Workers' Compensation

Workers’ Compensation

Injured in the Workplace?

Peter Russell, affiliated with Richard Shalhoub and Gary Orlacchio, specializes in Workers’ Comp cases and serve as the voice of the injured worker. After an injury, you likely have many questions and anxieties about the future and your income. Russell & Associates will help get you the information and resources you need to get back on your feet and obtain the compensation you deserve.

When you experience an injury at work, call Russell & Associates first. Attorneys Russell, Shalhoub, and Orlacchio have a team of investigators who specialize in on-site accidents and are able to get on the scene quickly to take photographs and gather information to help you and your family get the highest benefit possible. Then take advantage of Peter Russell’s extensive experience as a trial lawyer and prosecutor; he has parlayed his investigative background to help many union members get paid through Workers’ Compensation and through third-party lawsuits.

Resources

Mass.gov Labor and Workforce

FAQ, forms, options: Contact us to help you navigate the process and get you results.

US Dept. Of Labor

Information for federal workers injured: Let our experience guide you.

The Guide to Workers’ Compensation



What is Workers’ Compensation?

Workers’ Compensation is intended to make sure employees are protected by insurance if they are injured during the course of their employment or become ill as a result of their employment. Employers in Massachusetts are required to provide Workers’ Compensation insurance coverage to all of their employees under Massachusetts General Law. Workers’ Compensation insurance provides money for any necessary medical treatment for the injury or illness and for lost wages. In Massachusetts, The Department of Industrial Accidents (DIA) is in charge of administering Workers’ Compensation law.




Am I Eligible for Workers’ Compensation?

Massachusetts law states “every person in the service of another under any contract of hire, express or implied, oral or written” is a covered employee. Employees are covered under Workers’ Compensation from their first day of employment. The essential question in determining employment status is the nature of the relationship between the parties.




What Injuries Does Workers’ Compensation Cover?

Workers’ Compensation covers injuries and illnesses that occur during the course of employment. While the most common injuries covered are workplace accidents, Workers’ Compensation also covers occupational diseases and repetitive stress injuries. Workers’ Compensation may NOT cover injuries that occur while performing activities during employment hours that are purely voluntary. In order to receive Workers’ Compensation benefits, you must visit a doctor authorized by the Workers’ Compensation Board and they must file the appropriate paperwork.




Does Fault Matter?

The fault of the injury does not matter under coverage for Workers’ Compensation. Even if your actions caused your injury, you are still entitled to benefits.




Can I Sue My Employer?

In most cases, Workers’ Compensation is an exclusive remedy to recover for workplace injuries. If another person or entity other than your employer caused your injuries, you may be able to file suit against them. Certain exceptions apply to this rule.




What If My Employer Is Uninsured?

A special trust fund has been created to pay benefits for employees who are injured while working for uninsured companies.




What Will I Be Paid For?

The two primary categories that injured employees may receive money for are medical expenses and lost wages. Your employer may choose your healthcare provider for your first visit. After the initial treatment, you may choose your own provider. Additionally, the insurance company may periodically ask you to visit its doctor for evaluation of your injury or illness to determine if you still require benefits. You can receive payment for any lost wages after the first five days of full or partial disability. You may receive payment for the first five days if you are forced to miss 21 or more days due to your injury or illness. It is also important to note that the days do not need to be consecutive.




How Much Will I Be Paid?

Lost Wages

For weekly temporary benefits, an injured or ill employee will receive 60% of their Average Weekly Wage (AWW) as compensation for their lost wages. To calculate the AWW, the employee must show how much they earned in the previous year and divide that number by 52 to find the average weekly wage. This number should take into account salary or hourly wages as well as bonuses that were paid by the employer.




Medical Benefits

You will also receive payment for all necessary medical treatment resulting from your injury or illness. These medical benefits include:
A. Doctor’s visits to a Board-authorized healthcare provider
B. Hospital stays
C. Surgery
D. Nursing care
E. Medicines
F. Medical tests
G. Rehabilitation expenses
H. Prosthetic limbs or other devices
I. Dental care, if warranted by the injury
J. Eyeglasses, hearing aids, or false teeth
K. Travel expenses to and from medical visits.




