Your guide to workers' compensation

4 Pages·1994·0.31 MB·English

by  Massachusetts. Department of Industrial Accidents

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April 1994
JanriesJ. Campbell
Commissioner
YOUR GUIDE TO
WORKERS* COMPENSATION
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WHATWE Qf HHOOWWYYOOUURR BBEENNEEFFIITTSS AARREE
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If you are injured or expdti&cgnffft^Seffc
occupational illness, the Department of Most benefits are based on your own
Industrial Accidents can help you. Our staff average weekly wages (including overtime,
can answer your questions about your tips, etc.) for the 52 weeks prior to your
workers' compensation benefits, and if your date of injury.
claim is contested, help you resolve the
dispute. This booklet explains your rights
and responsibilities under the Medical Benefits
commonwealth's workers' compensation
system, and guides you in filing a claim, if Who qualifies?
needed. You are entitled to adequate and
reasonable medical care. You will also be
WHERE TO START paid mileage for travel to and from medical
visits. Your employer has the right to
Your employer begins the claim process. designate a health care provider within
When you are unable to earn full wages for a their preferred provider arrangement for
period of five or more calendar days due to your first visit to the doctor or hospital.
an illness or injury related to work, your After that initial treatment, you have the
employer has to report this injury to their right to choose your own health care
insurance company and to this department. professionals and to change these
This report must be sent within seven professionals once without the permission
business days of the fifth day of your ofthe insurer.
incapacity.
The insurer must begin to pay you
workers' compensation benefits or send you Temporary total disability benefits
a notice of denial, including their reasons for
the denial, within 14 days of receiving Who qualifies?
notification ofthe injury. You qualify if your injury renders you
The insurer may pay benefits to you for unable to work, considering your age,
up to 180 days without making a final training, and experience, for six or more
decision on your case. This is referred to as days. You can receive these benefits for
the "Paywithout Prejudice" period. up to 156 weeks, as long as you are
During this initial period the insurer may earning no income. You will be
stop or reduce your payments, with seven compensated for the first five days of
days written notice, giving you the reasons disability only if you are disabled for 21
for reducing or stopping the payments. days or more.
workers' compensation law. This benefit is
What are the benefits? paid in addition to other payments - medical
You will get 60 percent of your average bills, lostwages, etc.
weekly wages, based on the 52 weeks prior to
your injury, up to a maximum of the state's Otherbenefits
average weekly wage (SAWW) at the time of Reasonable burial expenses, up to
your injury. $4000, will be paid in cases where the injury
results in death. Surviving spouses can
Partial disability benefits receive weekly benefits equal to two-thirds of
the deceased worker's average weekly wage
Who qualifies? up to a maximum of the SAWW. They
You qualify ifyou can do some work but lose become eligible for yearly cost of living
part of your earning capacity due to your injury. increases two years afterthe injury date.
You can receive benefits for up to 260 weeks. If the spouse remarries, each eligible
For certain types of severe disability, you may child receives $60 a week until the payments
qualifyfor benefitsfor up to 520weeks. equal the total amount that the spouse would
have received.
What are the benefits?
Your benefit will be 60 percent of the WHEN YOUR BENEFITS MAY
difference between your average weekly wage BE STOPPED OR REDUCED
prior to your injury and the weekly wages you
are now capable of earning. Your maximum Your benefits also may be stopped or
compensation would be 75 percent ofwhat your reduced for several reasons, including: if it is
total temporary benefitwould be. ordered by an arbitrator, administrative
judge, reviewing board, or higher court; you
Permanent and total have returned to work (the insurer must
disability benefits resume benefits if within 28 days you leave
work again due to the injury); the insurer has
Who qualifies? been given a medical report by your treating
You qualify if you are totally and doctor, or an impartial medical examiner,
permanently incapable of working as a result of stating that you are capable of returning to
a work-related injury or illness. You can receive work, and your employer has reported that a
these benefits for as long as you are unable to suitable position is available for you; you are
work. requested to attend an evaluation by a DIA
vocational rehabilitation review officer and
What are the benefits? you refuse to attend; or you are incarcerated
You will get two-thirds of your average afterconviction for a crime.
weekly wage, based on the 52 weeks prior to
your injury, up to a maximum of the SAWW. LUMP SUM SETTLEMENTS
