Claims & AppealsProcess
Settling a Massachusetts Worker’s Compensation claim is one way a dispute can be resolved without having to complete the entire review and appeals process. Before discussing settlements, it will be helpful to understand how the claims and appeals process works.
When a worker is injured on the job, he or she can file a claim for medical benefits and lost wages with his or her employer. Claims for lost wages can be made once a worker has missed at least 5 days due to an on-the-job injury or work-related illness.
An employer must make the initial claim to his or her workers’ compensation insurance carrier within seven days of the claim being presented to the employer. Once the insurance company receives the claim (Form 110), the insurer has up to 14 days to either accept or reject the claim.
If the claim is accepted, an injured employee should start receiving benefits checks in no more than one month from the time of submitting the claim to the employer. As workers’ compensation attorneys at the Attorney Injury Group can explain, if an employer has not submitted the claim notice to the insurance company within 30 days, there are steps the employee must take to notify the insurance company personally and report employer’s failure to comply with the workers’ compensation law to the Department of Industrial Accidents (DIA).
If the insurance company rejects the claim, the employee, with the assistance of an attorney, should complete a claim form to start the dispute process with DIA.
Massachusetts Workers’ Compensation Dispute Process:
The first step in the dispute process is known as “conciliation.” Conciliation begins when DIA receives an employee’s claim form and employer’s complaint for modification, discontinuance, or recoupment of compensation. At this point, the commission will set an informal meeting between the employer and employee with a conciliator present. If an agreement cannot be reached, the claim is sent to a conference before an Administrative Law Judge (ALJ).
During a conference, which is an informal proceeding, the employee needs to prove that he or she is disabled due to a work-related accident or illness, and that any disputed medical bills were necessary for treatment. ALJ will make a ruling at this stage, but it can be appealed, and the next step will be a formal hearing.
A formal hearing will involve the testimony of witnesses and presentation of evidence. The Massachusetts Rules of Evidence will apply during this hearing. This is one reason why having an attorney is essential during the entire process. After a hearing, an appeal may be made to the Industrial Accidents Review Board, which consists of a three-judge panel. Any final order made by the review board may be appealed to the Massachusetts Court of Appeals.
As you can see, the claims and appeals process is lengthy and complex, but may be necessary to obtain a full and appropriate workers’ compensation benefits award. However, at any point during this process, the parties can agree to settle the matter and present the settlement agreement to the ALJ for approval.
A settlement may allow both parties to end the dispute without the need for further litigation and get a claimant much needed financial compensation. The settlement may involve a lump sum payment of benefits.
The Attorney Injury Group will fight aggressively to protect your rights. If you or a loved one have a workers compensation settlement call the experienced workers compensation attorneys at the Attorney Injury Group for help. Call us today at 617-934-7000 for a FREE, confidential consultation. When you call our experienced Massachusetts personal injury lawyers, we will investigate every detail of your accident at no cost to you.
At the Attorney Injury Group, you will never pay an attorney’s fee up front and we don’t get paid until you do. Call today to learn how we may be able to help.
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