We regularly answer questions about the Workers’ Compensation Claims Process. This can be a confusing and frustrating process to understand if you are trying to navigate it alone. Over the next few weeks we will break this process down into three parts in an effort to help you better understand how it works.
Massachusetts’ workers’ compensation laws govern the claims process for individuals who sustain work-related injuries and illnesses. The Massachusetts Department of Industrial Accidents (DIA) investigates and handles workers’ compensation claims throughout the state. The processing of a claim typically begins with a notice of injury and may end up in administrative or judicial appeal.
Notice of Injury: Employees must notify their employers as soon as practicable of any work-related accidents and any resulting injury or illness. To be valid, a notice of injury must:
- Be in writing;
- State the time, place and cause of the injury; and
- Be signed by the employee or the employee’s representative.
Benefit Eligibility: Employers must investigate each injured employee’s eligibility for benefits and, at the earliest practicable time, admit or deny the employee’s claim for compensation. An employer that denies a claim must provide a letter to the employee within 30 days stating the reasons for denying the claim.
Employers can pay a claim for up to 180 days following the initial injury or illness without accepting liability for the claim. During this 180-day period, employers can stop or modify benefit payments after providing a seven-day notice to the DIA and the injured employee. This 180-day period can be extended for an additional 180 days. Thereafter, employers can modify and cease payment only if allowed by state law.
Filing a Claim: An injured employee can file a claim with the DIA if:
- His or her request for benefits has been denied;
- The employer failed to respond to a request for benefits within 30 days; or
- He or she is not receiving all benefits he or she is entitled to under state law.
To file a claim, employees must submit Form 110 to the DIA within four years of when the employee first learns of the connection between his or her incapacity and his or her employment. To be valid, a notice of injury must:
- Be in writing;
- State the time, place, cause and nature of the injury;
- State the benefits claimed by the injured employee; and
- Be signed by the employee or the employee’s representative.
The DIA will tolerate inaccuracies in the description of the date, place, cause or nature of the injury, unless the inaccuracy was intentional, had the intent to mislead and the employer or the employer’s insurer was in fact misled.
The DIA will notify affected employers and any other applicable party when a claim is filed against them.
For more information contact FBinsure or visit the Massachusetts Department of Industrial Accidents website to learn about workers’ compensation laws in Massachusetts.
