FAQs For Workers’ Compensation Issues
I work with a substance that I think may be hazardous, and I’m not sure what it is; How can I find out?
Massachusetts has a “Right to Know” law, Chapter 111F of the general laws, dealing with hazardous material in the workplace. Employers must meet certain obligations, including labeling of containers, posting of information, and training of workers.
Employees have the right to request from the employer a Material Safety Data Sheet, which will include the properties of the hazardous material and how to handle them. For more information on the Right to Know Law, hazardous chemicals, Asbestos, or general information on workplace safety, call the Attorney General, 617-727-3465.
There appears to be an unsafe condition where I work; is there anyone I can contact to investigate?
Suspected violations of safety and health provisions can be reported at any time by employees to the Attorney General’s office, 727-3465. Employees or their unions can file a criminal complaint against an employer who violates safety and health standards established by the Department of Labor and Workforce Development; however, employees are urged to contact the AG before taking independent action.
I was insured on the job and I’m getting weekly checks. My employer has terminated me; are they allowed to do this?
Unless your union contract, or individual contract of hire, requires it, an employer does not have to hold your job open while you are unable to work due to an industrial accident. But, §75 of the workers’ compensation law does require employers to give preferential treatment in the rehiring of injured workers when they are ready to return to work.
What information do I need to give you to locate an old file?
We need either the DIA Board File number or the following four pieces of information:
- Name of the injured employee
- The exact date of injury
- Name of Employer
- Social security number of the injured employee
We also need a name and daytime phone number of a contact person.
How can I get a copy of the file of my industrial accident?
All requests for records must be made in writing to the Keeper of Records. If the accident date is before 1990 the record will probably be in the state archives. This process takes about two weeks. Records of more recent injuries are kept on file in the record room in the Boston office.
Complete files are releasable to parties to the cases only. Copies of documents are $.50 a page, payable before copies of documents can be released. A name and phone number must be included with every request so that the claims office can contact them with any questions.
What is CommonHealth?
It is a health insurance plan offered by the Department of Transitional Assistance, under the commonwealth’s universal health care legislation. The plan provides full or supplemental medical coverage to disabled working adults and disabled children under the age of 18 who are not eligible for Medicaid. Participants pay a monthly premium according to a sliding fee scale, based on income and family size. Their phone no. is 1-800-662-9996.
My employer got a stop-work order from your department and has been closed down. Does my employer have to keep paying me?
An employee affected by a stop-work order must be paid for the first ten (10) days lost pursuant to such an order under the workers’ compensation law, MGL Chapter 152, section 25C, paragraph 4.
Can my employer stop my health plan and other benefits while I’m out of work due to an accident?
Apart from the anti-discrimination provisions of §75B, there are no explicit provisions under the Massachusetts Workers Compensation law preventing employers from stopping all benefits while a worker is missing work due to a work-related accident.
But, M.G.L. 175, §110D, states that in most cases coverage will continue for 31 days following a termination, and §110G requires most employers to offer continued coverage under the medical plan for additional 39 weeks (as long as the employee does not become eligible for another plan); the employee can be required to pay the entire (group rate) premium.
Surviving spouses are also afforded the same coverage. Under applicable federal law (COBRA, Public Law 99-272), some employers are required to offer a continuation of whatever health plan the employee had prior to the termination or reduction in hours. This continuation period is usually 18 months; in some cases, it is three years. During this continuation period an employer can charge the employee the group rate, plus two percent, for coverage.
If you have any questions about what health care benefits, if any, your employer is required to offer you, contact your employer’s Health Plan Administrator. If you can not afford the coverage offered by your employer, you should contact the Department of Medical Assistance, which may be able to offer some medical insurance benefits, or MassHealth, (617) 210-5000. Or visit the DMA Webpage. To get more information on the COBRA law, call (617) 565-9600.
I injured my back on the job. When I went to a doctor for the treatment he refused to handle my case, saying he didn’t accept workers comp cases; can he do this?
Yes, unless a doctor has already begun treatment they can refuse to accept a workers’ compensation case.
I filed a claim (or some other form) weeks ago and have not gotten a response from the DIA; what do I do?
Contact the Office of Claims Administration, 617-727-4900 at extension 208 or 209.
How does collecting social security affect my workers’ comp benefits?
Workers Compensation insurance benefits are not affected by collecting Social Security benefits. More information on this is available from the Social Security Administration.
Under what circumstances, if any, can you collect vacation pay while collecting WC benefits? What happens to earned vacation pay if an employee is terminated while on WC?
