Workers Comp in Boston

A lot of people in the United States can say “I work in the next town over,” and it doesn’t mean much – unless you happen to be living in Massachusetts.

In that case, “the next town over” easily can mean “the next state over” and that could be an important factor if you happen to get injured on the job.

Massachusetts shares a border with five other states – Connecticut, Rhode Island, New Hampshire, Vermont and New York and Boston is only 60 miles from Kittery, Maine, the southern tip of that state.

With so many job opportunities so close, Massachusetts workers should know that where you live doesn’t matter, if you want to claim workers compensation benefits.

“Two things matter where you file a workers comp claim,” said Alan Pierce, a workers compensation lawyer whose offices are just outside Boston and maybe 40 miles from New Hampshire. “What state were you hired in … or what state were you injured in.”

Pierce has been practicing workers comp law for over 40 years and in more than a few cases which jurisdiction would cover an injury was as much a part of the workers compensation process as how badly the client was hurt. Often his clients are surprised to find out the rules of jurisdiction might make it difficult to receive treatment from hometown doctors because the patient got hurt on the job one state over with different rates or processes for medical payments.

Sometimes, it’s even more complicated than that. Someone could get hired by a retail store or restaurant that is part of a chain in Massachusetts, find out there is a promotion available in the chain’s store 10-15 miles away, only that means crossing the state line.

Now, the issue is dual jurisdictions – hired in one state; hurt in another. Where do you file the claim?

“We have jurisdictional issues a lot and recognizing that is part of our job as attorneys,” Pierce said. “We have to analyze the benefits in each state and make a decision on which is more generous for the worker. Sometimes, different types of benefits are better or worse.

“The good news is that the employee makes the decision on which jurisdiction to pursue benefits. The insurance carrier often will pay the claim where the rates are lower.”

Each state determines its jurisdictional factors which makes this even more complicated. Consider flight attendants – they are often hired at the airlines hub and are often injured in distant airports or in the air. Generally, however the state of hire or the state of injury would be the choice.

Signs You Need a Worker Comp Lawyer in Boston

So, you are one of the people who gets injured at work and thinks out loud: “How hard can this be? I got hurt … they pay for my medical … I get paid while I rehab … who needs a lawyer?”

You probably do.

While the majority of workers compensation cases can flow easily through the system, there are a lot of things that can happen to take it off course. It doesn’t cost anything to hire a workers compensation attorney and the sooner they look at your case, the easier it will be to get all the benefits you are due.

Here’s are 10 signs that your case – however simple – eventually will need some legal help.

• You’re being harassed by medical providers because bills aren’t being paid
• You wage compensation checks are late arriving and not the right amount when they do get here
• Neither your employer nor the insurance agency has contacted you since the accident
• Your employer tells you to use your own health insurance to pay for treatment
• You can’t get reimbursed for prescriptions
• Your employer can’t find any light duty work for you while you rehab
• You get harassed by your employer when you return to work
• The employer and/or insurance carrier claim the injury didn’t happen at work
• Your employer has not reported the injury to the company’s insurance carrier
• Your claim is denied by the insurance carrier

The first nine points above are serious reasons you should at least get a consultation with an attorney when you get hurt. The last one is a flashing red light that legal action is needed to get anything and you have very little chance of winning a trial without an attorney.

“Representing yourself is difficult and so fraught with mistakes that few workers proceed without an attorney,” Pierce said. “Those that do, more often than not, have a problematic case that no attorney will take.”

What Do Workers Comp Lawyers in Boston Do?

The laws governing workers compensation are difficult for the common worker to understand and Pierce has a nice explanation of why you shouldn’t even try to be your own attorney.

“Every element of workers compensation law is based on a provision of the workers compensation statute which, in Massachusetts, contains 75 sections,’’ the long-time Boston area workers comp attorney said. “Beyond that, every section contains subsections and then there is a whole book of rules and regulations for how cases flow through the system … if you don’t know the law, don’t follow the rules and regulations, you are not going to win your case. It’s as simple as that. Beyond the law, cases are decided every year by our appellate courts so a firm knowledge of case law is required.”

