Massachusetts Workers’ Compensation is designed to provide benefits for employees who are injured during the course of their employment. No act of negligence, or wrong-doing, needs to be shown. However, an insurance company or employer can contest how much of the medical care and expenses are actually attributable to the work injury. If the insurer decides to deny your claim, an appeal is available, and you or your family member can file a claim with the Department of Industrial Accidents (DIA). The DIA requires certain forms to be filled out, including medical evidence that supports the claim. The DIA, in its Guide for Injured Workers, encourages legal representation after an insurer denies the claim.
If your claim is accepted, or at least part of the claim, different benefits are available at different points of your recovery following the injury. Medical Benefits under Sec. 13 and Sec. 30 of the Workers’ Compensation Act provide payment for reasonable medical care that stems from the injury. Included is reimbursement for travel to and from the doctor’s office. There are also Temporary Total Incapacity Benefits, called Sec. 34 benefits, which are provided if the work injury causes you to miss work completely. The maximum amount of time that Sec. 34 benefits can be received is three years. If an injured worker is able to work, but not at the same capacity and pay before the injury, he or she is eligible for Partial Incapacity Benefits (Sec. 35). The injured worker can receive up to 75% of what the he or she would qualify to receive under Sec. 34 benefits. These benefits can be paid up to five years.
If the injured worker has received every type of medical treatment available for the injury, or reaches maximum medical improvement, then he or she can file for Permanent and Total Incapacity Benefits (Sec. 34A). These benefits are available as long as the worker is disabled. The Reviewing Board of Massachusetts recently reviewed an appeal from an employer in Tracy v. City of Pittsfield, who was also a self-insurer, who disagreed with the award of Sec. 34A, Sec.13, and Sec. 30 benefits to an injured employee who hurt himself after he hit a pothole while operating a road paver. He bounced out of his seat and injured his back, requiring surgery on his spinal column at different locations. The self-insurer agreed that the injury was a result of the workplace accident, but did not accept responsibility for the surgery and the protrusions.
The Reviewing Board agreed with the Workers’ Compensation Judge (WCJ), who looked at the testimony provided by a medical doctor during the hearing. The doctor determined there was enough evidence to show that the disc protrusions occurred as a result of the industrial accident. The WCJ accepted the doctor’s opinion, looked at his age, training, background, and experience, and awarded him Permanent and Total Incapacity Benefits. The Reviewing Board felt that the WCJ followed the criteria established for this sort of determination, and upheld the award of all benefits to the injured worker.
The Massachusetts workers’ compensation attorneys at Karsner & Meehan are here to help you receive the benefits you are entitled to under the law. Call today for a free, confidential consultation at 508.822.6600.
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First Circuit Court of Appeals Assesses Excess Insurer’s Duty to Defend, Massachusetts Injury Lawyers Blog, January 27, 2015
Massachusetts Supreme Judicial Court Allows Amendment to Trust to Help Avoid Taxes, Massachusetts Injury Lawyers Blog, January 20, 2015