The workers’ comp law does not address the continuation of any benefits – it’s usually a matter of wage/hour law and/or collective bargaining agreements. Generally, an employer must pay an employee for any earned vacation time or other earned benefits due to them, at the time of termination.
Questions about vacation pay owed to an employee should be addressed to the Attorney General, Office of Fair Labor and Business Practices, 727-3465. On the web, go to Workplace Rights. Workers’ compensation benefits are not paid for any period that a worker is receiving vacation pay.
How long do I have to file a claim after I am injured?
Under §41 of Chapter 152, for injuries on or after January 1, 1986, a claim must be filed within four years of the date an employee becomes aware of the causal connection between their disability and their employment. In the case of the death of an employee, the claim must be within four years of death.
For injuries prior to 1/1/86, the statute of limitations is one year, regardless of the employee’s knowledge of the causal connection, although it is the burden of the insurer to show prejudice by the employee’s failure to file within one year of injury.
Can I get a cost of living increase in my benefits?
You are eligible for a COLA increase if you are collecting benefits under §34A (permanent and total disability), and your injury was more than two years ago, or if you were injured prior to December 23, 1991, and you are collecting partial disability benefits (§35). You are not eligible if you are collecting under §34 (temporary total disability). You need not apply for these benefits, they should be paid automatically if you are eligible. The amount of the increase is determined annually by the DIA, and go into effect on October 1 of each year. These increases will be paid to the extent that they do not reduce benefits being paid under federal social security.
I know someone who may be defrauding an insurance company. What do I do?
If it is an employer who does not have worker’s comp insurance, speak to John Zimini, x 413; if it is an injured worker defrauding an insurer, you should contact the insurer directly, and notify the Insurance Fraud Bureau, at 1-800-32-FRAUD, or 617-439-0439.
The insurance company sent me to their doctor for evaluation and now they won’t send me a copy of the report. Don’t I have a right to that report?
An injured worker may invoke Sec. 20 or 30A of the MA workers comp law, which requires the insurer to provide a copy of the report. Also, the employee can invoke the Patient Bill of Rights.
How can I get a certified copy of a file?
For parties in a case, the DIA certifies orders, decisions, and memorandum of agreement (Lump Sums and Form 113), the procedure is:
1. Request in writing from:
ATTN: Keeper of Records
1 Congress Street, 10th Floor
Boston, MA 02114
2. Include a check, per item requested, made out to “Commonwealth of Massachusetts”
3. It takes about ten days.
How do I get access to or a copy of something in a file?
You must make the request in writing to our Keeper of Records. The address is:
ATTN: Keeper of Records
600 Washington St., 7th Floor
Boston, MA 02111
Copies of documents are $.20 a page, payable to “Commonwealth of Massachusetts”. Checks only. It usually takes at least ten to 14 days to respond. Information you must provide us with includes: the name of the injured worker, their social security number, date of injury, employer name, insurer name, name and phone number of the person requesting the information, and, if known, the DIA Board Number.
I had a conference recently and just got the judge’s order. I understand that a portion of my first month’s benefits might be deducted to pay for attorney fees. Is this right?
Yes, if you were injured on or after December 24, 1991. The workers’ comp law, § 13A (10), states that “the insurer may reduce the amount payable to the employee within the first month from the date of the voluntary payment, order or decision, by the amount owed the claimant’s attorney.” There is a cap of twenty-two percent of the first month’s payment on this reduction.
For example, an order issued May 1, 1995, for benefits due March 1, 1995 through April 15, 1995, will not involve any employee monies. An order issued May 1, 1995, for benefits due April 1, 1995 through May 15, 1995 might involve 22 percent of these monies for benefits due between May 1 and May 15, 1995. Finally, an order issued May 1, 1995 for benefits due May 1 and indefinitely into the future might involve 22% of those benefits due between May 1 and May 30, 1995, up to a maximum of the actual attorney fee. If, for example, 00 in benefits were due between May 1 and May 30, up to 0 could be deducted.
How long do I have to appeal an order or decision by a judge?
Under 452 CMR (1.11) and (1.15) you must file the appeal of a conference order (Form 121) within 14 days of the date of the order, and an appeal to the reviewing board (Form 112) within 30 days of the date of the decision. 452 CMR (1.02) defines filed as: postmarked by midnight of the 14th or 30th day.
I have a scar and a permanent loss of function due to a work-related injury. Do I get any additional compensation for this?
Yes, under §36 of the workers’ comp law you are entitled to a one-time payment for certain scars on the hand, neck or face, and permanent loss of function. Normally you would reach an agreement with the insurance company to settle this compensation anywhere between nine months and a year from your date of injury. The delay is to let the scar or loss of function stabilize. If you can’t reach an agreement with the insurer, you can file an employee claim, and get an appointment to be evaluated by a conciliator.
