If you are injured in a work accident in Massachusetts that affects your ability to work, you may be eligible for workers’ compensation insurance. According to the Department of Industrial Accidents (DIA), those who suffer a work-related illness or injury or is a dependent of someone killed on the job is eligible for these benefits, but what happens when your claim is denied?
The first step in the dispute resolution process is conciliation. This is when your have filed a claim for benefits and the insurer stops or modifies your payment. At this point a conciliation is scheduled as an informal meeting with a representative from the DIA, an attorney for the insurance company, you and your attorney. If an agreement cannot be reached through conciliation the next step is a conference.
This is another informal meeting, but an administrative judge is included. If your issues are resolved during this meeting, a temporary order is issued by the administrative judge that requires the insurance company to pay your benefits.
If the result is not satisfactory, the next step is a hearing. This is comparable to the trial phase of a case and witnesses are called. Oral testimony and evidence are often submitted before the administrative judge decides in a hearing. If you disagree with the outcome of the hearing, you have 30 days to appeal the decision.
Finally, the DIA’s reviewing board will hear appeals to these decisions. The decision may be reversed only if it was contrary to current law, capricious or arbitrary or beyond the administrative judge’s authority scope. At this point, if the case needs to be appealed further, it goes before the Massachusetts Court of Appeals.
This is intended for educational purposes and should not be interpreted as legal advice.