A problem that is becoming more common for injured workers in Massachusetts is finding a competent doctor who will accept worker’s compensation insurance and the medical medical-cross-3-971653-mreimbursement rates that Massachusetts’ workers’ compensation insurers are obligated to pay.  To better understand why not all doctors are willing to accept patients who have been injured on the job, one must have a grasp of how health insurance plans are written, the amount of money a workers’ compensation insurer is obligated to pay a doctor, and why it is not always in the best financial interest of a doctor to accept workers’ compensation insurance.

First, all health insurance policies have an exclusion for work-related injuries.  That means that if you are injured during the course of your employment, your health insurance policy will not pay for any medical treatment that is determined to be made necessary by your work injury.  The only exception to this rule is a situation where you are injured at work and your employer’s workers’ compensation insurer has denied payment for your medical treatment.  The workers’ compensation insurer’s denial will then trigger your health insurer’s obligation to pay for the medical treatment so long as it is determined to be treatment that is reasonable and necessary.  In this situation, your health insurer will likely then file a lien on your workers’ compensation claim if you decide to retain an attorney and file a claim at the Department of Industrial Accidents seeking to compel the workers’ compensation insurer to pay for your medical treatment.  All medical treatment made necessary by a work related injury should be billed to your employer’s workers’ compensation insurer. Continue reading

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Workers’ Compensation insurers must follow certain procedures in order to lawfully terminate or reduce Massachusetts workers’ compensation benefits.  The procedure for modification or termination varies greatly depending on how long the insurance company has been paying benefits.

THE FIRST 180 DAYS AFTER YOUR DISABILITY BEGINS

If the insurer has began to make payment of weekly benefits to you timely, namely within 14 days of notice, the insurer is allowed to stop payments to the employee without obtaining approval of the Department of Industrial Accidents (“DIA”) or the consent of the employee. However the insurer is required to give the employee seven(7) day written notice of their intent to stop benefits. The insurer’s written notice of termination must state their reasons and advise the employee of his or her rights to file a claim for further benefits.  If you return to work at the same rate of pay you were earning prior to your injury, the insurer may terminate benefits effective the last day you were disabled prior to your return to work.  If your own treating doctor clears you to return to your previous job, the insurer may terminate benefits regardless of whether or not your prior job remains available to you.

All Massachusetts weekly workers’ compensation benefits are based off of the average weekly wage of the injured worker.

How Is Average Weekly Wage Figured?

The calculation of average weekly wage is always based upon the employee’s gross earnings. If the employee has worked a full year prior to the injury, one averages the full 52 weeks prior to the injury. These gross earnings include such things as bonuses, vacation time, overtime, and commissions. The value of fringe benefits, such as health insurance, are not added in to the earnings. Total earnings in the 52 week period are divided by 52 to get the average weekly wage. If an employee has worked less than 52 weeks, the number of weeks actually worked will be divided into the gross earnings. For workers who have worked only a very few weeks, the calculations for average wage may be based upon a fellow employee who had worked for the same employer doing the same work for a longer period of time. A list of the maximum weekly compensation rates over the past ten (10) years is found below.

MAXIMUM RATES
Injury On or After Maximum Weekly Benefit
10/1/03
10/1/04
10/1/05
10/1/06
10/1/07
10/1/08
10/1/09
10/1/10
10/1/11
10/1/12
10/1/13
10/1/14
10/1/15

$884.46
$918.78
$958.58
$1,000.43
$1,043.54
$1,093.27
$1,094.70
$1,088.06
$1,135.82
$1,173.82
$1,181.28
$1,214.99
$1,256.47

What If I Work More Than One Job?

In cases where an employee has more than one job, his wages from both jobs can be included in the computation for workers’ compensation if both jobs are jobs covered by the Massachusetts Workers’ Compensation system. This essentially means that both jobs must be ones that are for legitimate employers who are deducting taxes from the employee’s wages and reporting income to the government, and have a policy providing workers’ compensation coverage. This situation is called concurrent employment and can substantially increase weekly benefits to the injured employee.

