Actual Employment as used in M.G.L. c. 152 and 452 CMR 1.00 shall include any job for which the employee receives earnings.
Additional Compensation as used in M.G.L. c. 152, §8(5), shall mean compensation due pursuant to an order or decision finding that prior compensation was illegally discontinued.
Advocate on Behalf of Any Party as used in M.G.L. c. 152, §10B, shall mean any person representing a party in any proceeding before the Industrial Accident Board or Reviewing Board, except where the sole consideration for the representation of any such party is in the form of regular wages or salary from employment with a self-insurer, labor organization, employee association, the Commonwealth or any of its political subdivisions, or any entity which receives no consideration in the form of premiums or fees for services relating to the representation of parties before the Industrial Accident Board or Reviewing Board.
All Payments Due an Employee as used in M.G.L. c. 152, Section 8(1), shall mean, in regard to past due or retroactive benefits only, the sum certain payable to the employee after the determination of the amount due a lien holder in satisfaction of any lien filed pursuant to M.G.L. c. 152, Section 46A. Unless otherwise agreed, the parties shall make reasonable efforts to expedite the determination of the amount due the Section 46A lien holder, but in no event shall payment be delayed beyond sixty days of the insurer's receipt of the order, decision, arbitrator's decision, approved lump sum or other agreement indicating that such payments are required to be made. All other payments due an employee shall be made by the insurer within the timeframe set forth in M.G.L. c. 152, Section 8(1).
Amount Payable to the Employee Within the First Month from the Date of the Voluntary Payment, Order or Decision as used in M.G.L. c. 152, §13A(10), shall mean any compensation due the employee under the terms of the voluntary payment, order or decision pursuant to M.G.L. c. 152, §36 or §36A and any future weekly benefits pursuant to M.G.L. c. 152 due the employee for the first 30 days subsequent to the date of execution of a voluntary payment or the issuance of an order or decision.
Average Weekly Wage in the Commonwealth as used in M.G.L. c. 152 and 452 CMR 1.00, shall be the wage, as calculated pursuant to M.G.L. c. 152, §1(9), on or most nearly previous to the applicable date.
Cash Award as used in M.G.L. c. 152, §13A(10), shall mean any specific compensation benefits payable under M.G.L. c. 152, §36 or §36A and any weekly benefits payable under M.G.L. c. 152 of an amount that exceeds the weekly amount being paid the employee for the week immediately prior to the date of the voluntary payment, order or decision.
Disputes Over Medical Issues , as used in §11A(2), shall not include any case in which:
(a) the parties disagree solely regarding the entitlement to weekly benefits concerning a specific period or periods of disability, or death, which occurred prior to the hearing scheduled pursuant to M.G.L. c. 152 § 11;
(b) the parties disagree regarding the liability of the named insurer for any claimed injury; provided, however, that the parties agree that no impartial physician's report is required;
(c) the parties agree upon both the nature of the impairment and the causal relationship between the impairment and the employment; provided, however, that the parties agree that no impartial physician's report is required.
(d) based upon the information submitted at a Conference pursuant to § 10A, the administrative judge determines that there is no dispute over medical issues. The judge's determination, and reasons therefore, shall be stated in the Section 10A Conference order.
Experience Modified Insured as used in M.G.L. c. 152, §48(1), shall mean any named employer in a proposed lump sum settlement which has an experience modification in effect at the time of the lump sum settlement that, under the terms of a rating plan approved by the commissioner of insurance, could be affected by the proposed lump sum settlement.
Factual Basis for an Insurer's Refusal to Pay Compens ation as used in M.G.L. c. 152, §§7 and 8, shall be a short and plain settlement of the specific facts supporting the grounds for said refusal.
Filed as used on M.G.L. c. 152, §§10A and 11C as used in 452 CMR 1.11(1) and 1.15(1) shall mean placement of the appeal in the mail to the Department postmarked no later than midnight on the 14th day when appealing a conference order under M.G.L. c. 152, §10A, and the 30th day when appealing the decision of an administrative judge pursuant to M.G.L. c. 152, § 11C.
Grounds for an Insurer's Refusal to Pay Compensation as used in M.G.L. c. 152, §§7 and 8, shall mean any defense available under M.G.L. c. 152, including but not limited to:
(a) lack of jurisdiction;
(b) late notice;
(c) late claim;
(d) no personal injury;
(e) no injury arising out of and in the course of employment;
(f) no disability; and
(g) no causal relation between personal injury and disability.
Hearing , as used in M.G.L. c. 152, §11A(2), shall be restricted to proceedings subsequent to a conference concerning medical disputes as herein defined. All other hearings shall be held in accordance with M.G.L. c. 152, §11 and 452 CMR 1.00.
Hospitalization Expenses as used in M.G.L. c. 152, §(13(1), shall mean any charges for in-patient hospital services adjudged compensable under M.G.L. c. 152.
Insurer as used in M.G.L. c. 152, §45 shall include the Workers' Compensation Trust Fund. Interest as used in as used in M.G.L. c. 152, §50, shall be calculated using the Department-provided formula available on its website. The parties may utilize other formulas but when a discrepancy exists the amount of interest in the Department formula will prevail for all purposes.
Interest as used in as used in M.G.L. c. 152, §50, shall be calculated using the Department-provided formula available on its website. The parties may utilize other formulas but when a discrepancy exists the amount of interest in the Department formula will prevail for all purposes.
Mid-term Notice of Cancellation as used in M.G.L. c. 152, §55A, shall mean any notice of policy discontinuance during the term of the policy where such discontinuance is initiated by the insurer, and shall not include discontinuances initiated by insureds.
Necessary Expenses as used in M.G.L. c. 152, §13A, shall mean all reasonable out-of-pocket costs, as the Department may set, to a claimant's attorney incurred by said attorney in prosecuting a claim for benefits or contesting a complaint filed by the insurer, including the cost of obtaining relevant medical records, doctor's reports, private investigator fees, constable charges, expert witness charges, interpreter fees and scientific testing costs, but specifically excluding telephone expenses, parking fees, postage, stationery, photocopies, meals, automobile expenses, and ordinary legal office overhead. Filing fees and impartial physician deposition costs required by M.G.L. c. 152, §11A, which are paid by claimant's counsel, shall not be submitted as necessary expenses but shall be reimbursable directly from the insurer against whom the claimant prevails at hearing.
180 Day Period as used in M.G.L. c. 152, §§8(1) and 8(6), shall mean the 180 day period beginning on the commencement of disability.
Payment of Compensation as used in M.G.L. c. 152, §41, shall include payments made without prejudice to the rights of either party.
Setting in Which the Service is Administered , as used in M.G.L. c. 152, §13(1) shall mean the physical location, including the jurisdiction and the type of facility, in which any health care service other than in-patient hospital service is administered.
Toll as used in M.G.L. c. 152, §41, shall mean permanently satisfies.