A very high percentage of applications for workers’ compensation benefits in Massachusetts are denied. Fortunately for injured workers, the workers’ compensation statute provides a multi-level appeal process in which an injured worker may be able to obtain a reversal of the initial denial.
The first level of appeal is a written appeal to the Department of Industrial Accidents. The worker must provide the date of the injury, the first calendar day of missed work, the employer’s workers’ compensation insurer, the nature of the injury or illness, the nature of the benefits that are being requested, the potential number of days off work, the name of the first provider seen for treatment and the current provider.
The worker must also provide Form 110 and a copy of at least one of the following: unpaid medical bills medical reports, any reports that show or describe how the accident happened, witness names and witness statements. Copies of these documents must also be provided to the employer’s worker’s compensation insurer. After reviewing the claim, the DIA can respond in one of two ways: reject the appeal because it does not comply with applicable appeal procedures (the DIA must specify the nature of the failings), or if the appeal is formally correct, schedule a meeting with a workers’ compensation conciliator to discuss the claim.
If the conciliation meeting fails to produce an agreement, the worker can request a full evidentiary hearing to review the evidence. This hearing is conducted much like a court trial. Both parties are allowed to offer new evidence that is relevant to any issue in the case. The DIA will provide a ruling on the issues. Either party may appeal this ruling by filing a notice of appeal with the Workers’ Compensation Reviewing Board within 30 days. Any party dissatisfied with the Board’s ruling may seek further review in the Massachusetts Court of Appeals.
Each step in the appellate process if a bit more complex than its predecessor, and the need for retaining an experienced attorney becomes more acute. Any person considering appealing an adverse decision on a compensation claim may wish to consult a lawyer.