Massachusetts residents who become sick or hurt while working should immediately report the job-related injury or illness to their employers. This notification should be in writing. Your employer is required to report the occupational illness or injury to the Department of Industrial Accidents (DIA), which administers the workers' compensation system, as well as its workers' compensation insurance carrier. The workers' compensation system is supposed to be easier to navigate than the civil litigation process. However, in practice, insurers do deny valid claims, and the dispute resolution process can be extremely challenging for a layperson. Rather than assume your insurer's denial is justified, you should consult an experienced Suffolk County workers' compensation attorney at Pulgini & Norton who can help you explore your options.
Pursuing Workers' Compensation BenefitsOnce you have been disabled for five partial or full days, your employer must notify the DIA and its insurer. The insurer will then make a decision about whether to accept or deny your claim. In some cases, an insurer simply begins paying benefits. You should not assume that this is an admission of liability.
An insurer in Massachusetts has a 180-day "pay without prejudice" period. If it decides to terminate benefits during that time, it needs to give you seven days’ notice. In some cases, an insurer wants to investigate your claim beyond the 180 days. In that case, it may ask you for an extension of the pay without prejudice period. If you are denied benefits to which you believe you are entitled, or the insurer asks for an extension, you should consult an attorney, rather than assume the insurer's intentions are fair.
If an insurer decides to deny your claim, it will send you a Notification of Denial on a Form 104. It must specify its reasons for the denial. You can appeal this decision through the DIA. In some cases, only part of a claim is denied, but you are entitled to appeal this partial denial as well. The Form 104 will specify how to appeal your denial.
Experienced attorneys usually represent insurers during the dispute resolution process. They know the ins and outs of the system, including all the technical rules that must be followed. Often, they are familiar with the administrative law judges. This means that you will not be on an equal footing with an insurer unless you have an experienced workers' compensation attorney of your own. Although the first two steps of the process are informal, they can have an effect on the outcome of your case. It is better to make a good first impression from the start by retaining an attorney who can present your case in the best possible light.
Appealing a denial starts with filing a Form 110 and sending a copy to the insurer. There are five steps to the dispute resolution process. If necessary, at the end of the process with the DIA, you can file an appeal of the administrative judge's decision.
Contact a Suffolk County Attorney for Your Workers’ Compensation ClaimIf you are hurt on the job, you should consult the Suffolk County workers' compensation lawyers at Pulgini & Norton for guidance and representation. Call us at 781-843-2200 or contact us via our online form for a free consultation with a knowledgeable workplace accident attorney.