What are Massachusetts’s Workers’ Compensation Guidelines?

In 2022, there were 81,700 work-related injuries in Massachusetts, of which more than half required missed workdays. This highlights the importance of knowing Massachusetts workers’ compensation laws to protect yourself in case you suffer a work-related injury.

In Massachusetts, all employers — with a few exceptions — must purchase workers’ compensation insurance for their employees. This coverage provides numerous types of benefits such as:

• Medical care
• Lost wages
• Physical therapy
• Temporary or permanent disability benefits

In return, an employee forfeits the right to sue their employer over the injury.

Fortunately our guide will help you better understand the benefits available to you via Massachusetts workers’ compensation. Keep reading to find out who qualifies, how to open a claim and when you need a lawyer’s help.

Who Qualifies for Massachusetts Workers’ Comp Benefits?

By law, workers’ compensation coverage is a requirement for all employers in Massachusetts.

That means most regular employees will have these protections as soon as they begin employment. There are a few exceptions that do not immediately qualify or may be exempt from Massachusetts workers’ comp:

• Domestic workers — Domestic workers must work 16 hours per week minimum to warrant coverage.
• Independent contractors — These workers don’t receive coverage unless classified incorrectly as an independent contractor instead of employee.
• Corporate officers — Any corporate officer who owns at least a 25% interest in the corporation may exempt themselves from Massachusetts workers’ comp.

Barring those exclusions, most Massachusetts workers have a right to workers’ compensation benefits for their work-related injuries and illnesses.

If an employer refuses to carry Massachusetts workers’ compensation insurance, they may face penalties like fines, or even prison time.

What to Do After a Work-Related Injury in Massachusetts

The first thing to do after any serious work-related injury is to get medical help. Do not hesitate to call 911 if you’re suffering an injury that threatens your immediate safety. Though you may not have permission from your employer, you don’t want to delay getting the medical attention you need.

However, definitely alert the doctor that it’s a work-related injury so they can make note of it. Be sure to ask for copies of your medical records for your attorney to analyze your case. Also note that it’s illegal for a doctor to bill you directly for a work-related emergency (MGL c. 152, § 30).

If an injury or illness is less pressing, reporting your condition to your employer is the appropriate initial step. No workers’ comp claims can proceed unless you alert your employer and if necessary, their insurer.

How to Apply for Workers’ Compensation in Massachusetts

If you experience a work-related injury or illness, there are certain steps needed to initiate your claim. This protocol is necessary to make sure all the appropriate parties get notification of your condition.

As soon as you become aware of your injury or illness, you should immediately report it to your supervisor. In turn, your employer should notify their workers’ comp insurance company so they’re aware of the situation.

If your injury/illness doesn’t cause you to miss at least five days of work, it’s a “medical only” claim. In that case, your employer doesn’t have to report it to the Massachusetts Department of Industrial Accidents (DIA).

However, your employer does have a responsibility to report your claim to their insurance carrier. That’s because the insurance company has to pay for your medical treatments.

If your injury forces you to miss five or more days of work, the requirements change. Then, your employer has seven days to file an Employer’s First Report of Injury or Fatality (Form 101). Copies of this report must go to the DIA, the insurance carrier and the employee.

This form is not an admission of liability, however. It’s a notification that an employee is missing work for a work-related injury, but further investigation may still happen.

Types of Workers’ Compensation Benefits You May Qualify For

Any injury that occurs during your course and scope of employment is compensable under Massachusetts workers’ compensation. What this means is that as long as the injury occurs at work, a worker should generally have coverage.

There are various forms of benefits available per Massachusetts workers’ compensation guidelines.

Medical Benefits

If an injury happens during an employee’s general work duties, your medical fees should be covered under workers’ compensation. Any employee who experiences a work-related injury or illness should not have to pay for their medical care.

Medical benefits don’t only include hospital and doctor’s visits, but may take the form of:

• Surgery
• Hospitalization
• Prescription drugs
• Diagnostic tests (X-ray, MRI, CT scan)
• Blood work
• Physical therapy
• Chiropractic treatment
• Assistive devices (wheelchairs, crutches)

Basically, if it’s a medical expenditure that’s necessary for your recovery from a work-related illness or injury, it may be coverable. This also includes transportation to and from appointments at the IRS mileage rate of 67-cents/mile.

In Massachusetts, injured workers have the right to select their own doctors. The only caveat is employers with preferred provider arrangements may choose a healthcare provider for your first medical visit.

After that initial treatment, however, the employee may choose their own healthcare providers. However, they will need to show their workers’ comp claim number for correct pre-approval and billing for services.

There are no limits to the duration or amount of medical benefits an injured employee may receive as long as they’re necessary.

Temporary Total Incapacity Benefits

Massachusetts workers qualify for temporary benefits if their injury or illness prevents them from working for six or more days. They don’t have to be consecutive, and can be full or partial missed days.

A worker will not receive compensation for the first five days of incapacity, unless they miss work for 21+ days.

