If your Massachusetts workers’ compensation claim is denied because the insurer claims you had a pre‑existing condition, that denial is not the end of your case. Insurance companies frequently rely on pre‑existing conditions as a reason to deny benefits, but Massachusetts law allows injured workers to recover when a job injury aggravates, accelerates, or combines with an existing condition.
What Happens After a Workers’ Comp Denial in Massachusetts?
When a claim is denied, you have the right to file an Employee’s Claim for Benefits with the Massachusetts Department of Industrial Accidents (DIA). Filing a claim begins the formal claim’s process and places your case before a workers’ compensation judge. Many legitimate claims are initially denied and later approved once evidence is properly presented.
|
TIP: If you suspect your claim is going to be denied, it’s very important to make sure you have all of your documentation (e.g., medical records, incident reports, disability (out-of-work) notes) to allow your claim to be filed as soon as possible. Time is of the essence in these situations. It takes time to get your claim before a judge and during that time frame you may not have any source of income. This puts injured workers in Massachusetts in a tough financial position. |
Your case will usually proceed to a conference before a DIA judge. Any party unhappy with the decision at that stage can appeal the judge’s Order and then the judge may order an impartial medical examination, which is often a turning point in pre‑existing condition cases. The impartial physician’s report carries significant weight and can strongly influence whether benefits are awarded.
.png)
Can I Get Workers’ Compensation If I Had a Prior Injury or Condition?
Yes. Massachusetts law, specifically M.G.L. c. 152, § 1(7A), allows workers with pre‑existing conditions to receive benefits when the work injury is still a major cause of disability or the need for treatment. Even if a prior condition existed, benefits may be available if your job duties worsened or aggravated that condition.
Why Medical Evidence Matters in Pre‑Existing Condition Cases
Cases involving pre‑existing conditions often depend on how the medical evidence is written, not just your diagnosis. Medical reports should clearly explain how your work activities contributed to your condition and address the legal causation standard required under Massachusetts law. Strong, well‑supported medical opinions can make the difference between a denial and an approval.
Should I Hire a Massachusetts Workers’ Compensation Attorney?
Insurance companies are represented by attorneys whose goal is to limit what they pay. Having an experienced Massachusetts workers’ compensation attorney helps ensure your rights are protected. A lawyer can manage deadlines, prepare you for conference and hearing, coordinate medical evidence, and challenge unfavorable opinions when necessary.
Free Help for Workers With Pre‑Existing Conditions
If you were injured at work and have a pre‑existing condition, Framingham workers’ comp Attorney Chuck Pappas can help. He handles cases all over Massachusetts from Boston to Worcester and beyond. We offer free consultations and handle workers’ compensation claims on a contingency fee basis — you pay nothing unless we recover benefits for you. Call (508) 879‑3500 or contact us online.
We understand that being hurt on the job can be extremely stressful. After a serious injury, you may not only be losing time at work and your paycheck, but you may require extensive medical treatment which can be costly. You are probably concerned about how you are going to provide for yourself and your family and how you are going to cover the cost and expense of your treatment. These are completely valid concerns. Injured workers in these positions need the help of an experienced Massachusetts workers’ compensation attorney.
A work accident isn't something most think about often until it happens to them. This is why injured workers typically have many questions and concerns after being seriously injured on the job. If you were hurt at work, you should have a good understanding of the workers’ compensation process and benefits available in Massachusetts. The experienced workers’ compensation lawyers at Mahaney & Pappas, LLP, are here to help you during this difficult time.