You will start receiving checks
When you have been unable to earn full wages for 5 or more full or partial calendar days because of an injury on the job, your employer has 7 days, not including Sundays and legal holidays, from the 5th date that you aren't able to earn full wages, to report the injury to its workers' compensation insurance company. The insurance company has 14 calendar days from when they receive the first report of injury to mail you a check or, if it denies the claim, to send you a form stating its reasons for denying compensation. An Employee Claim - Form 110 may be filed with the insurance company at any time, but the Department of Industrial Accidents (DIA) can't accept it until at least 30 calendar days have passed since your first date of disability, or you have received a denial from the insurance company. You can obtain claim forms from our website or call the Public Information Office at 617-727-4900, Ext. 7470 to have one mailed to you. You may also e-mail the Public Information Office at Info2@dia.state.ma.us and we can e-mail you the form.
Finding the insurance company for your employer
Please visit our online Proof of Coverage tool to find out if your employer has workers' compensation insurance. If you don't find anything, please call our Office of Insurance at (617) 626-5480 or (617) 626-5481.
Who pays for your day if you get hurt during your work hours
The only requirement under state law is that your employer needs to pay you for the hours you actually worked. If your employer does pay you for just the hours you worked, then the day you were injured would be considered the first day of disability. If your employer paid you for the entire day, or shift, then the next day would be considered the first day of disability.
Insurer requests you see an IME doctor
You do need to go to the appointment. You're compensated for lost work time only if you are going for a medical exam at the insurer's request and the appointment conflicts with your scheduled work hours.
Even if you are being treated by your own doctor, you still need to attend the medical examination set up by the workers' compensation insurance company.
Statute of limitation for filing a claim
Under the workers' compensation law, (MGL c. 152 § 41) for injuries on or after January 1, 1986, a claim must be filed with the insurer within 4 years of the date you become aware of a connection between your injury/illness and your employment. In the case of the death of a worker, the claim must be within 4 years of the date of death.
If you receive a Form 104 - Insurer's Notification of Denial, you have 4 years from the date you received the denial to appeal the it.
For injuries prior to 1/1/86, the statute of limitations is 1 year, regardless of the employee's knowledge of the connection between your injury and/or illness and your work, although it is the burden of the insurer to show prejudice by the employee's failure to file within 1 year of injury.
When your employer has no insurance
You can still file a claim. Please go to Find out how to file a claim against the Trust Fund and what you need to do in order to get benefits.
Hired in Massachusetts but hurt working out-of-state
In Massachusetts, you can file in the state of injury or the state of hire.
Your check is late
How late is the check? Have you changed addresses lately? The insurance companies have high turnover rates with their claims adjusters, and sometimes checks that should be mailed out aren't. If you have been getting checks regularly and the most recent check is a week or more late, or it has been more than 2 weeks since the insurance company agreed to compensate you, contact your attorney. Should you not have an attorney, contact the insurer and ask to speak with the claims adjuster handling your case. Call the Information Office in Boston, 617-727-4900 ext. 7470, or e-mail Info2@dia.state.ma.us to a have claim form sent out to you if you still do not receive your check after talking with your claims representative.
You receive benefits, return to work, and then need to go back out
If you return to work for less than 28 calendar days, and are forced to leave work again due to your injury, the workers' compensation insurer must resume payments to you, but only if the insurer has voluntarily accepted responsibility for the injury, or been assigned responsibility by a judge.
However, you are required to report your renewed disability to the insurer, in writing, within 21 calendar days of going back out. The insurer must resume these payments within 14 calendar days of receiving notice from you, again if they have accepted responsibility for the injury or a judge has previously ordered the workers' compensation insurer to pay you.
If, however, responsibility has not been established, then the insurer wouldn't be required to reinstate benefits. In that case, you would need to file an Form 110 - Employee Claim .
When the insurer has to pay you if a judge has ordered them to pay you or has approved an agreement
Compensation must be issued within 14 calendar days of knowledge from any source that payment is due. This means that the insurer can wait until the 14th day to issue your check.
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.
If your injury on 1 job prevents you from working your 2nd job
You would have to report your earnings from the 2nd job to the insurer paying your workers compensation benefits. The insurer would pay you partial benefits, compensating you for a percentage of your lost wages. You would have to be covered by a workers' compensation insurance at your 2nd job for the income to be included in your average weekly wage (i.e. - if you had a 2nd job with the federal government, that income would not count towards determining benefits under state law.)
When an insurance company can be fined
If the Department of Industrial Accidents determines that a workers' compensation insurer has failed to pay or contest payment of a claim in a timely manner, a $200 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.
