Workers’ Compensation Appeals

In the Commonwealth of Massachusetts, the workers’ compensation appeals process begins in an informal manner and continues to become more complex, depending on how the appeal progresses. In the later stages of the workers’ compensation appeals process, it will be extremely difficult for an unrepresented injured worker to even participate in the process, let alone receive a benefits award. Thus, the Executive Office for Labor and Workforce Development (EOWLD) and the Department of Industrial Accidents (DIA) for the Commonwealth of Massachusetts strenuously recommends an employee seek legal representation as early in process as possible to aid with the complex requirements and maximize the chance for obtaining an appropriate benefits award.

As the work injury attorneys at the Attorney Injury Group can explain, the process technically begins when your employer denies your initial claim. By employer we also mean your employer’s workers’ compensation insurance company, as is often the case.

When an insurer denies your claim for benefits, you must file a benefits claim package with DIA. You must include medical documents that support your claim. Within a few weeks of receiving your on-the-job injury claim package, DIA will schedule a conciliation process that starts with an informal meeting. At this meeting, your experienced workers’ compensation attorney will negotiate a settlement with the insurance company in the presence of a conciliator provided by DIA. If you are unable to reach an agreement during the meeting, a formal conference will be scheduled.

At the formal conference, an Administrative Law Judge (ALJ) will hear what witnesses would have said had there been a full hearing and listen to your attorney make arguments as to why you should be entitled to workers’ compensation benefits. During this hearing, the ALJ will make a finding as to whether you are entitled to workers’ compensation benefits. If you are denied benefits, you can appeal this for a formal hearing with witness testimony.

At the hearing, the rules of Evidence will apply, and your attorney will call witnesses, seek to have evidence of your disability admitted, and cross-examine your employer’s witnesses. The judge will make a formal ruling following this hearing. Either party can appeal the ruling within 30 days of the final order.

The next appeal is heard before six ALJs who sit on the Industrial Accidents Review Board for the Commonwealth of Massachusetts. Three of the six ALJs will examine the transcripts and record from the prior hearing pursuant to state law. These ALJs may also request the parties submit additional legal briefs on the matter. The review board has the power to affirm ALJ’s prior order, reverse ALJ, or remand the case back to ALJ for further proceedings if they deem necessary.

If one or both parties wishes to appeal a decision by the Massachusetts Industrial Accidents Review Board, they must note such appeal within 30 days of the board’s final decision. This appeal will be heard by the Massachusetts Court of Appeals.

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