You receive a minimum of 20 percent of the
SAWW. A lump sum is a settlement or contract
between you, your employer's workers'
Permanent loss offunction compensation insurer and, in some cases,
and disfigurement benefits your employer. This one-time payment will
be made in place of your weekly
If your injury results in a permanent loss of compensation checks, and other benefits. In
certain specific bodily functions or in scarring of accepting a settlement you give up certain
the face, neck or hands you qualify for a rights, so you must carefully consider
onetime payment under Section 36 of the whether or not settling your case is in your
best interest.
Your rights to future medical care foryour Hearing
injury may or may not be kept open following The hearing is a more formal
the settlement. proceeding, held before the same judge
You have two years from the date your who presided at the conference. Rules of
lump sum agreement is approved to enter evidence apply and sworn testimony is
into a vocational rehabilitation program taken. The judge may continue to gather
approved by the department, otherwise you information after the hearing, and then
forfeitthis benefit. render a decision. The guideline for
issuance ofa decision is 28 days, but this is
WHAT IFYOUR CLAIM IS CONTESTED? only a guideline and it may be longer.
The decision at a hearing can be
If your employer's insurance company appealed by either party by submission of
decides to dispute your case they must send the correctform to this departmentwithin 30
you a certified letter telling you their reasons, days ofthe issuance ofthe order.
and informing you of your right to file a claim
with this department. The Reviewing Board
This board is made up of six judges
Conciliation three of whom will examine the hearing,
If you file a claim with us, you will be transcripts, and may askforwritten briefs or
scheduled for an informal meeting between oral arguments from either party. This
you, the insurer, and a conciliator from this panel can reverse the decision of the
department. This meeting, called a administrativejudge.
conciliation, takes place within a few weeks Review Board decisions can be
of your filing your claim. At this informal appealed to the Massachusetts Court of
meeting we will attempt to reach a voluntary Appeals.
agreement between you and the insurer. If a
voluntary agreement cannot be reached, DO YOU NEED AN ATTORNEY?
your case could be referred to one of our
judgesfora conference. You do not need an attorney to file a
claim for benefits and you are not required
Voluntary Arbitration to have an attorney for any proceedings
Any time prior to five days before a before the department. However, you may
conference you and the insurer can agree to be represented by anyone you delegate,
refer your disputed case to an independent including an attorney. If you do get an
arbitrator by signing a written agreement. attorney the law requires that the insurer
pay theirfee if you win your case. In some
Conference cases the insurer can reduce payments to
The conference is also informal but will you to help pay for your legal
result in the judge issuing an order, either representation. If you lose, the attorney
telling the insurer to pay your benefits, or can charge you only for very specific
ruling that they are not liable for payments to expenses.
VOCATIONAL
you.
The conference order can be appealed REHABILITATION SERVICES
by either party. This appeal must be filed
with this department within 14 days of the These services cover all non-medical
issuance of the order. If either party does services that you may require to return to
appeal the conference order, a hearing suitable employment.
before the samejudgewill be scheduled. They include:
- vocational testing Workers' compensation law can be
- counseling/guidance complex, and the procedures for filing a claim
-workplace modifications can be confusing. This pamphlet should
- job placement assistance / formal retraining answer most ofyour basic questions, but ifyou
should need more information, you can call
any of our regional offices, or contact our
You must attend a meeting with a DIA public information office on ourtoll-free line:
vocational review officer when you are 1-800-323-3249. TTY: 1-800-224-6196.
requested to determine if you are suitable for RegionalOffices
these services. If you refuse your benefits Boston: (617) 727^900, 600 Washington St., 7th
may be discontinued. And if you refuse to Floor; Lawrence: [phone], 11 Lawrence
take part in a rehabilitation program after St.; Fall River: [phone], 30 Third St.;
being determined suitable, your weekly Worcester: [phone], 44 Front St.;
benefits may be reduced by 15 percent. Springfield: [phone], 436 Dwight St.
COMMONWEALTH OFMASSACHUSETTS, DEPARTMENTOFINDUSTRIALACCIDENTS
Governor
WilliamF. Weld
SecretaryofLabor
ChristineE.Morris
Commissioner
JamesJ. Campbell
YOURGUIDETOWORKERS'COMPENSATIONispublishedbytheDepartmentofIndustrialAccidents,600
WashingtonSt., SeventhFloor,Boston,MA 02111.
DEPARTMENTOFINDUSTRIALACCIDENTS
CommonwealthofMassachusetts
600WashingtonSt.; SeventhFloor
MA
Boston, 02111