The insurance company paying me weekly benefits just told me that I was being overpaid and they want to get the overpayment back from me. Can they do this?
Under the Workers Comp law, M.G.L. 152, § 11D, insurers may recoup overpayments but can reduce weekly checks by no more than 30 percent. If no future payments are due, the insurer may start an action in superior court.
Can the insurance company be fined for not paying my benefits on time? How much? Who gets the money?
Yes; if the DIA determines that an insurer has failed to pay or contest payment of a claim in a timely manner, under §7 (1), a 0 fine may be assessed, payable to the injured worker. Further delays in payment may result in additional fines, payable to the Workers Comp Trust Fund.
I was injured at my full-time job and I’m going to be out for several weeks. I also have a part-time job and am able to keep working there. How does this second job affect my benefits?
You would be required to report your earnings from the second job to the insurer for your full-time job. The insurer would pay you partial benefits (§35), compensating you for a percentage of your lost wages. This compensation would probably be less than what you would have received under §34, temporary total benefits. (§35 benefits are capped at 75% of what a person’s §34 benefits would be.) You would have to be covered by workers’ compensation insurance under Massachusetts law at your second job for the income to be included in your average weekly wage (i.e. – if you had a second job with the federal government, that income would not count towards determining benefits under state law.)
I came to an agreement for compensation with the insurance company… (OR) a Judge ordered them to pay me compensation… How soon do they have to pay for me?
Compensation must be paid within two weeks of knowledge from any source that payment is due. An exception is made for employees of the Commonwealth of Massachusetts, and for employees receiving benefits from the Workers Compensation Trust Fund, whose checks may take a bit longer.
I collected WC benefits for several months then tried to go back to work. After a week I had to leave again due to my injury; I notified the insurance company. Do they have to resume my benefits?
Yes; under the worker’ compensation law, §8 (2) (c), in cases where liability has been established, if you return to work for less than 28 days, and are forced to leave work again due to your injury, the insurer must resume payments to you. However, you are required to report your renewed disability to the insurer, in writing, within 21 days of going back out. The insurer must resume these payments within 14 days of receiving notice from you.
My check is late OR the insurance promised to pay but I haven’t received any money yet. What do I do?
I was injured working out of state, but I was originally hired in Massachusetts; what state should I file a claim in?
The National Commission on State Workmen’s Compensation Laws has recommended that an employee be given the choice of filing a claim in the state where the injury occurred, or where the employment was localized, or where the employee was hired. In the majority of states, jurisdiction will be found if one of these alternatives is satisfied. 9 Larson, § 143.01 (2000). In Massachusetts, it is settled law that either the place of injury or the place of hire will confer jurisdiction
I was hurt at work and my employer does not have workers comp. Can I sue him? Is there a fund to pay me benefits?
Employees of uninsured employers who are injured on or after December 12, 1985 can both sue their employer in a civil action and file a claim against the Worker’s Compensation Trust Fund at the DIA. If you were injured before that date, you cannot file against the trust fund. You have the right to sue your employer.
The insurance company sent me a notice about having their doctor examine me. Do I have to? Do they have to reimburse me for lost wages?
Yes, you have to submit to reasonable requests for examination by the insurance company’s doctor. However, these examinations must be at ‘reasonable’ intervals for each particular injury claimed, and the insurer must reimburse you for reasonable travel expenses.
I don’t know the name of my employer’s workers comp insurance company. What do I do?
Ask your employer — they are required by law to have a notice posted somewhere in the workplace, providing you with that information. Also, if you have been injured, and have been unable to earn full wages for five or more days, your employer must report your injury to their insurance company and to the DIA. They are required to give you a copy of this report, which contains the name and address of the insurer. If you have tried to get this information from your employer and failed, the Office of Insurance in Boston can assist you, 727-4900, x404 or 405.
After I am injured on the job how long does the insurance company have to start sending me my checks?
When you have been unable to earn full wages for five or more days due to an injury on the job, your employer has seven days, not including Sundays and legal holidays, to report the injury to its insurance company. The insurance company then has 14 days from receipt of the first report of injury to mail you a check or, if it intends to contest the claim, to send you a form stating its reasons for denying compensation.
An employee claim form may be filed with the insurance company at any time, but the DIA cannot accept it until at least 30 days have passed since your first date of the disability. You can obtain claim forms from this website, the public information counter at any D.I.A. office, or by calling 727-4900 x470.