How much money will I receive from the insurance company?
If you are temporarily totally disabled, the insurance company is required to pay you 60% of your so-called average weekly wage. If you are partially disabled, the amount is 60% of the difference between your average weekly wage and what you are able to make after your injury. If you are totally and permanently disabled, the amount is 2/3 of your average weekly wage. If you have a very high or very low average weekly wage, special rules apply.
What is my “Average Weekly Wage”?
Your individual average weekly wage is the average weekly gross pay you received during the year prior to your injury. This amount includes overtime, shift differential, and bonuses. If you changed jobs within the past year, special rules apply.
How long will my weekly benefits continue?
If you are temporarily totally disabled, your weekly benefits may continue for no more than 3 years. If you are partially disabled, your weekly benefits may continue for 4 or 5 years (longer in exceptional circumstances), depending on how many years you also received total temporary benefits. If you are totally and permanently disabled, your benefits may continue for the rest of your life. If you die as a result of your injury, certain family members may continue to receive weekly benefits for varying periods.
What happens if the insurance company refuses to pay?
You will have to file a claim with the Department of Industrial Accidents.
How long do I have to file the claim?
You have 4 years from the date of injury to file a claim. In certain circumstances, you may have even more time.
If I file a claim, how soon will my case be decided?
Once your claim is filed you (and your attorney if you have one) will meet with a representative of the Department of Industrial Accidents and someone (usually an attorney) representing the insurance company within 30 days. If necessary, an administrative judge will be assigned to make a decision on your case. This usually takes another 8 to 12 weeks. If a hearing is necessary, the process may take a year or more from the time the claim is filed.
Do I have to pay for doctors or medicine?
You do not have to pay for any medical treatment, including doctor’s appointments, tests, or medicine which is related to treatment of your work injury. Most insurance companies do not have arrangements with pharmacies, so you will generally have to pay for medicine, then be reimbursed. However, there are specific procedures which must be followed to ensure the insurance company is responsible for the payments. If the insurance company denies your claim, they will probably deny payment for any medical treatment. In this case an administrative judge will probably have to decide the issue.
When do I need a lawyer?
When you feel you are not receiving due compensation for your work-related injury.
If I hire a lawyer, how much will it cost me?
Attorneys are not allowed to charge clients for representing them in workers’ compensation cases. If the attorney is successful, the insurance company will pay the required attorney’s fee. If there is a settlement, then the attorney is allowed to receive no more than 20% of the settlement. Clients may be responsible for paying certain fees or costs related to the claim, but many attorneys will advance these costs.
Will I lose my job if I receive workers’ compensation benefits?
If you are a member of a labor union or work for city, county or state government, your job will probably be protected for a period of time. However, most private employers are not required to save your job for more than three months if you are unable to work. Massachusetts law gives you some reemployment rights when you are able to return to work, even if you were fired or laid off while out of work due to your injury.