What is Workers Compensation?

Most people know that if you were injured at work, you may be eligible for what is known as “Workers’ Compensation.” But, oftentimes, injured workers don’t know what kind of benefits are available, and they don’t always know how to qualify.

What is Workers’ Compensation?

Workers’ Compensation is a form of insurance that every employer is supposed to have to cover injured employees. While there are many types of benefits available, the two main types of benefits provide wage replacement and medical benefits to employees injured during the course of employment. One of the good things about Workers Comp is that it is supposed to provide you benefits right away. The system was set up this way because when a worker is injured, he/she might not be able to pay rent or put food on the table if they go too long without a paycheck. However, there is a tradeoff for these “quick” benefit. Under the Workers’ Compensation system, the employee forfeits the right to sue his or her employer for negligence. 

Should I get an attorney for my Workers’ Compensation claim?

According to the Commonwealth of Massachusetts, half of all injured worker claims are not disputed by an insurer or employer. This means that you should receive your benefits without having to “put up a fight” with the insurer or employer. If the insurance company agrees to pay the claim without any pushback, you can get your first check in a week or two, and then either weekly or bi-weekly after that.

However, this doesn’t mean you don’t need a lawyer. Even in undisputed claims, having an attorney can help facilitate the process with the insurer and get you your payments as soon as possible. The attorney can make sure you’re getting the right amount of benefits. Your lawyer will also be able to tell you when it’s best to think about settling your case. In short, Workers’ Compensation can be complicated and having an attorney on your side can help you navigate through these issues. 

Many people who come see us are not as lucky. The insurance company that’s supposed to pay for your injury denied your claim. If that’s the case, it is a good idea to work with an attorney to protect your rights and interests right away. In these situations, you have to file a claim with the Department of Industrial Accidents (“DIA”), which oversees the Workers’ Compensation system in Massachusetts, and have your case heard in front of an Administrative Law Judge (“ALJ”).Going in front of a judge and getting your benefits can take up to five (5) months, so waiting to hire an attorney is never advised.

What does the claim appeal process look like?

In the event you and your employer’s Workers’ Compensation insurer can’t agree on your claim, the DIA will help settle the dispute through a four-step process:

  1. Conciliation – A conciliation is an informal meeting between you, your attorney, the insurer’s attorney, and a conciliator from the DIA.
  2. Conference – A conference is where the judge makes an initial determination about your claim. It is still an informal process, despite the ALJ’s presence. At the end of the conference, the ALJ will issue an order.
  3. Hearing – If the conference order is appealed, the case will go to a full evidentiary hearing. This hearing is similar to a trial. Witnesses are called, and a stenographer records testimony. 
  4. Reviewing Board – If a hearing decision is appealed, the DIA’s Reviewing Board hears the appeal. Three (3) ALJs will examine the hearing transcripts. The reviewing board has some discretion as to how the review will proceed. They can ask for oral arguments.

They can affirm the hearing decision with no discussion or they can send a decision back to the administrative judge for further findings of fact.

The process can be a long one and it can be in your best interest to have an attorney at your side. If you’ve been hurt on the job, it’s important to find an experienced Workers Compensation Attorney quickly so that you can get your benefits as quickly as possible.

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