Worker’s Compensation. Denied? – That’s Not The Last Word
Worker’s Compensation law is complex, and you may actually have the legal right to compensation when an insurer doesn’t agree to pay you benefits. Each situation is different, and you should always seek legal advice whenever an insurer refuses to pay worker’s compensation benefits. Sometimes, your legal rights depend on whether the insurer has “denied” your claim, “terminated” your benefits, files a request to “modify” your benefits, or where the insurer has taken no action at all. After over 27 years of representing injured employees in worker’s compensation cases, I can say that most of my cases have started out this way. It’s important to ask now about your rights, because time limits may prevent you from collecting benefits later. Regardless of what an insurer did – or didn’t do – about your injury, you may also have rights to other benefits outside the worker’s compensation system.
Lesson #1: If you received a form in the mail, take a look at the top part of the form you got from the insurer. It says “Commonwealth of Massachusetts” at the top, but the state did not send you this form, and no judge at the Massachusetts Department of Industrial Accidents has decided anything about your case yet. The form is only a blank provided by the DIA for the insurer to fill out.
Was Your Work-Related Injury “Denied” by an Insurer?
Again: If you received this “Form 104”, it only came from the insurance company, and not the Department of Industrial Accidents. The state did not deny your worker’s compensation claim. This form is only a statement that the insurer doesn’t want to pay benefits to you. The denial itself may only mean that the insurer that it intends to rely on a technicality, or that it didn’t get enough information from your employer to pay benefits to you. If you got one of these forms after being injured at work, seek legal advice. Legal time limits may act to prevent you from getting benefits later. You have the right to file a claim with the DIA to ask a judge to review the facts of your case and order the insurer to pay you.
Were Your Payments “Terminated” by an Insurer?
A Notice of Termination (DIA form 106) comes from an Insurer and not the Department of Industrial Accidents. You have the right to file a claim with the DIA to ask a judge to review the facts of your case and order the insurer to pay you. If you were injured at work, you have the right to bring your own claim, whether or not the insurance company will agree with it.
Warning: If you have contacted the insurance adjuster who sent this form to you and he or she told you they may reconsider their decision, seek legal advice. Legal time limits may act to prevent you from getting benefits later, and the adjuster may only be hoping that you will forget about your case.
Is an Insurer Requesting Permission to “Modify” Your Compensation?
If you received one of these forms, it means the insurance company is filing a claim with the
Department of Industrial Accidents and that they are planning to ask a judge to stop or reduce your worker’s compensation benefits. The insurer will be represented by an attorney who is experienced in worker’s compensation law, and many of them have been practicing worker’s compensation law for years. You have the right to legal representation, too.
What if You Were Injured at Work, and Nothing Happens?
Sometimes, employers fail to notify their insurer about your injury, or the insurer makes a mistake and takes no action on your file. This is a potential “hole” in the system: Without a “First Report of Injury” from your employer, the Insurer may never know about your injury. Or the insurer may fail to tell you what they’re going to do about your injury. You may be out of work, with medical bills coming in and no way to get further medical attention. What’s the solution? Seek legal advice: it may be necessary to find out who the insurer is to notify them of the injury, and get medical proof of your injuries.
In All These Cases, YOU Have a Right to be Heard at the DIA:
In all these cases, where whether the insurer has “denied” your claim, “terminated” your benefits, files a request to “modify” them, or where your employer or the insurer has taken no action at all, you have the right to file a claim to explain to a judge at the Department of Industrial Accidents about your injury and why you should be entitled to compensation. Employees have the right to file claims with the DIA to let them know there’s a problem:
If you were injured at work, you may have legal rights. But legal time limits may apply to your case, and waiting too long can cause you to lose your legal rights to compensation. By law, an attorney cannot charge you by the hour, or charge you a “retainer” for legal services, or even bill you directly for legal work when representing you before the Department of Industrial Accidents. Instead, the law requires that an insurer must pay your lawyer’s fees if you win your claim.
One injury at work may also entitle you to other forms of disability payments and/or the right to bring a civil claim for your injuries, and these are not even governed by the Massachusetts Department of Industrial Accidents:
- Social Security Disability benefits
- Public Employee disability benefits
- The right to sue those responsible for your injuries
In some cases, it’s possible for an injured employee to receive weekly worker’s compensation and also be entitled to all of the above, but you shouldn’t depend on an insurance company or the DIA to call you up and tell you about these rights.