Permanent Loss of Function and Disfigurement Benefits

You may receive a one-time payment for total loss of certain specific bodily functions or disfigurement or scarring on the face, neck, or arms. This amount will vary based on the location and severity of the loss of function, disfigurement, or scarring.




Permanent and Total Incapacity Benefits

If your injury or illness leave you totally and permanently unable to work, you may qualify for permanent and total incapacity benefits. These benefits will provide you with two-thirds of your AWW or a minimum of 20% of the State Average Weekly Wage (SAWW). You may also be able to receive Cost-Of-Living Adjustments. You will be able to receive these benefits for as long as you are disabled.




Partial Incapacity Benefits

You may qualify for partial incapacity benefits if you can still work but lose part of your earning capacity due to your injury. Partial incapacity benefits may be available if you are forced to work fewer hours or you are forced to switch to a lower paying job due to your injury or illness. The maximum amount paid for partial incapacity benefits is 75% of what your weekly temporary benefits would be. These benefits can be received for up to 5 years.




Survivors’ Benefits

If you are killed, your family may qualify to receive survivors’ benefits. The spouse and children are able to receive the benefits. Children are only eligible if they are under 18-years-old, are full-time students, or are unable to work due to physical or mental disabilities. The spouse can receive two-thirds of the decedent’s AWW at the time of injury or illness up to the SAWW. Spouses may also receive Cost-Of-Living Adjustments beginning two years after the time of injury or illness. Spouses can receive these benefits for as long as they remain dependent as determined by a judge and so long as they do not remarry. If the spouse remarries, $60 per week is paid to each eligible child.
Additionally, in cases where death occurs, the insurer will pay up to $4000 for burial expenses.




Vocational Rehabilitation Services

Workers’ Compensation may also provide payment for services to try to get you back to earning as close as possible to what you were earning before your injury or illness. These services may include additional training, workplace modification, or counseling among various other services. Vocational rehabilitation services cover all non-medical expenses that you may require to return to work.




Lump Sum Settlements

Lump sum settlements are contracts between the injured worker, the insurer, and sometimes the employer. The lump sum settlements are one-time payments in place of weekly compensation checks. Before accepting such a benefit, you must weigh the pros and cons and completely understand what you are giving up and what you are receiving.




Maximum and Minimum Compensation Benefits

The maximum and minimum compensation rates for workers’ compensation are set each year on October 1. As of October 1, 2014 the maximum rate was set at $1,214.99, the State Average Weekly Wage, and the minimum rate was set at $243.00, 20 percent of the State Average Weekly Wage.





When Will I Begin Receiving Benefits?

You should begin receiving payments within three to four weeks of your injury or illness. The first 180 days after your injury are considered a “Pay Without Prejudice” period where the insurer may pay you benefits without accepting liability. During this time, the insurer may stop or reduce your payments by giving you seven-day notice with their reasoning. After this period, the insurer will likely need permission from you or a judge to stop or reduce payments.




How Do I File For Workers’ Compensation?

If your injury or illness cause you to miss five or more full or partial days of work, your employer must file the Employer’s First Report of Injury or Fatality (Form 101). This form will be filed with the DIA and an additional will be provided to the employer’s Workers’ Compensation insurer with another copy provided to you. The form must be filed within seven days of the fifth missed day. Once the insurer receives the form, they have 14 days to investigate the claim and decide whether or not Workers’ Compensation payments should be provided. If the insurance company determines that the claim should be paid, they will provide you with the Insurer’s Notification of Payment (Form 103). If the insurance company denies your claim, they will provide you with the Insurer’s Notification of Denial (Form 104). This form will explain why they have chosen to deny your claim and will give you notice of your right to appeal.
Regardless of how insignificant you believe your injury may be, it is in your best interest to report it in case it winds up being something more serious. Additionally, to make your case easier to present, you should collect and keep all of your medical bills, records, pay stubs, and all other documents relating to your injury. This will make your case clearer and give you the best chance of receiving the maximum amount of benefits for your injury or illness.
If you were originally hired in Massachusetts but were injured while working out of state, you will most likely have the choice of filing your claim in the state where you were hired, the state where you are primarily employed, and the state where the injury took place.
If you believe you are not receiving the Workers’ Compensation benefits that you should be receiving, you should complete the Employee Claim Form (Form 110). This may be necessary when your claim is being contested, you begin receiving reduced payments, or the insurer stops your payments for a reason you believe to be incorrect.




