Massachusetts workers who are injured on the job might expect workers’ compensation benefits to cover their losses and pay for treatment. However, it is not guaranteed that the insurer will approve of the benefits. There are certain steps to take if the insurer denies the claim or does not provide all the workers’ compensation benefits that the person believes he or she should receive. When this happens, it is imperative to understand what to do and to have legal help in getting what is owed.
When the insurer denies the claim, the claimant will be informed via an Insurer’s Notification of Denial, also known as Form 104. The reasons for the denial will be listed and there will be information as to the claimant’s right to file an appeal. After the denial or if the claimant does not get all the benefits he or she believes should be provided, there is the right to file a claim with the Department of Industrial Accidents.
The form to appeal – known as the Employee’s Claim, or Form 110 – should not be sent until Form 104 has been received denying the claim or more than 30 days have passed from the time the injury or illness came about and no notification has come from the insurer. With Form 110, there must be copies of medical evidence supporting the claim, medical bills and medical reports attached. The claimant should not provide any diagnostic attachments such as an MRI. When the DIA gets Form 110, Conciliation will be scheduled within approximately the next two weeks. This will be the beginning of the dispute process.
Since a dispute regarding workers’ compensation benefits can be complicated and the person who is filing is already dealing with an injury or illness preventing the ability to work as well as medical treatment, it is vital to have legal assistance throughout the process. Discussing a case with an attorney who is experienced in helping clients with workers’ compensation is imperative.
Source: mass.gov, “Massachusetts Workers’ Compensation Guide For Injured Workers — page 3,” accessed on Oct. 2, 2017