Insurers deny many legitimate workers' compensation claims. Unfortunately, there may be errors made when an administrative law judge hears your case as well. Before appealing to a Massachusetts state court, you must first complete four prior appeal levels within the Department of Industrial Accidents (DIA): the conciliation stage, the conference stage, the hearing stage, and the Massachusetts Review Board Stage. At Pulgini & Norton, our workers’ compensation attorneys can guide people in Boston and the surrounding communities through each of these stages.
Appealing Your Claim to a Massachusetts State CourtAt the review board stage, three administrative law judges (ALJs) will review the hearing judge's decision. They only review transcripts and the evidence that was presented at the hearing. You cannot submit any new evidence, and the review board will only change the determination of the hearing judge if the determination made fell outside the judge's authority, was not factually justified, or violated the law.
A written decision will be issued, and either the insurer or the claimant can appeal that order to the state Court of Appeals. Only the appellate court can review a final decision of the reviewing board. Except when a party is trying to enforce an order of the review board, it is improper to bring the case to the Superior Court. If a case is submitted at too soon a stage to the Massachusetts state court, the court will likely find that the claimant failed to exhaust his or her administrative remedies, and send the case back. The courts are required to preserve the integrity of the administrative process, and they cannot review administrative orders piecemeal.
The state court is restricted in what it may review substantively as well. The appellate court is required to give great weight to an agency, such as the Department of Industrial Accidents, when it interprets its own rules. The board's determination is set aside only if it is in error, not simply because the appellate court disagrees with a credibility determination. It does not reverse a reviewing board's decision to affirm an administrative law judge's decision unless it is either lacking in evidentiary support or a different conclusion is necessary as a matter of law. An administrative decision can be set aside if it is arbitrary or capricious.
For example, if were disabled by an accident on your way into your office and the ALJ denied your claim on the basis of the going and coming rule, the court would look at whether the going and coming rule was correctly applied. Generally, employers are not liable under the workers' compensation law for any injuries that an employee sustains while traveling to and from work. Therefore, you probably could not recover if the injury arose from a car accident on the freeway before you got to work. However, if the car accident happened on the employer's premises, or in a parking lot where employees are required to park, the appellate court might reverse the administrative decision.
Contact a Boston Attorney to Explore Your Options after a Workplace AccidentIf an insurer denied your workplace accident claim, you should consult a Boston lawyer before you appeal to Massachusetts state court. Bringing an appeal is a complex process, and legal representation can make a difference to the outcome of your case. The experienced attorneys at Pulgini & Norton can advise you on your claim and represent you through the appellate process. We also can assist claimants in Braintree, Somerville, Weymouth, and other cities in Massachusetts. Call us at 781-843-2200 or contact us via our online form for a free consultation.