Workers compensation is a type of compulsory insurance, provided by employers for their employees, that provides wage replacement, medical expenses coverage and other benefits to employees for injuries arising out of and in the course of employment. As part of the grand bargain that led to employers having to carry this kind of insurance, workers’ compensation law prohibits employees from suing their employers if they are injured do to their employers’ negligence. So for example, if an employer negligently fails to provide a guardrail and because of that an employee falls and is injured, the employee would be entitled to workers’ compensation benefits but could not sue the employer for pain and suffering and other damages the way that he could if the accident happened at a store or a restaurant rather than at his place of employment.
To whom does this apply?
In Massachusetts, all employers are required by state law to carry workers’ compensation insurance. This law applies to almost all employees, with very few exceptions. But do not assume that you are covered just because you are working. To know whether you are covered under an employer’s workers’ compensation insurance, you should consult a workers’ compensation attorney.
What Determines Eligibility?
An injured worker is eligible for workers’ compensation benefits becomes partially or wholly incapacitated from work due to an injury or illness arising out of and in the course of employment. A claimant is not eligible to receive weekly wage replacement benefits unless she or he is incapacitated from work for five calendar days following the accident. When an employee has been unable to work for five calendar days, employers are required, within seven days, to send a report of injury to the employee, the insurer and to the DIA (Department of Industrial Accidents). Upon receipt of that notice, the insurer has 14 days within which to either commence paying benefits or send notice of a denial of the claim to the employee, the employer and the DIA.
Can the Employer stop benefits after commencing payment?
Insurance may pay on a claim for up to 180 days without prejudice. In other words, they can pay benefits for 180 days even though they have not been found liable to make those payments. During this time, they can modify or terminate payments simply by giving a seven-day notice to the injured worker and the DIA. But if the insurer continues to pay benefits after the 180-day period has concluded, the insurer cannot unilaterally stop or reduce payments. After 180 days it must file a complaint and obtain approval from a judge at the DIA in order to terminate or modify payments.
If the insurer denies the claim right away or terminates or reduces payments during the first 180 days, the employee can file a claim for the benefits that have been denied. However, an employee claim will not be accepted unless it has been 30 days since the onset of disability or unless the claim is accompanied by a notice of a denial of the benefits sought.
If you have any questions, don’t hesitate to consult a trusted MA workers’ compensation law firm such as The Law Offices of Terrence A. Low and Anthony J. Canata.
Workers’ Compensation, Mass.gov