When a worker is injured on the job in Massachusetts, sometimes, unfortunately, their workers’ compensation claim is denied by the insurance company. There are a variety of reasons a workers’ compensation claim is denied. Regardless of the reason, there are options available to an injured worker after a denial.
Generally, after an employee is hurt on the job in Massachusetts and is unable to earn full wages for five (5) or more full or partial calendar days, their employer has seven (7) days, not including Sundays and legal holidays, from the fifth date of loss, to report the injury to its workers’ compensation insurance company. Once the insurance company receives the First Report of Injury from the employer, they will then have fourteen (14) calendar days to either voluntarily pay the injured employee or notify them of their denial to pay benefits.
If the insurer decides to deny a workers’ compensation claim, the workers’ compensation laws in Massachusetts require that they send the injured worker an Insurer’s Notification of Denial (Form 104) by certified mail. This denial must include the reasons for denial and must inform the worker of their right to appeal.
If the injured worker believes his workers’ compensation claim was wrongfully denied, a claim can filed at the Massachusetts Department of Industrial Accidents (“DIA”). The form to file the claim is an Employee Claim for Benefits (Form 110). This claim will commence the process of seeking the worker’s compensation benefits (i.e., disability benefits or medical benefits) that the injured worker contends they are entitled to.
While an injured worker can certainly file the claim by themselves, it is strongly advised to seek the assistance or guidance of a qualified and experienced Massachusetts workers’ compensation attorney. There are many requirements when filing a claim, such as including copies of any medical evidence that supports the claim and properly serving the workers’ compensation insurer. Once the claim is duly filed and DIA receives and processes the claim, the claim will proceed through the usual course of a Massachusetts workers’ compensation claim.