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What an Employee Should Know About Workers' Compensation Insurance in the Pandemic

The information below addresses questions concerning COVID-19 and possible workers’ compensation claim eligibility and procedures.

 Whether a worker is entitled to coverage is determined by the Governor’s Department of Industrial Accidents (DIA) on a case-by-case basis, and workers can appeal these cases to the Courts.  If you believe that you meet the criteria below, have been denied workers’ compensation by your employer’s insurance company, and have additional questions, please call our office at (888) 830-6277. 

What is workers’ compensation?

Workers' compensation insurance provides financial protection for employees who are unable to work because they were injured on the job. If you qualify for workers' compensation, you will be eligible to have your medical expenses covered (including prescriptions and travel costs to get to your doctor) and to receive payments that include a percentage of your gross average weekly wage. The exact percentage depends on whether the injury is fatal, permanent or temporary, or if it is partial or total. For temporary total disability (the most likely type with COVID-19), workers' compensation provides a 60% wage replacement, up to the current maximum of $1,431.66 per week.

Am I covered?

Most businesses in Massachusetts are required to have workers' compensation insurance.  You can check to see if your employer has insurance by looking at the Massachusetts Labor and Workforce Development webpage here or by checking the list of self-insured employers here.

If your employer does have workers' compensation insurance, all employees, including undocumented workers, are covered for eligible claims. Even without insurance, you may still be eligible to have your claim paid by the Commonwealth’s Workers’ Compensation Trust Fund.

 

Is a claim for COVID-19 eligible for coverage?

Workers' compensation only covers injuries that are work related. Coverage for communicable disease, such as COVID-19, is further limited to situations where “the hazard of contracting such diseases by an employee is inherent in the employment.” The Attorney General's Office believes employees in certain fields where the employment inherently leaves them with a heightened risk of COVID-19 exposure are likely to meet this test. Nurses working with COVID-19 patients, for example, will likely qualify. However, no matter what your job, lost wage benefits are generally only available if you miss more than five days of work due to the illness.

What if I’m in a high risk field, but I definitely was exposed outside of work?

Your insurer may ask about whether any of your family members have previously contracted COVID-19, whether you were exposed at a voluntary gathering relating to employment as opposed to as part of your official duties, or whether you attended any events that have been known hot-spots for transmission of the disease. In these circumstances, some insurers might try to reject your claim, arguing that you were infected outside of work and therefore are not eligible for coverage. As mentioned above, all workers’ compensation claims are handled on a case-by-case basis depending on the facts and circumstances of the case.

How do I apply for workers' compensation benefits?

To submit a claim under workers' compensation insurance, simply notify your employer or your employer’s insurer of the injury. Keep a record to show that you notified them. Your employer must display its workers' compensation insurer’s information in the workplace. If your employer does not have workers’ compensation insurance, then please visit the DIA website here to learn about filing a claim against the Workers’ Compensation Trust Fund.  

My employer won’t submit my claim to the insurer. Is that legal?

No. Once you notify your employer of your illness, it has seven days (not including Sundays and holidays) to notify both the insurer and the Department of Industrial Accidents. It must also provide you with a copy of the form submitted to the insurer in that timeframe. If your employer refuses to file your claim, you can contact the insurer or file yourself at the Department of Industrial Accidents’ website here. Don’t file on the website first – start with your employer.

Can I receive workers' compensation for lost wages while I am also on unemployment?

If you are eligible for workers’ compensation total disability benefits, you are not eligible for MA unemployment benefits. If you are eligible for partial disability workers’ compensation benefits, you are required to file for unemployment benefits, if requested by your insurance company.  Such unemployment benefits will offset your workers’ compensation lost wage benefits.There are also benefits available to unemployed workers under the CARES Act that extend or expand on traditional unemployment assistance remedies. How these will be coordinated with workers’ compensation payments is a new issue on which DIA has not yet offered any guidance.

What if I am quarantined but I haven’t had a test for COVID-19?

While you can submit a claim without having the results of a test, you will need to show that you have the disease in order to be considered for eligibility. 

What if I lost my job but never got sick?

You are not covered by workers' compensation.

What if I am sure I caught COVID-19 at work, but I won’t pass the “inherent in the employment” test?

You must pass this test or insurers are not likely to pay your claim. There are cases in Massachusetts where factory workers caught a disease at work, but still were rejected for workers' compensation because the nature of their jobs did not qualify.

If your claim is denied, you can file an appeal on the state’s website here.

When can I expect to receive workers' compensation benefits if I qualify?

The insurance company has at most 14 days from receipt of the claim to either start paying your claim or notify you of its refusal to pay. If the insurer refuses to pay, and you appeal the case to the DIA, it can take a significant period of time to complete the administrative process. If you succeed in your appeal, then your claim will be paid and you may be entitled to interest and attorney fees. There may also be possible penalties levied on the insurance company in certain circumstances. Even if an insurer does not want to admit to your eligibility up front, it has the option to pay you for an initial period of time without agreeing to be liable for later payments regarding your injury. This initial period can last up to 180 days (which may be extended in certain circumstances); at that point, the insurer must make a decision on whether it intends to pay you for the rest of your claim. Additional information regarding the DIA claim process can be found here.

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