Temporary total incapacity benefits provide injured workers a portion of their lost wages while they’re unable to work. Per Massachusetts workers’ compensation law, workers may receive 60% of their average weekly wage (AWW) through temporary benefits.

However, there is a benefit maximum cap set annually. An injured worker can receive these benefits for up to 156 weeks (three years).

Partial Incapacity Benefits

These benefits kick in when an injured employee can still work, but in a reduced capacity. Such as if a work-related injury/illness forces an employee to switch jobs for less pay or cut back their hours.

The maximum compensation from partial incapacity benefits is 75% of their temporary total incapacity benefits.

For example, if an individual financially qualifies for the current max weekly benefit of $1,829.13, they’d receive 75% of that, or $1,371.85 per week. Partial incapacity benefits can last for up to 260 weeks.

Permanent and Total Incapacity Benefits

If an injury or illness leaves a worker permanently unable to work, then they may qualify for permanent disability benefits. These benefits provide ongoing support to injured workers in Massachusetts potentially for the rest of their lives.

Though total disability doesn’t become available until you’re unable to work for 52 weeks, you can apply sooner. You also don’t have to wait until your temporary benefits run out before filing.

The total amount of benefits depends on your average weekly wage and degree of disability. Generally, however, these benefits are 67% of a person’s AWW in the year before their injury, up to weekly maximums. Qualified applicants may also receive cost of living adjustments (COLA) annually.

Permanent Loss of Function and Disfigurement Benefits

Employees sustaining a work-related injury that results in scarring, disfigurement, or permanent body-part loss of function may receive additional benefits.

This is a one-time payment and depends on the location or severity of the injury. It’s in addition to other benefits like medical and wage loss.

Vocational Rehabilitation Benefits

If a work-related injury results in a permanent inability to perform essential job duties, a worker may receive vocational rehabilitation. These benefits seek to enrich the lives of workers suffering from disability, while building them up for work development.

These benefits can include job search assistance, placement, retraining or schooling. The workers’ comp insurer will pay for these services with the goal of helping the injured worker find alternative employment.

Death Benefits

In the unfortunate situation that an employee doesn’t survive their work-related injury or illness, there are provisions for death benefits. These benefits cover things like burial expenses (up to $4,000) and survivors’ benefits.

Surviving spouses can receive weekly benefits equal to two-thirds of the deceased worker’s AWW, up to the state maximum. These benefits may continue as long as the spouse doesn’t remarry.

Why a Massachusetts Workers’ Comp Claim May be Denied

Once an insurer receives your workers’ compensation report, they have 14 days to accept or deny. They’ll either notify you and DIA through the following forms:

• Approval through an Insurer’s Notification of Payment (Form 103)
• Denial through an Insurer’s Notification of Denial (Form 104).

If you receive a claim denial, note that the letter must state the reasons for rejection. It must also inform you of your right to appeal.

To be fair, there are some very valid reasons a claim may not receive approval. These include that the injury must not be:

• Self-inflicted or intentional
• Due to horseplay or fighting
• Because the employee is under the influence of drugs or alcohol
• In violation of company policy

Another reason for denial could be that the insurer rejects that your injuries came from your employment. This may occur due to various mistakes a worker may make when suffering a workplace injury, lowering their chances of approval.

If you don’t feel your claim fits any of the workers’ comp denial categories, then you may need to appeal. You’ll have to file an Employee Claim Form (Form 110), requesting a hearing before an Administrative Law Judge.

However, workers’ comp appeals can be very tricky to handle solo, So, consulting with a workers’ comp attorney at this juncture is a good idea.

Can I Sue While on Workers’ Comp?

Remember that if you accept workers’ comp benefits, you do so in exchange for not suing your employer. The system is set up to keep employees and employers out of messy personal injury lawsuits following work-related injuries.

However, if you’re hurt at work and your employer doesn’t have the proper workers’ compensation insurance, you may sue. You may also bring cases against third parties, like other employees who contributed to your work-related injury.

Is There a Time Limit to Apply for Workers’ Compensation?

The short answer is you should always report your work-related injury or illness to your employer as soon as possible.

However, per Massachusetts law, the time limit to file a claim with your employer’s insurer is four years. The clock for that starts as soon as you become aware of the connection between your disability and your employment.

Schedule a Consultation With a Workers’ Compensation Attorney

If your employer doesn’t send your claim to their insurance within 30 days, you may have to manage matters yourself. However, even the Massachusetts government recommends that injured workers issuing a claim get legal counsel.

Though half of injured worker claims receive approval without question, it’s still smart to protect your rights and interests. That’s because of the complexity of Massachusetts workers’ compensation law.

The good news is that workers’ comp attorneys work on a contingency basis. So, you won’t have to pay anything out-of-pocket for legal services if you qualify for a claim.

Let LegalASAP connect you with a lawyer in your area today! We can help you get the benefits you deserve so you can focus on healing and getting back to work.