In our final review of the Workers’ Compensation Claims process, we will detail the claims appeals process.
Filing an appeal
You may file an appeal with the reviewing board within 30 days from the time the decision was issued. You must apply to the DIA for an extension if you fail to file or are unable to file an appeal in a timely manner within the 30 day time frame. If you do appeal you will be required to pay a fee equal to 30 percent of the State Average Weekly Wage (SAWW) which may be waived for indigent claims, claims that place an undue hardship on the appealing party.
In an appeal, there are a few actions that can be taken by the Reviewing Board. They may:
- Reverse a DIA decision only if it determines that the decision is beyond scope, arbitrary, capricious or contrary to law;
- Recommit a case to the DIA for further findings of fact, when appropriate; or
- Issue a summary judgment affirming the decision without a discussion of the issues raised on appeal.
- Award reasonable attorneys’ fees, proceeding costs and other appeal-related expenses to an injured employee who wins the appeal.
If the decision of the Reviewing Board is unsatisfactory, an appeal may be filed on that decision with the Massachusetts Appeals Court within 30 days. There are two additional options for appeals, mediation and arbitration.
Mediation
If a party chooses mediation, this can be done at any time during the dispute resolution process. Mediation does not postpone or stay any ongoing proceedings or waive the parties’ rights.
Arbitration
The independent arbitration route is a final and binding dispute resolution process that can determine all questions regarding a claim. Parties that wish to participate in arbitration must:
- Submit their claim dispute to arbitration at least six days before a DIA conference
- Select an independent arbitrator who has not have represented either party for at least one year prior to arbitration
- Sign an agreement to arbitrate
Once a claim or complaint is in arbitration, The DIA will not accept additional claims or complaints related to the injury or condition. After the Arbitrators award, or following the submittal of an arbitration withdrawal signed by both parties, The DIA will then accept additional claims and complaints on the injury or condition in dispute. Once an arbitration decision is made, the parties must abide by the findings and awards ordered by the arbitrator. The DIA will enforce arbitration awards as if they were DIA orders.
Contact FBinsure or visit the Massachusetts Department of Industrial Accidents website for more information on workers’ compensation laws in Massachusetts.