Section 34/Temporary Total Disability Benefits

In Massachusetts, workers are entitled to weekly temporary total disability benefits if they are unable to perform any job. It should be noted that inability to do one’s former job is not necessarily enough. Continue reading

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There are many factors that determine the Lump Sum settlement value of a Massachusetts’ workers’ compensation claim. Some Massachusetts’ workers compensation claims may have no settlement value at all, while some may have a settlement value of several hundred thousand dollars (or more).  While it is important to stress that each individual workers’ compensation claim must be evaluated individually, there are some important factors that determine if a claim has settlement value, and if so, the amount of that settlement value.

Each state administers its own individual system of workers’ compensation benefits. In Massachusetts, the workers’ compensation system is known as what is commonly referred to as a “wage loss” system. That is, if a work related injury or medical condition causes a period of disability from work that also causes wage loss, then the injured worker is entitled to weekly wage loss benefits.  It should be noted that not all work related injuries (even if the injury prevents the injured worker from returning to the previous occupation that they were performing while they were injured) cause a wage loss. For example, a forty five year old employee with a master’s degree in computer science is laid off from his job as a computer software programmer where he was paid $78,000.00 per year, or $1,500.00 per week.  In order to pay his bills while he looks for another job in the computer software field, he takes a job in the construction industry as a laborer.  While working as a laborer, he strains his back.  Although the injury isn’t serious enough to cause him to need back surgery, the injured worker is permanently disabled from working as a laborer where he was earning $1,000.00 per week. His treating doctor is of the opinion that he can return to work at a sedentary or light duty job.  Because he is capable of earning more money as a computer software programmer, an occupation he is trained for, physically able to do, and pays him more money than the laborer job, he has no wage loss and would not be entitled to any weekly workers compensation after the point in time where his doctor cleared him to return to light duty work.  Continue reading

Traumatic Brain Injury On March 24, 2016, Alan Schwarz of the New York Times wrote a revealing article outlining the actions the NFL took to manipulate the opinions of neurologists they retained to study the effect of concussions and the health risks related thereto. The article also suggests that the NFL has relied upon lobbyists and lawyers also retained by the Tobacco industry, who used them to deny health risks associated with smoking cigarettes.  Schwarz’s article has revealed information not previously made public, including the fact that the NFL omitted at least 100 reported concussions (many suffered by star players such as Steve Young and Troy Aikman).  At least one doctor retained by the NFL to study the effects of concussions on the brain admitted that if the data supplied to him was incomplete then his opinions would not be valid. Continue reading

medical-doctor-1314902-mInjured workers in Massachusetts who are eligible for Massachusetts’ workers’ compensation benefits may be required by the insurance company and/or their employer to submit to an examination by a registered physician.  This requirement is pursuant to Massachusetts General Laws, Chapter 152, Section 45.  The workers’ compensation insurer and/or the employer must pay for this examination.  This examination is typically scheduled by a workers’ compensation insurer at either the outset of the claim (just after the injury has occurred) or at a point in time where the insurer wants to either terminate or reduce weekly disability payments to the injured worker.  Many questions and issues typically arise for an injured worker when they receive a notice of an IME examination from the workers’ compensation insurer or their employer.  Here are some important things to know about the IME exam: Continue reading

gavel-5-1409595-m          Injured workers in Massachusetts who are disabled from work and receiving workers’ compensation benefits may receive an unexpected “light duty” job offer from their employer.  The light duty job offer by an employer to an injured worker can often times create a confusing situation for the injured worker because they are unclear what they should so in order to protect their own best interests.  It is not uncommon for an employer to not contact an injured worker for many months, even perhaps years, and then all of a sudden a letter with a light duty job offer appears in the mailbox of an injured worker.

