Why Would My Massachusetts Workers’ Compensation Claim Be Denied?

As a Massachusetts worker, you should be entitled to benefits under the Massachusetts workers’ compensation system if you suffer a qualified workplace injury. Filing a Massachusetts workers’ compensation claim can be a lengthy, and complicated, process. A claim for benefits could be denied for any number of reasons.

Some of the common reasons a claim is denied include the following:

• Technical Requirements—For a Massachusetts workers’ compensation claim to be approved, a claimant must follow the proper procedure when submitting the claim. There are also a number of important timeframes that must be adhered to. An initial claim should be filed by your employer on Form 101—Employer’s First Report of Injury or Fatality. A claim cannot be filed prior to the fifth calendar day after your disability occurred but should be filed prior to the 12^th calendar day. After that, the Department of Industrial Accidents, or DIA, will review the claim. Additional documentation may be requested by the DIA and/or an appointment scheduled with a DIA-approved physician for an examination. Each step in the process has a deadline and must be completed according to procedures set forth by the DIA. Failing to follow the correct procedures, missing a deadline, or not responding to requests for additional information by the DIA could cause your claim to be denied.
• Injury not eligible—Even if the claim was properly filed, an insurer could claim that the injury is not compensable. In other words, the insurer may claim that the injury is not work related. This could happen if the insurer believes that the injury is a pre-existing injury or if the insurer claims that the injury occurred outside the scope of employment. True pre-existing conditions do not qualify for a new workers’ compensation claim; however, a pre-existing condition that is aggravated by your job could potentially qualify for workers’ compensation benefits. Likewise, if an injury truly occurred outside the scope of your employment then it does not qualify for benefits; however, there are many situations wherein the line that divides inside and outside the scope of employment is hard to define and make an appeal worthwhile when benefits are at stake.
• Employee not eligible—Your Massachusetts workers’ compensation claim could be denied because the insurer claims that you were not a covered employee at the time of the injury or because your employer did not have workers’ compensation coverage in place at the time of the injury. Although employers are required to have workers’ compensation coverage, some employers do not follow the law. A worker may still be protected under Massachusetts law. An employer may also try to classify an employee as an independent contractor to avoid paying workers’ compensation benefits. Massachusetts law is very favorable to workers in this situation, making it difficult for an employer to get out of paying benefits by categorizing an employee as an independent contractor.

Although a claim can initially be denied for any of the above reasons, a claimant has the right to appeal that denial. Often, the reason for the denial can be easily cleared up with the assistance of an experienced Massachusetts workers’ compensation attorney. The appeals process has numerous stages under the Massachusetts workers’ compensation system. Your initial denial could be overturned at the first stage of the appeal process or it could require a more formal hearing in order to get your claim approved.

Of course, not all appeals are approved; however, you stand a much better chance of approval when you have the assistance of a knowledgeable workers’ compensation attorney who is familiar with the appeals process. If you have applied for benefits under the Massachusetts workers’ compensation system and your claim was denied, we may be able to help. The Massachusetts workplace injury lawyers at Kantrovitz & Associates, P.C., are available to review your claim and help you decide what your next move should be.

If you would like to know what legal options you have for a work-related injury, we can be reached by calling 800-367-0871 or by using our online contact form.