If that’s not easy enough to understand, consider this list of things a workers compensation lawyer does that an injured worker can’t do or doesn’t know should be done:

• Investigate your claim
• Depose doctors involved in your medical treatment
• Get a full understanding of your injury and how that will affect your ability to do your job in the future
• Use experience to negotiate a fair settlement with lawyers who represent the insurance company
• Use experience with judges to know what medical experts to call as witnesses or what areas of law to emphasize during a trial
• Handle preparations and meet deadlines leading up to trial
• Know laws and procedures for filing a successful appeal
• Conduct settlement negotiations
• Understand other benefits you may be entitled to

How Much Does a Workers Comp Lawyer in Boston Charge?

One of the biggest concerns for people considering hiring an attorney is: Can I afford an attorney?

In workers compensation the answer is easy: Yes! You can.

Getting a consultation with a workers compensation attorney – a meeting to determine whether you are receiving all the benefits you should be getting – is most often free of charge.

Having the attorney gather things you will need if the case goes in front of a judge – witness and doctor’s depositions; medical experts to testify on your behalf, time spent studying case law related to your injury – are not billed to the client.

In fact, in nearly all cases, you shouldn’t have to dig into your wallet for anything to compensate your attorney.

Workers compensation lawyers get paid when they win or resolve a case, whether that happens through a mutual agreement with the insurance carrier, or you receive an award via pre-hearing conference or for after a successful hearing.

And then, the insurance company has to pay your attorney’s fee.

The attorney also gets paid if he/she negotiates a settlement decision for you. There are limits on how much compensation an attorney can receive through settlement. If liability is established before the settlement, the attorney can receive no more than 20%. If no liability is established, the fee can be no more than 15%.

“The services of a competent workers compensation attorney – which are paid only upon success — likely results in a better outcome for the worker,” Pierce said. “That more than pays for any possible savings by a worker representing themselves.”

Handling a Workers Comp Case on Your Own in Boston, MA

The first step in a workers comp case is to notify your employer. That will kickstart the process of filing a workers compensation claim. If your claim is denied, you have the option to appeal the decision.

Filing a Workers Comp Claim in Boston

The process for injured workers in Massachusetts filing a workers compensation claim begins with immediately notifying your supervisor, or at least a co-worker of the accident so there is a witness.

Seek medical treatment right away, but if there is time, use a smartphone to take pictures at the scene in case they are needed to settle future disputes. After receiving treatment, check with your supervisor or your employer’s human resources department, to be sure a claim has been filed.

To file a claim, you will need a laundry list of paperwork that includes:

• The date for the injury
• If you missed more than five days of work, the date for the first day you missed and the fifth day you missed because of the injury
• The insurance carrier’s name
• What body parts were injured
• What benefits you are seeking
• Where you first went for treatment and the doctor currently treating you.

You should make copies of all the information and attached them to a claim form. Keep the copies handy for later stages in the process. If you fail to provide any of the necessary paperwork in filing your claim, the DIA can deny the claim right away.

Having that long list of specifics is the first of several reasons you should consider contacting an attorney, early in the process. Even the Department of Industrial Accidents recommends you hire a workers comp attorney to steer you through the process.

Deadlines for Filing a Claim

Officially, the deadline in Massachusetts for an injured worker to report an injury is four years, but the reality is … the sooner the better!

So many things can happen in just one week – let alone four years! – that it’s just common sense to let you employer know the day an accident happens.

Other important deadlines to keep track of:

• Employer has 14 days to report the injury to the insurance carrier
• Either side has 14 days to appeal an administrative judge’s decision after a worker’s compensation conference.
• If either side dispute the judge’s decision at an evidentiary hearing, they have 30 days to appeal
• There are several other deadlines depending on the circumstances so you should always consult with an experienced workers’ compensation attorney.