Workers’ Compensation insurers have a financial interest in getting an injured worker back to earning wages.  Quite simply, if the injured worker returns to work, the insurer can either reduce or terminate their payment of weekly workers’ compensation benefits to the injured worker.  This is a tremendous cost savings to the workers compensation insurer and will also reduce the employer’s insurance premiums.  The more money that the injured worker is able to make, the less money the injured worker receives in workers’ compensation benefits, and, if the light duty job pays the same amount of money as the injured worker was receiving before he or she got hurt, they will not be entitled to receive any more weekly workers compensation benefits.  So it is easy to understand why these light duty job offers are made by employers. Continue reading

calculator-1560882Another disability benefit available for Massachusetts’ employees injured and out of work for more than one year is social security disability. For more information on who qualifies for SSDI benefits and how you can apply for SSDI, please refer to our SSDI practice area page. It is important to note that any worker who is out of work for one year or who has a condition which will clearly lead to disability lasting more than twelve months should consider filing for social security disability.

There are certain coverage requirements which generally state that a worker must have had a fairly steady work history to qualify; but assuming you do qualify, social security disability could provide significant additional benefits to you and your family in addition to your workers’ compensation benefits. There is no effect on your workers’ compensation claim by filing for social security. Indeed, an award of social security disability benefits may even help your workers’ compensation claim. Social security disability could pay an injured worker and his family up to an additional two thousand four hundred ($2,400.00) per month, depending on the amount of the worker’s pre-injury wages. In addition to monthly money, social security can also provide the worker with Medicare coverage after the second year of social security entitlement. This may be important since many workers who are on workers’ compensation have their health care insurance canceled after being out of work for a period of time. Continue reading

On concrete-circular-saw-20507539May 7, 2012 Sylbert Stewart fell from the edge of a dipping tank into a pool of chemicals, while cleaning the top of ventilation ducts in the course of his employment at the Belmont metal finishing factory where he has been employed for fourteen years. The Occupational Safety and Health Administration (OSHA) cited his employer for three separate violations in connection with the incident. Mr. Stewart sustained second and third degree burns from his thighs to his feet, and doctors removed skin from his back, chest, and arms for skin grafts to wrap around his legs.

Mr. Stewart received temporary total disability benefits through the Massachusetts workers’ compensation system, which pays 60 percent of his wage loss, and the full cost of medical treatment. However, he did not receive compensation for the scarring on his legs, which covers 38 percent of his total body surface. Currently, in order to be compensated for permanent scarring under the Massachusetts Workers Compensation Act a worker’s blemish has to be on the face, neck, or hands. Thus, if workers are disfigured on their arms, legs, or torsos they do not receive compensation. The disfigurement portion of the Act is obviously pro employer and insurer, which simply fails to take into account the burden it places on the daily life of an employee, like Sylbert Stewart. Continue reading

gavel-5-1409595-mOften times, injured workers who are receiving Massachusetts workers’ compensation benefits are mailed a form titled “Form 105 – Agreement to Extend the 180 Day Payment Without Prejudice Period.”  Workers’ compensation insurers may  send this form to an injured worker who has not yet retained an attorney in hopes of getting the unrepresented injured workers to sign the form without fully understanding the ramifications of doing so.  It is usually sent to the injured worker during the 3rd to 5th month of disability following a work injury.

Signing the Agreement to Extend 180 Day Payment Without Prejudice Period form sent to you by the workers’ compensation insurer can have an extremely negative impact on your claim.
Insurance companies will send you this form under the guise that they are doing you a favor and agreeing to pay you for another 180 days, however by signing this form you are giving up legal rights and you may expose yourself to allowing the insurer to legally terminate benefits and put you in the position where you could go many months with no benefits while you fight the insurance company in court.  In order to fully understand why singing this form can have negative consequences for an injured worker, it would be helpful to explain exactly what the 180 Day Payment Without Prejudice Period is.

THE FIRST 180 DAYS AFTER DISABILITY BEGINS

If the insurer has commenced benefits timely, namely within 14 days of notice, the insurer is allowed to stop payments to the employee without obtaining approval of the DIA or the consent of the employee. However the insurer is required to give the employee seven(7) day written notice of their intent to stop benefits. The insurer’s written notice of termination must state their reasons and advise the employee of his or her rights to file a claim for further benefits. Continue reading