Workers’ Compensation Process
These materials have been prepared by the Law Office of Joyce E. Davis for informational purposes only. They are not meant to be and should not be construed as specific legal advice. For assistance with a particular legal question, please consult a lawyer.
THE FIRST REPORT OF INJURY
The Massachusetts General Laws require an employer to submit a First Report of Injury form to the insurance company when two conditions are met: 1) the employer has received proper notice that the employee was injured and 2) the employee was unable to earn his full wages for at least five calendar days (including weekends and holidays). Under the statute, the employer has seven days (excluding Sundays and legal holidays) after he receives proper notice of an injury to file the form. If the employer violates this Section three or more times in a year, a penalty of $100.00 will be imposed for each violation. If the fine is not paid within three days of receipt of the bill, it is considered a separate violation.
If your employer does not file the First Report of Injury when he is supposed to, you can contact the Office of Claims Administration at the Massachusetts Department of Industrial Accidents ("DIA"), telephone number (617) 727-4900. You can also consult with an attorney about filing a claim.
FILING A CLAIM
If the insurance company does not begin paying you benefits after your injury, you can file a claim at the Massachusetts Department of Industrial Accidents ("DIA" or the "Board"). Your claim must be accompanied by medical records showing that you became disabled as the result of an injury at work. At the point that you begin thinking about filing a claim, you you should request your medical records from your doctor. It would also be wise to consult with an attorney specializing in workers' compensation. In fact, if you appear at the Department regarding a claim that you filed, you will usually be advised to return with a lawyer.
THE CONCILIATION
About a week after you file a claim, your case will be scheduled for a conciliation at the DIA office closest to where you live. The conciliation is an informal meeting between the attorney for the insurance company and you and/or your workers' compensation attorney. The conciliator is not a lawyer and cannot grant your request for benefits. Rather, the conciliator's job is to see if there is some way that the parties can reach an agreement. If an agreement cannot be reached, the conciliator will make sure that there is enough medical documentation to support your claim and will then forward it to the Division of Dispute Resolution.
THE CONFERENCE
The next step in the Massachusetts workers' compensation process is a conference before an administrative judge who will make a decision about your claim. At the conference, your lawyer and the insurance company's lawyer will submit medical documentation and other information to the administrative judge and will make fairly brief presentations of about fifteen minutes each. Within a week or so, the administrativde judge will issue a conference order awarding or denying your claim for benefits. It can take several months for a case to be scheduled for a conference after the conciliation. You can, however, file a request for a speedy conference with the Massachusetts DIA. This will shorten the wait for a conference to about a month.
THE IMPARTIAL MEDICAL EXAMINATION AND THE HEARING
If either side is unhappy with the judge's conference order, it can file an appeal. If you are still disabled, you will usually be required to be examined by an impartial physician appointed by the Massachusetts DIA. Following his examination, this doctor will submit a report discussing his opinion about your disability. Your case will then be scheduled for a hearing before the same judge who presided over the conference. The hearing is a formal proceeding, like a trial. The rules of evidence apply and witnesses testify under oath. After the hearing, the administrative judge again issues a decision awarding or denying your claim for benefits. Unlike the conference order, a hearing decision is usually fairly long and will let you know the reasons why the judge made his decision. There can be a number of months between the close of evidence in the hearing and receipt of the judge's hearing decision. During this period, the terms of the conference order will remain in place. Thus, if the judge awarded you benefits at the conference, you will continue to receive them until the hearing decision is issued. In Massachusetts, the hearing is a procedure de novo, which means that the judge's decision can reverse his prior conference order. As a result, the insurance company may wind up owing you benefits retroactively. Conversely, you may turn out to have been overpaid, which will allow the insurance company to seek to recoup the excess payment.
APPEALS
After the hearing decision is filed, the parties have thirty days to file an appeal to the Reviewing Board at the Department of Industrial Accidents. Further appeals may be had to the Massachusetts Appeals Court and the Supreme Judicial Court.