You're back to work after your injury, but still need treatment during work hours
If you return to work, but continue medical treatment, your employer wouldn't be required to pay you for the time you take off to go for medical visits. The employer is only required to let you have the time off from work, if these visits can't be scheduled outside your normal work hours. The insurer must reimburse you for reasonable travel expenses. You're compensated for lost work time only if you're going for a medical evaluation at the insurer's request and the appointment conflicts with your normal, scheduled working hours.
The workers' compensation insurance company notifies you that they have overpaid you
Under the workers' compensation law, insurers are allowed to collect any overpayments from you. They can reduce weekly checks by no more than 30%. If no future payments are owed to you, the insurer may start an action in superior court to get their money back.
Who has access to your Department of Industrial Accidents file
Not everything in your DIA file is public. Your Social Security Number, date of birth, nature of injury, body parts affected, medical records, and employee telephone number are NOT public record.
A signed authorization by you, or a subpoena, is required before this information is released to anyone NOT affiliated with your file.
The insurance company refuses to give you a medical report from a doctor they sent you to
You may invoke the workers' compensation law - MGL 152, §§ 20 and 30A, which requires the insurer to provide a copy of the report. Also, you can tell them you want one under the Patient Bill of Rights.
Reporting someone who is fraudulently collecting workers' compensation
- Contact the insurer, or employer, directly (if you know that information), or
- Notify the Insurance Fraud Bureau or at 1-800-32-FRAUD or 617-439-0439
Cost-of-Living Adjustments (COLA)
You ARE eligible for a COLA increase if you are:
- Collecting permanent and total disability benefits and your injury was more than 2 years ago: OR
- You were injured prior to December 23, 1991 and are collecting partial disability benefits
You are NOT eligible if :
- You are collecting temporary total benefits.
You don't need to apply for COLA benefits as the insurance company should automatically pay you if you're eligible. The amount of the increase is determined annually and goes into effect on October 1st of each year. If you are collecting Social Security Disability, your COLA may be lower so as not to reduce your social security disability benefits.
Collecting vacation pay and or accruing vacation time while on workers' compensation
Workers' compensation benefits are not paid for any period that a worker is receiving vacation pay.
Whether you continue to accrue vacation time while out on workers' compensation is up to your employer. If there is a collective bargaining agreement in place, you will need to check with your union.
Generally, whatever vacation time you have when you get terminated, your employer should pay you for.
However, questions about vacation pay owed to a terminated employee should be addressed to the Attorney General's Office of Fair Labor, 617-727-3465 because the issue doesn't fall under the jurisdiction of the Workers' Compensation Law or the Department of Industrial Accidents.
Workers' compensation and SSI or SSDI
Workers' Compensation insurance benefits are not affected by collecting Social Security benefits.
If you are receiving Social Security Disability benefits, that could affect any cost of living adjustments. More information on this is available from the Social Security Administration.
Doctors and workers' compensation medical fees
There is no requirements in the law for doctors to accept workers' compensation cases. The DIA DOESN'T have a list of medical providers that accept workers compensation rates.
While it might be ethically questionable to stop treatment on a patient once it's discovered the injury or illness is work-related, it wouldn't be illegal for medical providers to refuse to continue treatment on workers compensation cases. However, if they do agree to continue, they must either accept the medical rates set by the state, or negotiate a better rate with the workers' compensation insurer.
Balance billing of the employee is specifically prohibited by law.
Your employer gets a Stop Work Order from the DIA and has been closed down
An employee affected by a Stop-Work Order must be paid for the first 10 days lost when the department issues the order.
Your health insurance and other benefits while you're out on workers' compensation
Apart from the anti-discrimination provisions of § 75B of the workers' compensation law, there are no clear rules under the law preventing employers from stopping all benefits while a worker is collecting workers' compensation. But, Massachusetts General Law c. 175, § 110D, says that in most cases coverage will continue for 31 days following a termination, and Massachusetts General Law c. 175, § 110G requires most employers to offer continued coverage under the medical plan for additional 39 weeks (as long as the employee doesn't 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's 3 years. During this continuation period an employer can charge the employee the group rate, plus 2%, 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't afford the coverage offered by your employer, you should contact MassHealth, 1-888-665-9993. To get more information on the Federal COBRA law, call the U.S. Department of Labor, 617-565-9600.
Fired while out on a work-related injury or illness
Unless your union contract, or individual contract of hire, requires it, an employer doesn't have to hold your job open while you can't work due to an industrial accident. But, 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.
MGL c. 152, § 75B provides protection to injured workers while they're out, or can work but have a disability. Your best bet is to consult a workers' compensation attorney or a labor law attorney.
You can also contact the Americans With Disabilities (ADA) to find out if you fall into the protected class and what your employer may be required to do. You would need to contact the ADA: (800) 514 - 0301 (voice) or (800) 514 - 0383 (TTY).