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With a few exceptions, if you are an employee of a Massachusetts company or are working in Massachusetts and you have suffered from a workplace injury, workers’ compensation laws provide compensation. Unfortunately, not every claim goes as planned. Understanding the process and getting legal assistance is important to getting the insurer to start paying all of the benefits that you are entitled to without delay.

1. Why was my workers’ compensation claim denied?

One of the biggest problems that I see with workers’ compensation cases is that the insurer has initially denied the injured workers’ claim. A claim denial happens for many reasons. In some cases, if notice of the injury is not given immediately, the insurance provider may believe that your injury was not a result of a workplace incident. Or they may feel that the injury was a pre-existing condition. The insurer may also deny the claim because they have not been provided adequate medical evidence that there was an injury which is work related and is disabling the employee.

In Massachusetts an insurer has fourteen days after they are notified of a disabling injury, to either pay or deny the claim. If the injured worker does not supply the medical evidence, the insurer will usually deny the claim. Most insurers will not seek the medical evidence. I believe that they use this tactic knowing that it will take months for the case to be heard by a Judge of the Department of Industrial Accidents (DIA). For most injured workers this wait without any income is a financial hardship.

2. When should I hire a workers’ compensation lawyer?

In an ideal situation, your claim gets approved, and you get your compensation and medical treatment right away. When that doesn’t happen, it gets complicated. Even if you do not want to hire a lawyer right away, I recommend calling an experienced workers’ compensation lawyer like myself right away. Knowing what your rights are and how the case should be handled will go a long way to preventing a denial and delays. Initial consultations with me are free. I regularly take phone calls and take whatever time is necessary to answer questions and explain the process to injured workers.

If your case has already been denied, or if you were receiving benefits and the insurer has terminated them, you should consult and hire a workers’ compensation lawyer right away. In those cases, a claim will need to be filed with the DIA. The claims process with the DIA is a complicated one that an injured worker cannot navigate on their own.

3. How do attorney fees work?

In Massachusetts, most workers’ compensation lawyers use a contingency-based fee. That means you do not pay anything upfront. If a lawyer files a claim on behalf of the injured worker, or defends a claim by an insurer to terminate or reduce benefits, and the lawyer prevails, the insurer has to pay most of the legal fee and expenses. If there is an order by a Judge for ongoing weekly benefits, the insurer is allowed to withhold 22% of the first four regular weekly checks to offset the legal fee paid. But the bulk of the fee and expense are paid by the insurer.

The state has a clear and succinct attorney structure fee. The other way any legal fee and expenses are paid is if the injured worker’s case is settled via a Lump Sum Settlement. If that happens, state law sets the lawyer’s fee at 20% of the settlement on an accepted case. That dips to 15% for an unaccepted case. Workers’ compensation can get complicated, but that does not mean you should give up your case.

Don’t Wait. Insurers only have 14 days to pay or deny your claim. Learn how to improve your chances of having your claim approved.