Why Are Workers’ Compensation Claims Denied in Massachusetts?

An injured worker seeking workers’ compensation benefits is at a terrible disadvantage. A workers’ compensation claim can be denied for any number of reasons.

Under Massachusetts workers’ compensation law, the employee has the burden of showing that a workplace injury or disabling condition warrants payment of workers’ comp benefits. The injured worker’s employer doesn’t pay these benefits. Instead, the employer has workers’ compensation insurance. That insurance company and its attorneys will do everything it can to avoid paying a claim.

If you believe your workers’ compensation claim was wrongfully denied, you need an experienced Massachusetts workplace accident attorney on your side. Contact Kantrovitz & Associates, P.C., toll free at (800) 367-0871 or contact us online for an evaluation of your case. The workers’ compensation lawyers of Kantrovitz & Associates, P.C., have more than 20 years of experience fighting for the rights of Massachusetts workers who are injured on the job.

Reasons Why Workers’ Compensation Claims Are Denied

A workers’ compensation in claim may be denied for many different reasons, including:

1. The injury or illness was not reported properly.

Workers’ comp law requires an employee to report a workplace injury or disabling condition to his or her employer in writing right away. If a worker fails to file a prompt, accurate and detailed report , it could lead to denial of a workers’ compensation claim.

After a work-related injury or disabling condition is reported, the employer must notify its workers’ compensation insurer of the injured employee’s condition. This creates a deadline for the insurer to either begin paying benefits or deny the claim.

The report should include:

  • What injury the worker suffered
  • When the injury occurred
  • Where the injury occurred
  • What the employee was doing
  • How the injury happened
  • Why the accident / injury happened
  • Names of any witnesses to the worker’s accident / injury.

If an employee doesn’t report a workplace mishap or illness promptly, it will also be more difficult to gather facts about what happened later. Memories fade, documents can get misplaced and physical evidence related to the accident or condition can be lost.

2. The employee’s injury is not work-related.

An injured employee is eligible for workers’ compensation in Massachusetts when his or her injury arises from the course of their employment. This means that a workers’ compensation insurance company may reject a claim if a particular worker’s injury or condition is not related to their work.

An insurer might claim the employee suffers from a pre-existing condition unrelated to the job or from a prior injury. The insurer might also say that the employee has a naturally occurring degenerative condition not related to his or her job, such as a degenerative disc disease or arthritis.

It’s true that pre-existing conditions and degenerative conditions unrelated to work are not compensable under the workers’ compensation system. But if a work-related accident or illness aggravates a pre-existing condition or causes symptoms in a degenerative condition that were not present or disabling before, the worker may be eligible for benefits.

Workers often develop disabling conditions over several years. The aggravation that causes a disability need not happen in a single, identifiable workplace accident. Repetitive motion injuries, such as carpal tunnel syndrome, are an example of disabling conditions that are not caused by a single accident or sudden illness.

3. The insurer says the injured worker isn’t a covered “employee.”

Under Massachusetts workers’ compensation law, benefits are available to almost anyone who earns a salary or wages, whether employed full-time or part-time. But, independent contractors are not considered “employees.” So, they fall outside the mandatory workers’ compensation benefits scheme.

Too often, an employer and their insurance company will wrongly claim that an injured worker was an independent contractor.

The Massachusetts Independent Contractor Law presumes an employer-employee relationship unless someone challenging that status can show three things:

  • The worker must be free from the presumed employer’s control and direction in performing the worker’s service, both according to the parties’ contract and in fact;
  • The service provided by the worker must be of a type outside the employer’s usual course of business; and
  • The worker must be customarily engaged in an independent trade, occupation, profession or business of the same type as that involved in the service that the worker is performing.

The Massachusetts workers’ compensation lawyers at Kantrovitz & Associates, P.C., believe most denials of workers’ compensation benefits deserve further investigation on the injured employee’s behalf. But going it alone against a complex benefits system and an insurer’s skilled attorneys is a daunting task.

Don’t go it alone. A skilled and knowledgeable workers’ compensation attorney from Kantrovitz & Associates, P.C., will bring to your case the benefit of years of experience successfully representing workers who have suffered workplace injuries in Massachusetts.

Workers’ Comp Benefits Denied? Contact Our Massachusetts Workplace Accident Lawyers

The experienced workers’ compensation lawyers at Kantrovitz & Associates, P.C., based in Boston, Massachusetts, can help you obtain all of the benefits you deserve after a workplace accident.

For a free evaluation of your workers’ compensation claim, please contact us online or call Kantrovitz & Associates toll free at (800) 367-0871. We have more than 20 years of experience protecting the rights of individuals injured in the course of their employment.

The workplace accident lawyers at Kantrovitz & Associates, P.C., help injured workers in locations across Massachusetts, including but not limited to Boston, Essex, Middlesex, Norfolk, Suffolk, Plymouth and Merrimack River. We also represent Rhode Island and New Hampshire residents whose injuries occurred in Massachusetts or who were hired in Massachusetts but injured out of state.