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Denied Workers' Compensation Claims

In the Commonwealth of Massachusetts, the Executive Office of Labor and Workforce Development (EOLWD) advises all claimants to obtain legal representation to assist with the claims process. However, many injured employees choose to file a workers’ compensation claim without consulting an attorney, and many of these claims result in a denial of benefits.

It is important to understand that a denial does not mean all hope is lost when it comes to obtaining benefits. There is often a lot that can be done to fix the situation but you should contact at attorney who regularly handles workers’ compensation claims as soon as possible to maximize your chances of obtaining a full and appropriate benefits award.

As our Boston workers’ compensation attorneys at the Law Offices of Jeffery S. Glassman, LLC can explain, when your employer’s insurance company denies your claim, there are certain steps that must be taken, preferably with assistance of an experienced attorney in a timely fashion.

The first thing that must happen is an Employee’s Claim Form must be submitted to the Department of Industrial Accidents (DIA). Medical evidence beneficial to your workers’ compensation claim should be submitted to the DIA along with the form. Your attorney will be able to assist you in determining which information is beneficial to your case and which information may not be as helpful to your claim of an on-the-job injury.

Conciliation in Massachusetts Workers’ Compensation Cases:

Once the DIA receives your claim package, they will schedule a Conciliation to occur within two weeks. This may be longer due to an administrative backlog, but the target is two weeks. Conciliation is the first stage in the Dispute Resolution process. A workers’ compensation befits insurer in Massachusetts can also file an Insurer’s Complaint for Modification, Discontinuance or Recoupment of Compensation form when it intends to stop or change your benefits and needs agency permission. This will also start the formal process.

During the conciliation process, the parties will try to reach a workers’ compensation settlement at an informal meeting between you, your attorney, and the insurer. It is best not to attend this meeting without first consulting with an attorney. If a settlement cannot be reached, the case will be referred to a DIA judge for a formal conference.

Workers Compensation Conferences in Massachusetts:

A workers’ compensation conference in the Commonwealth of Massachusetts is a formal meeting before an Administrative Law Judge (ALJ). While this is not a hearing, and no witnesses will testify, your attorney can present evidence and explain how witnesses would testify through the use of affidavits. The ALJ will issue an order at this stage in the process, but that order can be appealed in order to have a formal legal hearing.

Appeal Hearing in Massachusetts Workers’ Compensation Cases:

The appeal hearing is a formal hearing before the same ALJ who handles the conciliation process. At this hearing, your attorney will be able to present evidence, cross-examine witnesses, and argue for your rights to workers’ compensation benefits. The rules of Evidence for the Commonwealth of Massachusetts apply during this hearing. Again, EOLWD strongly urges claimants to seek legal representation at this stage in the process, if they have not already done so.

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