Workers Comp in Fall River

GET LEGAL HELP

If you’re hurt on the job in Fall River, Massachusetts, one of the biggest challenges you might face is geography. The city is so close to Rhode Island, Lizzie Borden could throw an axe and hit the Ocean State.

“Lizzie Borden’s home just down the street,” said Deborah Kohl, a workers compensation attorney in Fall River.

Well, the house where Borden allegedly gave her mother 40 whacks is in downtown Fall River. When she saw what she had done, of course, she gave her father 41.

That Borden murder-mystery captivated America in 1892. Nowadays, people who get hurt (hopefully not axed by their offspring) on the job in Fall River often have a more pressing question.

Should I file for workers compensation in Massachusetts or Rhode Island?

Since Fall River is near the border, a lot of companies do business in both states. When an employee is hurt, they can often file a claim in either state – sometimes both, depending on where they were working or where they were hired.

“We have a lot of people who work in Massachusetts but happen to be in Rhode Island at the time of the injury,” Kohl said.

Massachusetts workers who are injured in Rhode Island have the option of filing in that state. A workers compensation claim can be puzzling enough, but the dual-state option can add a wholly different layer of perplexity.

“You can go back and forth with different parts of the law. You don’t have to pick one state,” Kohl said. “A lot of times we file in both states.”

Sign You May Need a Workers Comp Attorney in Fall River

The best reason is often to help figure out which state to pursue your claim in. Weekly benefits may be higher in one state and scarring or disfigurement benefits may be higher in the other.

“We look at the benefits package and see which one is better,” Kohl said. “For instance, there are better scarring benefits in Rhode Island, but post-settlement, the employee retains the right to open medical treatment in Massachusetts.”

Not every injured worker has to deal with the complexities of the dual-state option, of course. But even if you have no choice where to file, every state case has potential problems. Here are a few red flags that indicate you may need an attorney.

  • Your employer does not respond in a timely manner to your workers compensation claim.
  • Your employer asks you not to file a claim and says the company will pay your medical bills.
  • Your employer retaliates against you after you file a claim.
  • Your employer disputes whether your injury is work-related.
  • Your medical treatment is delayed, or you start getting medical bills.
  • You don’t begin receiving benefits that have been agreed on.
  • You are injured so badly you will not be able to return to work.

“The problems usually boil down to treatment issues at the beginning,” Kohl said. “The insurance company adjuster is a little stand-offish, or your employer is not getting back to you, or you’re not getting an immediate response for medical treatment.”

Those are good indications your injury claim is going to turn into an ordeal.

What Do Workers Comp Attorneys in Fall River Do?

As if things weren’t complicated enough, Massachusetts passed the Paid Family Medical Leave Act in 2018 that provides a variety of health-care benefits to citizens. Starting in 2021, people can receive up to 26 weeks of protected leave from work for family and medical reasons.

That just added another variable to the dual-state equation.

“We’re all trying to figure that one out,” Kohl said. “There are a lot of things that change over time that people wouldn’t really know.”

If workers comp lawyers have difficulty trying to figure it out, imagine what it would be like for an injured worker whose legal experience consists of watching “Matlock” reruns. Not only would a lawyer help decide which state is better to pursue a claim in, he or she would guide the case through the minefield.

If the workers comp claim is disputed, the first step is a conciliation meeting with the Department of Industrial Accidents. If the case isn’t resolved there, it goes to an administrative judge. That can lead to a full-blown hearing, where testimony and evidence is presented.

It’s also the step where a “neutral” or impartial doctor is brought in by the Judge to assess the severity of the worker’s injury. The neutrality of the doctors is often in question.

A lawyer’s job is to question the witnesses, take testimony from the doctors, including the impartial doctor, and make the presentation as fair and accurate as possible.

Among the other things he or she will do:

  • Handle negotiations with the employer’s workers comp insurance company.
  • Fill out all forms and file them properly and on time.
  • Help arrange vocational training if a worker is unable to return to his or her job.
  • Manage medical care.
  • Make sure your benefits are delivered when promised.
  • Argue against the insurance company’s attorney’s case if your claim ends up before a judge.

“Knowing what questions to ask and what’s important is our job,” Kohl said. “We’re there to make sure there’s a level playing field.”

How Much Does a Fall River Workers Comp Lawyer Charge?

Attorneys are paid on a contingency basis. That means the injured worker doesn’t pay any upfront costs. Lawyers get paid if they win the case at conference or hearing. Their fees are set by statute and are paid by the insurance company. Fees on workers comp settlements also are set by the state at a maximum of 20% of the settlement.

The attorney gets paid only if you win the case or successfully defends against the insurer’s attempts to reduce your compensation. The fees are capped at 20%, though that can vary slightly depending on the type of payments awarded.

For instance, it’s 20% when the employer is ruled liable or accepts responsibility for the claim. When liability is not assigned or accepted, the fee is 15% of the total benefits.

“Everything is set by statute and must be approved by a judge,” Kohl said.

So, is a lawyer worth 20% of an injured worker’s benefits? Every case is unique, so it’s hard to say. But the potential to get 0% of any benefits decreases if a lawyer is on your side.

“It can get extremely complicated,” Kohl said.

And that’s true, regardless of whether you’re in Massachusetts or Rhode Island.

Handling a Workers Comp Case on Your Own in Fall River, 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 Fall River

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 Fall River

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

Fall River DIA Office

Email: info2@mass.gov
Phone: (508) 676-3406
1 Father DeValles Blvd., 3rd Floor
Fall River, MA 02723

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.

Directions to the DIA office in Fall River:

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.

Sources:

About the author

Bill Fay has touched a lot of bases in his 45-year career. He started as a sports writer, gaining national attention for work on college and professional sports. He had regular roles as an analyst on radio and television and later became a speech writer for a government agency. His most recent work is as an internet content marketing specialist. Bill can be reached at bfay@workerscompensationexperts.org.