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Massachusetts Compensation Lawyer For Denied Claims

By Author: Tina Smith
Total Articles: 4

To be denied of anything is always traumatic - especially a compensation claim.

Yes, compensation claims are sometimes denied. But it does not mean that it is dead in the water and nothing can be done about it anymore.

Under Massachusetts Workers Compensation
Law, it is the employee’s responsibility to prove that the work-related injury or illness warrants compensation.

The denial simply means that some of the requirements for approval were not met and, maybe, a help from a Ma Workers Compensation lawyer is necessary.

Reasons for denying a compensation claim are very much the same in all states with little variations depending on their labor laws. In Massachusetts, there are three:

1.Improper reporting of the injury or illness:

Different companies and insurers have different forms to fill up in case of an injury or illness, and time frame for submission.

This must be filled up as completely, accurately and honestly as possible and submitted immediately to the employer within the set time frame. .

2. It was not work-related:

The employee must prove, beyond doubt, that the injury or illness was work-related.

If he/she has a pre-existing condition, this will be used by the insurer to deny a claim unless the employee can prove that it has nothing to do with the injury or illness, or that the work done has worsened it.

3.The claimant is not a “covered” employee:

Under Massachusetts law every employee is entitled to compensation for work-related injury or illness.

Contractors are not covered because they are not considered employees. The insurer will try to find a way to exploit this provision to deny a claim.

The silver lining is that a denial can be appealed and the employee must take advantage of this mechanism. For this reason, a compensation lawyer is indispensable.

An appeal is a very lengthy and tedious process which involves a lot of legal knowledge, time, and resources for an employee to have.

In Massachusetts, an appeal goes through this process:

1.Your compensation lawyer, on your behalf, fills up an official appeals form, Employee’s Claim - Form 110 and submits to the DIA (Department of Industrial Accident) together with any medical or documentary evidence, with a copies to the insurer.

Upon receipt, the DIA, will then schedule a “Conciliation.”

2.The “Conciliation”is an informal meeting of two compensation lawyers - the employee’s and the insurer’s.

If both reach an agreement, the issue is closed and settlement given. If not, it will go to an Administrative Law Judge for a Conference..

The “Conference” is also informal, but the Judge has the authority to grant or not to grant compensation to the employee.

Either way, grant or not, the parties involved can appeal the Judge’s decision within 14 days.

The appeal will then be heard by another Administrative Law Judge, but the setting is formal where testimonies are given and admitted.

Based on the merits of the case, the Judge will make a formal ruling to approve or deny a claim.

Denied claims are then sent to a Review Board, consisting of three Administrative Law Judges, for review.

They will review the transcripts of the formal hearing and may ask further arguments from the contending compensation lawyers.

The Review Board rarely reverses the ruling of the Administrative Judge unless there is clear evidence that he had no basis for his decision, it conflicts with an existing law, or he did not have the proper authority to make the decision.

The appeal may be long, may be tortuous, but it must not cow or dishearten an employee who went through physical, emotional and financial anguish due to work-related injury or illness. Statistics show that appeals have almost a 50/50 chance of success and, in some cases, settlements bigger than originally asked for - depending on one’s compensation lawyer.

for more information ,Please vist us on : yourworkinjurylawyers.com

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