If you have been injured in a work-related accident, or have been diagnosed by a doctor as having a condition that has been brought on by your work environment, job requirements, the stress level of your job, or if you are suffering the psychological affects of a work-related incident, you can claim workers’ compensation benefits.
Here are the steps to proceed with making this claim:
- Bring your injury or condition to the attention of your immediate supervisor, manager, or HR administrator, and tell them you wish to make a claim for workers’ compensation.
- Your company then will have 7 days (in Massachusetts, 5 days in New Hampshire) to forward your claim to their workers’ comp insurer.
- Once the claim has been properly reported, the insurer has 14 days to investigate the claim and either begin paying you or deny your claim. During that time, you will likely be contacted by a representative of your company’s workers’ compensation insurance carrier who will ask you some questions about your claim.
- Workers’ comp law mandates that the first week you are off-duty because of a work-related injury, you are “on your own” or without compensation for your income, and are expected to use your own personal time. By the second week, if you are still out of work, the insurer must pay you 60% of what you earned, and you do not owe taxes on this income. It sometimes takes a few weeks to receive your first check, but it should include any back payments. If you have any questions at this point in time about the benefits you are receiving and how your claim is being handled, you can contact the insurance carrier, the Department of Industrial Accidents, or an attorney.
- Your benefits and the length of time in which you receive them will depend on your ability to return to work, which is determined by your physician, who may also add limitations to your job details, such as no heavy lifting.
If you have been feeling pain and discomfort for some time and it is not getting better, do not wait to report it. The longer you wait, the more difficult it becomes to make a claim and collect benefits.
WHAT YOU NEED TO OPEN THE DOOR TO YOUR CLAIM
In order to make your claim for benefits, there are three basic elements that establish a workers’ comp case and must be documented in writing by a medical professional who has the authority to understand your health condition. First, you will need to be seen by a doctor and get a diagnosis for your condition. Secondly, ask this doctor what is your prognosis and what restrictions are advised, such as “no work” or “no heavy lifting.” The third element is key, that your doctor will then need to determine and put in writing that your condition is causally related to your work. Sometimes the doctor will provide you with an out-of-work note to take to your employer.
This documentation of your injury—your medical record—can be done by your primary care physician, or a specialist to whom you are referred, or even an emergency room doctor if your condition is so dire it cannot wait for a scheduled appointment. These three elements—diagnosis, prognosis/restrictions, and the relation of the health condition to your work activity—are absolutely necessary to proceed with the Department of Industrial Accidents. It is essential to your claim that you are seen by a physician who will provide the evidence you need to substantiate your claim and that your medical condition is due to work. Know that you may see whichever doctor you wish to see—you do not need to see only a doctor that the WC insurance carrier for your employer dictates, except for scheduled IMEs (independent medical exams) that you must attend. You also do not need to approve of a Nurse Case Manager, nor must it be dictated that this type of nurse accompany you to any physician appointments. You may refuse altogether any assistance from a Nurse Case Manager. Also, do not sign anything from the insurance company without first speaking to an attorney.
Understand that there is a 4-year statute of limitations on filing a workers’ compensation claim in Massachusetts (in NH, the statute of limitations is just 2 years.) If, for whatever reason, you have waited, it is recommended that you speak with an attorney. It is your right to file a claim for benefits, and it is between you and your employer’s insurance, not your boss or manager. Your health and ability to work without further injury are more important, and continuing to work can put you and fellow employees at risk of injury.
WHEN TO CONTACT AN ATTORNEY TO ASSIST YOU WITH YOUR WORKERS’ COMP CLAIM
If you are encountering an employer or insurance company who is not willing to help you with your claim or has denied your benefits, then, by law, you have the right to pursue a claim before the Department of Industrial Accidents (in MA) or the Department of Labor (in NH). An attorney will help guide you through this process.
There are no fees charged to you for contacting an attorney for answers to your questions regarding your claim and how it is being handled.
The number one reason why people don’t contact attorneys in disability cases is because they are afraid of how much it will cost. Most people are surprised to discover that they do not pay an attorney for legal fees themselves. In WC cases in Massachusetts, if you hire an attorney and win your case, the employer or their insurance company will be ordered to pay for your legal representation. If you settle your case, then your attorney will be paid on a contingent fee basis.
MOVING FORWARD, WHAT YOUR CLAIM MEANS
Workers’ Compensation is a system that replaces the need for a person to sue their employer for personal injury suffered at work. However, work-related injuries can result in claims only for WC benefits. You cannot sue your employer for things such as “pain and suffering.” There are some instances where you may be able to pursue an action against a third party, if someone other than work caused your injury.
Remember that if your claim has been denied, and you pursue benefits before the Workers’ Compensation Board, you are involved in a legal dispute. Be aware of some factors that may come up in the days, months, and even years ahead. You will receive forms from the insurance company that may be confusing whether they are in your best interest to sign—and for that reason, there are some forms you would be advised not to sign!
Never sign anything before speaking with an attorney. You are always welcome to call and ask questions while going through the claims process.
Also consider this: your online presence (through social media) may be monitored by the opposing side and you may be video recorded and photographed by professional private investigators, without knowing and without any warning. All of this is part of the legal process—their hope is to capture evidence of you in an act that contradicts your claim. For instance, if you are making a claim to your employer that you have injured your back at work, meanwhile you try to rake your yard or mow your lawn, assume that you will be photographed or video recorded doing this by someone hired by your employer’s insurance company. This is not a violation of your privacy (acts performed in public are subject to public scrutiny), but do understand that in a legal dispute, these tactics may be employed by those representing the other side of the case and may be submitted as evidence by them.
MEDICAL EVIDENCE IS ESSENTIAL TO SUPPORT YOUR CLAIM
It is very important for you to see your physicians as scheduled and not miss any appointments, including those for physical therapy, chiropractic, or other therapists or specialists. Your workers’ compensation benefits will cover the travel expenses for you to get to and from these appointments, even if you use your own car. Keep track of mileage and save receipts if paying for transportation. Some claims go on for a long period of time, and it is wise to apply for reimbursement for anything related to your recovery from your work injury. Keep all of your receipts for any medicines, medical aids, or equipment your doctor prescribes or therapist suggests. If an additional health issue arises for you while you are treating, report it to your physician and ask if it is related to your original work-related injury.
Please call to schedule a free consultation. There are no fees involved with this first step, and you will pay nothing out-of-pocket for legal representation. Whether you are looking to hire an attorney or simply have questions, Attorney Levin can assess your situation right over the phone.
email: michael@MichaelLevinEsq.com | tel: (508) 347-1048 | fax: (774) 243-2684