benefit rate will be two-thirds of your average weekly wage, and you may be entitled to a cost of living adjustment. All workers compensation payments are tax-free.

7.) HOW LONG WILL I BE ELIGIBLE TO RECEIVE THESE BENEFITS?

If your injury was after December 24, 1991, then you can receive temporary total benefits for up to 156 weeks and partial disability for up to 260 weeks. However, the combination of temporary total benefits, and temporary partial benefits, cannot exceed 364 weeks (7 years).

8.) I WAS INJURED AT WORK A YEAR AGO AND MY CONDITION HAS GOTTEN WORSE. HOW LONG DO I HAVE TO FILE A WORKERS COMPENSATION CLAIM?

An employee has four years from the date that he or she first became aware that the disability arose out of their employment, within which to file a claim.

9.) I SUFFERED A SEVERE BURN TO MY FOOT AT WORK, AND I AM LEFT WITH PERMANENT SCARRING, CAN I RECEIVE BENEFITS FOR MY SCARRING?

Unfortunately, recovery for scar-based disfigurement is limited to the face, hands, and neck. A scar to any other body part is not compensable under the Workers Compensation Act.

10.) I SUSTAINED A TORN ROTATOR CUFF AT WORK. CAN I RECEIVE COMPENSATION FOR MY PERMANENT LOSS OF FUNCTION?

Yes, Section 36 of the Act provides for specific compensation for losses of function to the various body parts. You should consult an experienced attorney to ensure that you receive the correct amount of benefits under the Act.

11.) I WAS INJURED AT WORK AND JUST FOUND OUT MY EMPLOYER DOES NOT HAVE WORKERS COMPENSATION INSURANCE. CAN I STILL COLLECT WORKERS COMPENSATION BENEFITS?

Yes. You may be eligible to collect benefits through the Workers Compensation Trust Fund. In order to file a claim against the Trust Fund, certain preliminary requirements must be met. It is advisable for you to consult with an experienced attorney to ensure that correct procedures are followed. Additionally, you may be entitled to commence a tort action against your employer.

12.) I RECENTLY RECEIVED A LETTER IN THE MAIL FROM AN INSURANCE COMPANY INSTRUCTING ME TO APPEAR AT A MEDICAL EXAMINATION, DO I HAVE TO GO?

Yes, you have a duty to appear and cooperate with this examination. If you refuse to submit to such an examination, or obstruct it, your weekly benefits may be suspended or forfeited. If requested, the insurer must send to you a copy of their doctors report, and reimburse you for all reasonable travel.

13.) I AM PRESENTLY TREATING WITH A DOCTOR THAT I HAVE CHOSEN, CAN THE INSURANCE COMPANY REQUIRE ME TO SWITCH DOCTORS?

No, you have the right to treat with a doctor of your choice. The insurer cannot tell you where or with whom you should treat. However, if you do decide to switch doctors, you should be aware that you may only change your treating physician once in a specific specialty.

14.) AT THE TIME I WAS INJURED, I WAS ALSO WORKING PART-TIME AT A SECOND JOB, WHICH I CAN NO LONGER PERFORM BECAUSE OF MY ACCIDENT. HOW DOES THIS AFFECT MY WEEKLY BENEFIT?

Under the Act, your total wages earned from all insured employers may be calculated to determine your Average Weekly Wage.

15.) I AM A UNION WORKER WHO WAS INJURED ON A PUBLIC WORKS PROJECT. SHOULD MY FRINGE BENEFITS BE CALCULATED IN DETERMINING MY AVERAGE WEEKLY WAGE?

Yes, in most cases, under the Workers Compensation Act as well as Massachusetts General Laws, your employer contributions to your health and welfare, pension, and annuity should be included in determining your Average Weekly Wage.

16.) I AM RECEIVING WORKERS COMPENSATION BENEFITS; CAN I ALSO RECEIVE SOCIAL SECURITY DISABILITY BENEFITS?

Yes, you are entitled to apply for, and receive Social Security Disability benefits while you are receiving workers compensation benefits. However, you should be aware that the amount of Social Security Disability benefits you receive may be affected by your workers compensation benefits.

17.) I WAS INJURED ON THE JOB DUE TO THE NEGLIGENCE AND CARELESSNESS OF A WORKER FROM ANOTHER COMPANY. DO I HAVE ANY RIGHTS AGAINST THE WORKER AND HIS COMPANY?

Yes, in situations where someone other than your employer or co-worker caused your injury, you may pursue what is known as a Third-Party Action. This entitles you to relief for pain and suffering, to which you are otherwise not entitled under the Workers Compensation Act. In such cases, the insured worker should be aware that the workers compensation insurer has the primary lien on any recovery from a negligent third-party. An attorney seasoned in handling cases of this sort can often negotiate a compromised payback to the workers Compensation insurer, on behalf of the injured employee.

18.) I AM RECEIVING WORKERS COMPENSATION BENEFITS DOES THE INSURANCE COMPANY HAVE TO SETTLE MY CASE?

No, there is no obligation on the part of the insurance to offer what is called a lump sum settlement. However, experienced insurance claims representatives, or their attorneys may offer a settlement to you. Therefore, it is important that you consult with an experienced workers compensation attorney before agreeing to accept such a settlement. There are many issues to consider before settling your case, such as vocational assistance, payment of medical bills, and the effect that such a settlement may have upon the receipt of other benefits

19.) IF I SETTLE MY CASE, WILL THE INSURANCE COMPANY CONTINUE TO PAY MY MEDICAL BILLS?

Not necessarily, it would depend on whether that settlement is made with liability, which would mean the insurance company would be responsible for payment of reasonably related medical expenses.

20.) I WAS INJURED AT MY JOB AND MY DOCTOR NOW TELLS ME I WILL NEVER BE ABLE TO RETURN TO THAT TYPE OF WORK, WHAT ARE RIGHTS?

Under the Workers Compensation Act, you have the right to seek vocational counseling, which is administered through the Department of Industrial Accidents. If you are found suitable for vocational services, you may be eligible for job placement, or for re-training, in an effort to place you in an occupation that pays very close to your pre-injury wage.

For a free initial consultation and answers to other questions you may have about the workers' compensation system, contact us via e-mail with a brief description of your situation or reach us by phone at our Downtown Boston, Hyde Park, or Braintree, Massachusetts, office locations.