Employers Responsibility for Filing Claim

The employer’s first responsibility is to cooperate with the insurance company, meaning notify them of the accident and tell them if the employee has missed five days (not consecutive) of work because of the injury.

The employer also should be prepared to:

• File appropriate forms at the appropriate time
• Provide the insurance carrier with the worker’s average salary over a 52-week period
• Answer questions on whether the accident happened as claimed
• Describe the worker’s duties and responsibilities
• Provide light-duty work, if available
• Not retaliate against workers who file a claim
• Make reasonable accommodations for disabilities

Insurance Company’s Responsibility with Claims Form

There is a hard-and-fast rule on insurance companies: they have 14 days to tell injured workers whether they will pay the claim or deny it.

The insurance carrier must file a notice of payment with the injured worker and the DIA, if it agrees with the claim. They must file a notice of denial if they reject the claim.

If the claim is approved and an injured worker returns to work in less than five days, the insurance company is responsible only for medical treatment. If the worker misses more than five days because of the injury, the insurance carrier is responsible for medical treatment and lost wages.

If the claim is denied, the insurance carrier must provide a list of specific reasons for denying the claim and grounds they used for each of the reasons.

The insurers have an obligation to get the injured workers copies of their records.

How to Appeal a Workers Compensation Claim in Boston

If insurance carrier denies or wants to modify claim benefits — or the injured worker disputes the carrier’s decision — they must file a form 110 – Employee Claim with the Department of Industrial Accidents (DIA) to begin an appeals process.

The appeals process is a four-step action, during which either side can dispute the outcome and move on to the next stage, or, more likely, come to resolution.

The process begins with conciliation and includes a conference, a hearing and finally, a presentation to a review board.

Here is a look at what happens on each step of the way.

Step 1: Conciliation Meeting

Once a claim is filed, the DIA will schedule a conciliation meeting, typically within 3-4 weeks. Conciliation is a meeting between the injured worker, his/her attorney (if they have one), the insurance carrier representative and a conciliator from the DIA to discuss what benefits the worker is qualified to receive.

The worker should bring documentation of the accident as well as at least one of the following items to a conciliation:

• Medical reports
• Reports on how the accident happened
• Names of witnesses and their statements
• Unpaid medical bills

Email: info2@mass.gov
Phone: (617) 727-4900
Lafayette City Center, 2 Avenue de Lafayette
Boston, MA 02111-1750

Sometimes, the carrier will ask for more time to investigate the accident and will be granted an extension of 3-4 weeks.

There could be more than one conciliation. Less than 50% of claims are resolved at the conciliation level. If the two sides can’t agree, the matter is administratively sent on for a conference before an administrative judge.

At this point in the process, even the government website strongly recommends that injured workers hire an attorney.

Step 2: Conference Proceeding

A conference proceeding is a more formal meeting where the injured worker, their attorney (if they have one), a lawyer from the insurance carrier and an administrative judge try to resolve disputed issues.

If the issues are resolved, the judge will issue a temporary order that says whether benefits must be paid and what modifications, if any, there are in benefits. If the insurance carrier denies the claim, the judge will address that, too.

If the claim is denied, the worker or his/her attorney can file an appeal within 14 days and the matter goes to the “hearing” level.

Step 3: Hearing

A hearing is a formal trial of the case where the rules of evidence apply and a court stenographer records the entire proceeding.

At the hearing level, witnesses will be called; depositions will be filed; and the judge can ask for both sides to submit new evidence and oral testimony.

The judge will then issue a decision, usually within 30-90 days, which can be appealed by either side and sent to a Review Board.

Step 4: Review Board

The Review Board is a panel of three judges who will review the transcripts from the hearing, receive briefs from the parties and may hold oral argument. The judges then decide whether to approve, modify or reverse the original decision.

If either side wishes to appeal again, the next stop is Massachusetts Court of Appeals. Most cases are resolved before reaching the Review Board level and very rarely do cases proceed to the Appeals Court or beyond, to the Supreme Judicial Court.