After the Accident

Getting hurt on the job encompasses everything from bumps and bruises to life-altering trauma. 

Workers’ compensation laws can help, but many workers aren’t sure what qualifies for coverage or how to obtain the benefits. The first step, though, attorneys say, is reporting it to the employer as soon as possible and seeking medical attention promptly.

“Minor injuries, even a bump on the head, are worth reporting,” says Judson Pierce, a workers’ compensation attorney at Pierce, Pierce & Napolitano in Salem. Symptoms may not fully appear for days or weeks, and a record of the incident can become important if further treatment is needed. 

More Than One-Off Accidents

In addition to acute workplace accidents like falls, employees may also qualify for benefits if they develop a work-related medical condition over time. This includes cumulative stress injuries such as carpal tunnel syndrome and back problems, says Pierce.

The injury doesn’t need to happen at an employer’s physical workplace, either. Employees who travel for work or perform duties off-site can still be covered if they are injured while acting in the course of their employment, says John Sheehan, a personal injury and workers’ compensation attorney at the Law Office of John J. Sheehan in Wakefield and Boston. 

Independent contractors, however, are not eligible for workers’ compensation. Those who think they should be classified as employees might want to have their employment status reviewed, Sheehan adds.

Certain mental health conditions may also count, although those claims carry a higher burden of proof. The circumstances must go beyond the expectations of an ordinary workplace environment, often involving harassment, bullying or psychological trauma, says Pierce.

The Timeline

In Massachusetts, lost-wage benefits are typically calculated at 60% of a worker’s average weekly earnings from the previous year. Medical coverage of the injury may continue even after wage-replacement payments have ended. Additional compensation for permanent scarring or loss of function may be available, as well as vocational rehabilitation services to help individuals return to their previous job—or, when necessary, a new one, Pierce notes. 

Employees have four years from the time they become aware that a condition or injury is work-related to file a claim, though exceptions may apply.

While an employer can require an injured employee to see a “preferred” healthcare provider, Sheehan says the claimant is generally not required to continue with that provider and can seek care elsewhere. 

After an injury is reported, the employer notifies its workers’ compensation insurer, which then reviews the claim’s eligibility. Massachusetts law permits insurers to start paying claims while they gather more details and conduct investigations, says Sheehan, so workers may begin receiving payments even before an insurer has formally accepted liability. This window gives insurers more leeway to adjust or stop payments than they have once they officially accept responsibility for an injury, he adds. If a claim is denied, or coverage is later reduced or discontinued, employees can challenge those decisions through the Massachusetts Department of Industrial Accidents.

Sheehan urges workers to carefully read any documents they receive. In some cases, insurers may ask the injured party to sign paperwork extending the initial six-month review period. “But there’s no requirement for the employee to sign that form,” he says, “and you should contact a workers’ comp lawyer to discuss it.”

Common Misconceptions

One reason some employees hesitate to file a claim is the belief that they are suing their employer or that they could lose their job for doing so. However, state law prohibits employers from retaliating against employees for filing a claim or exercising their rights under the workers’ compensation system. 

“You won’t get fired just for filing,” Pierce says. “You’re making a claim against their insurance company.”

Workers may worry that a court battle will ensue, but that’s usually not the case. While some disputes require hearings before an administrative judge—not a jury—many are resolved through communication among attorneys, insurers, medical providers and claims adjusters, Pierce says. 

Because eligibility requirements, benefit calculations and filing deadlines can vary, employees should seek information on their case early.

“Calling a lawyer, just to have a conversation—there’s no charge for that,” says Sheehan. “You’ll have the benefit of being educated about your situation and your options.”