What is the Process of Filing a Claim?

Conciliation

A conciliation occurs when you file a claim for benefits or the insurer files a complaint to stop or modify your benefits. A conciliation is an informal effort to try to resolve the matter. You, your attorney, and the insurer meet with a conciliator from the DIA where you attempt to reach a voluntary agreement. If a voluntary agreement is not reached, the dispute is not resolved and a conference is arranged.




Conference

A conference is an informal proceeding before an Administrative Judge. Both sides present their cases with documents, such as medical records, pay stubs, and affidavits from witnesses. During this conference, you must show that you were injured, the injury was work-related, and the medical expenses being disputed were necessary. At the conclusion of the conference, the judge issues an order whether payments must be made, payments are not required, or payments may be stopped. This conference order may be appealed within 14 days and a formal hearing in front of a judge will be arranged.




Hearing

A hearing is a formal trial in front of the same Administrative Judge that oversaw the conference. Evidence is presented in accordance with the Massachusetts Rules of Evidence and sworn testimony is taken. The judge will make a final decision on whether or not the Workers’ Compensation benefits must be paid. This decision can only be appealed if a party believes the judge made an error of law in their decision or during the hearing.




Reviewing Board

The Reviewing Board is the authority that oversees the appeal to the hearing. It is composed of two panels of three Administrative law Judges. They may only reverse the decision from the hearing if they find the decision was beyond the scope of the judge’s authority, the decision was arbitrary or capricious, or the decision was contrary to law.





How Long Do I Have to File a Claim?

For injuries that occurred after January 1, 1986, a claim must be filed with the insurer within 4 years of you becoming aware of the causal link between your injury or illness and your employment. If you receive a Notification of Denial, you have 4 additional years to appeal from the date of receipt. If your injury occurred before January 1, 1986, you must file a claim within 1 year of becoming aware of the causal link between your injury or illness and your employment.




What Happens If I Return to Work?

If you return to full-time work after collecting Workers’ Compensation benefits, your benefits will be discontinued. However, if you are forced to leave work again within less that 28 days as a result of the same injury or illness, your insurer is required to resume your payments. In order for these payments to resume, you must report your renewed disability to the insurer, in writing, within 21 calendar days of leaving work again.




Will My Relationship With My Employer be Affected?

Your employer has Workers’ Compensation insurance for instances like this. Your employer will be upset that you have to miss work but they will most likely want you to get better and return to work as soon as you can. Even if your employer does become upset, it is against the law to retaliate against an employee for filing a Workers’ Compensation claim.




Should I Hire an Attorney?

You are not required to hire an attorney in order to file a Workers’ Compensation claim. However, in many instances, it may be in your best interest to hire legal counsel. Half of Workers’ Compensation claims are not disputed by employers or insurers. These cases likely do not require an attorney. Additionally, if your injury is insignificant and you get back to work quickly, you probably do not need legal assistance. However, if your claim is disputed, it is strongly advised that you seek legal counsel. If your injury is more significant and keeps you out of work for a significant period or if there is are disputes about things such as your employment status, whether your injury or illness is work-related, or whether you are able to return to work, it may be wise to hire an attorney to ensure you receive the proper treatment and benefits you deserve.




Why Choose Peter Russell to Represent You?

You want a lawyer with experience dealing with various employers and familiarity with insurance companies and Workers’ Compensation cases. You want a lawyer who genuinely believes in your case and wants to help you. Peter Russell and the lawyers of Russell & Associates are considerate and willing to do anything possible to help you get the money you deserve.
Over the past three decades, Gary Orlacchio has successfully helped numerous clients recover the money they deserve. He is an experienced attorney with a track record of success.
The Workers’ Compensation Law Judge sets attorney fees in Workers’ Compensation cases. You will be charged nothing up front. Fees are collected from a portion of the benefits you receive upon the conclusion of your case.
Russell & Associates will strive to help you if your case is solid, giving you direct access to the full team – you’ll be able to speak directly to an attorney, not a claims processor – and putting the top lawyers to the task of getting you all the money you deserve. Get in touch today to discuss your Workers’ Compensation issue.