Everything you need to know to file a workers’ comp claim
The first workers’ compensation laws in Massachusetts were passed in 1911. The laws were seen as a compromise between workers who wanted to be compensated for workplace injuries and employers who wanted immunity from lawsuits filed by injured workers.
If you were injured at work, you might be eligible for workers’ compensation benefits.
In this guide, we’ll explain how to file a workers’ compensation claim, what benefits you might receive, and how to appeal an unfavorable decision.
What is workers’ compensation?
Workers' compensation is a type of insurance that provides benefits to employees who are injured on the job. It’s a no-fault insurance system, which means injured workers can receive benefits regardless of who's at fault for their injuries.
Workers' compensation is also an exclusive remedy, which means that injured workers must typically file a workers’ compensation claim in lieu of a personal injury lawsuit. The main exception is if a third party (someone other than your employer or colleague) causes your injury. When this happens, you may be able to file a workers’ compensation claim and a personal injury lawsuit against the third party.
Verifying workers’ compensation coverage in Massachusetts
ALL Massachusetts employers are required to carry workers’ compensation insurance for their employees. This requirement applies regardless of the number of workers employed or the number of hours the employees work.
The only exception is for domestic employees (babysitters, housekeepers, etc.) who must work at least 16 hours a week to be covered under a workers’ compensation policy.
Out-of-state employers operating in Massachusetts must provide workers’ compensation coverage for all employees working in the state.
Independent contractors are NOT required to be covered by workers’ compensation insurance. An independent contractor typically meets the following criteria:
- Has an express contract to perform services;
- Is free from direction and control over the means and manner of providing services;
- Incurs most of the expenses for tools, labor, and other operational costs;
- Has an opportunity for profit and loss from the services performed;
- Is free to hire and fire employees to help perform the services for the contracted work;
- Has all business, trade, or professional licenses required by federal, state, or municipal authorities of an individual or business engaging in the same type of services; and
- Follows Internal Revenue Service requirements by obtaining an employer identification number and filing business income appropriately.
What injuries and illnesses are covered by workers’ compensation insurance?
Your injury or illness is covered by workers' compensation insurance so long as it arose out of and in the course of your employment.
For example, a Massachusetts teacher who was injured in a skiing accident while serving as a chaperone for a school ski trip was entitled to workers’ compensation because the injury arose out of and in the course of her employment. Karen Sikorski, 455 Mass. 477 (2009).
On the other hand, an injury is NOT considered to have arisen out of and in the course of your employment if it occurred at work but would have occurred anywhere. For example, if you have a heart attack at work due to high cholesterol, you probably won't receive workers' compensation benefits.
Are mental health injuries covered by workers’ compensation in Massachusetts?
Mental disorders, including depression and anxiety, are covered by the Massachusetts workers’ compensation system if you can prove that “the predominant contributing cause of such disability is an event or series of events occurring within [your] employment.”
To put it another way, your mental disorder may be covered if you can prove:
- You developed a mental health injury,
- Your mental health injury was caused by a stressful or traumatic event or series of events at work, and
- The event or series of events was outside the norm for your particular job.
Workers' compensation covers both traumatic work injuries and occupational work injuries:
How to file a workers’ compensation claim in Massachusetts?
Filing a workers’ compensation claim in Massachusetts is largely the responsibility of the employee. Here are the steps:
Step 1: Download and complete Form 110 – Employee Claim.
You’ll need the following information to complete the form:
- Date of injury or illness
- The 1st calendar day of work you missed
- The 5th calendar day of work you missed
- The name of your workers’ compensation insurance carrier
- The body parts and types of injuries you suffered
- The type of benefits you’re looking for
- The name of your treating doctor
You’ll also need to attach at least one of the following documents to the form:
- Unpaid medical bills
- Medical reports
- Any reports that support how the accident happened
- Witness statements
- Witness names
Step 2: Make three copies of your completed Form 110 (including all supporting documents).
Step 3: Send your original signed copy of Form 110 with your supporting documents to the Department of Industrial Accidents (DIA).
The address for the DIA is as follows:
Department of Industrial Accidents
Lafayette City Center
2 Avenue de Lafayette
Boston, MA 02111-1750
Step 4: Send a copy of Form 110 to your employer’s workers’ compensation carrier by Certified Mail.
Step 5: Wait for a response.
Once the DIA receives your Form 110, they’ll respond in one of two ways:
- The DIA will reject your form and send all of your documents back to you. A rejection letter will be attached explaining why your claim was rejected.
- The DIA will send a notice to you, the insurance company, and your employer with a date, time, and place to appear to meet a conciliator to discuss your claim.
Workers’ compensation benefits
In Massachusetts, injured workers can receive the following workers' compensation benefits:
• Medical expenses. Injured workers can receive “reasonable and necessary medical expenses.” These expenses include things like doctor’s visits, hospital bills, prescriptions, and physical therapy sessions.
• Wage loss benefits. You can receive wage loss benefits if you’re unable to return to work or you’re unable to return to the same type of work.
Wage loss benefits are calculated according to the nature of the injury, with injuries falling into one of the following categories:
• Temporary total disability (TTD). If you're temporarily unable to work (for at least six days), you may be eligible for TTD benefits. These benefits are paid weekly and are typically 60 percent of your average weekly wage before your injury. You can receive these benefits for up to 156 weeks.
• Temporary partial disability (TPD). If you're able to return to part-time or light-duty work while you're recovering but earn less than your normal wages, you may be eligible for TPD benefits. TPD benefits are typically 75 percent of your TTD benefits. You can receive these benefits for up to 260 weeks.
• Permanent total disability (PTD). If you're totally and permanently disabled, you may be able to receive PTD benefits. These benefits are paid weekly and are typically 66 percent of your gross average weekly wage before the injury. You can receive these benefits for as long as you are disabled.
It’s not always clear what wage loss benefits you should receive and for how long. DO NOT assume that your employer or the insurance carrier correctly calculated your wage loss benefits. An experienced workers’ compensation attorney can help make sure you receive the benefits you deserve.
• Death benefits. In the case of a fatal work injury, weekly benefits must be paid to the deceased worker’s spouse and dependents at an amount of 66 percent of the deceased worker’s average weekly wage.
• Vocational rehabilitation benefits. Massachusetts workers may be eligible for some vocational rehabilitation benefits, including meetings with the Office of Education and Vocational Rehabilitation.
Can I appeal an unfavorable workers’ compensation decision?
If your workers’ compensation claim is denied, you can file an appeal within 30 days of the denial. This can be done by completing Form 112 – Appeal to the Reviewing Board and mailing the form (along with a filing fee) to:
Reviewing Board Fee Processing
Department of Industrial Accidents
Lafayette City Center
2 Avenue de Lafayette
Boston, MA 02111
The appeal process is formal and may involve oral arguments. It’s strongly recommended that you speak to an experienced Massachusetts workers’ compensation attorney before filing an appeal.
Hiring a Massachusetts workers’ compensation attorney
You’re allowed to hire an attorney at any point in the workers’ compensation claims process. An attorney can help you file your claim and handle an appeal if your claim is denied.
Most workers’ compensation attorneys accept cases on a contingency fee basis, which means they receive a percentage of what you receive (and nothing if your claim is unsuccessful).
The basis for personal injury law is fairly straightforward:
If you're injured because of someone's negligence, then you're entitled to recover for your financial losses related to the injury.
The premise for the workers' compensation system is similar:
Your employer is required to have specific insurance that provides benefits if you're injured at work.