Temporary Total Incapacity Benefits
You qualify for these benefits if your injury or illness leaves you unable to work for six or more full or partial calendar days. Your age, training, and experience are considered, and the days do not have to be consecutive.
Your benefits will be 60% of your gross average weekly wage. To determine your benefits:
- find your actual gross earnings, including overtime, bonuses, etc.
- divide this number by the number of weeks you worked at your job to compute your average weekly wage
- Multiply that number by 60% (.60) to come up with your approximate weekly compensation
The most that you can receive is the State's Average Weekly Wage (SAWW) at the time of your injury. The SAWW is set annually by the Massachusetts Division of Unemployment.
You can receive these benefits for up to 156 weeks. Compensation begins on the sixth day of incapacity. You will not be compensated for the first five days of incapacity unless you are disabled for 21 calendar days or more.
Partial incapacity benefits
You qualify if you can still work but lose part of your earning capacity because of your injury or illness. This may include an injury forcing you to change jobs at a lower pay rate or to work fewer hours.
The maximum compensation under this section of the law is limited to 75% (.75) of what your weekly total temporary benefits would be. For example:
- If you receive $440 a week as a total temporary benefit, the most you could receive if you collected partial benefits would be $330 a week ($440 x .75 = $330)
You can receive benefits for up to 260 weeks.
Permanent and total incapacity benefits
You qualify if you are permanently unable to do any kind of work as a result of a work-related injury or illness. You do not have to wait until your temporary benefits finish before applying for permanent benefits.
You will get two-thirds of your average weekly wage (or a minimum of 20% of the SAWW) based on the 52 weeks before your injury, up to a maximum of the SAWW. You are also entitled to annual Cost-Of-Living Adjustments (COLA).
You can receive benefits for as long as you are disabled.
You qualify for medical benefits if you suffer a work-related injury or illness that requires medical attentions.
You are entitled to adequate and reasonable medical care as a result of the injury or illness. You are also entitled to prescription reimbursement and reimbursement for travel to and from medical visits for these injuries or illnesses. For your first visit to the doctor or hospital, your employer has the right to choose a healthcare provider within the employer's preferred provider arrangement. After that initial treatment, you have the right to choose your own healthcare providers. The insurer has the right to send you periodically to see its doctor for an evaluation of your incapacity.
Once you report your claim to the insurance company, the insurer must issue you an insurance card with a claim number and contact information on it. Give the claim number to your doctor so the doctor can bill the insurer directly and get pre-approval for treatment. If you do not get this card right after your injury or illness, contact the insurer and get the number as soon as possible. Most medical providers will not treat you without the claim number.
You can receive benefits for as long as medical and hospital services are required due to your injury or illness.
Permanent loss of function and disfigurement benefits
You qualify for these benefits if a work-related injury or illness results in a permanent loss of certain specific functions, scarring and/or disfigurement. The scars must be on your face, neck or hands.
You receive a one-time payment for your disfigurement and/or scarring. You receive this benefit along with other payments, like medical bills, lost wages, etc. The amount paid depends on the location and severity of the disfigurement or function lost.
If your injury or illness happened before December 24, 1991, you have different benefits. Contact our Public Information Office if you have any questions about these benefits. If you do not have an attorney, you may want to contact our Conciliation Unit once the insurer has made an offer for your treatment and speak to a Conciliator. The Conciliator can give you an idea of whether the offer falls within established guidelines.
You receive a one-time payment for your loss of body function, disfigurement and/or scarring.
Survivors' and dependents' benefits
You qualify for these benefits if you are the spouse or child of an employee who has died as a result of a work-related injury or illness. Children are eligible only if they are under age 18, are full-time students or are unable to work because of physical or mental disabilities.
Surviving spouses can receive weekly benefits equal to two-thirds of the deceased worker's average weekly wage, up to the maximum of the State's Average Weekly Wage (SAWW) in place at the time of their injury or illness.
Surviving spouses become eligible for yearly cost of living adjustments two years after the date of the injury or illness.
If the spouse remarries, each eligible child gets $60 a week. The total weekly amount paid to dependent children cannot exceed the amount the spouse had been receiving.
Surviving spouses can receive these benefits for as long as they remain dependent and do not remarry.
In all cases where death has occurred as a result of an injury or illness, the insurer will pay up to $4,000 for reasonable burial expenses.