Workers' Comp Benefits FAQs

You become eligible for workers’ compensation benefits if you are an employee who suffers a work-related injury. This can include an injury that results from an accident as well as a repetitive stress injury or an illness that develops because of exposure to chemicals or toxins at work. It does not matter where the injury occurs as long as it is work-related and happened while performing required tasks for your job. This means you can receive workers’ comp benefits even if you were hurt at a location outside of your normal work site. 

Benefits for workers’ compensation can include payment of medical bills and costs as well as payment of lost wages. Additional compensation is available for certain types of specific and ongoing or permanent injuries such as the loss of a limb or disfigurement. If a death occurs as a result of a work-injury, then surviving family members can be entitled to benefits including payment of funeral expenses.

When you report an injury to your employer, your employer has to submit a form to the workers’ compensation insurer. The insurer will have 14 days to investigate and to either approve the claim and begin benefits payments or to deny the claim and provide a reason for the denial.

You will be entitled to begin receiving lost wages benefits once you’ve missed at least five calendar days of work time. If you miss 21 or more days, then you’ll also get paid for those first five days.

Lost wages are calculated by considering your average weekly wage prior to the injury. If you have suffered a temporary disability, you may receive as much as 60 percent of your lost income or wages for up to three years. If your disability is a partial disability, then you can receive up to 60 percent of the difference between what you were making before the accident and what you are making after the accident. You may only receive temporary disability benefits- including full and partial disability benefits- for seven years total except in limited circumstances where you may receive up to ten years of benefits. If your disability is a permanent one, however, then you may receive weekly benefits equal to 2/3 of your average weekly wages for the rest of your life.

When determining your average weekly wage, non-salary compensation including contribution to pension plans or health plans are counted.

Your average weekly wage is used to determine the weekly compensation you will receive for lost wages. Union fringe benefits are not factored in when determining your average weekly wage.

Your weekly compensation for workers’ compensation disability benefits is based on total wages earned at the time when you were injured. The total wages earned are used to determine your average weekly wage. If you worked more than one job and you were covered under workers’ compensation for both jobs, then the weekly wages from both jobs are factored in and used to calculate average weekly wages.

There is a minimum workers’ compensation rate. This minimum changes on October 1 each year. As of October 1, 2012, the minimum weekly compensation rate is $234.61. This minimum will remain in effect through September 30, 2012.

There is a maximum weekly workers’ compensation rate. This rate changes on October 1 each year. The rate effective between October 1, 2012, and September 30, 2013, is $1173.06 per week. Even if your weekly lost wages exceed this amount, you cannot receive more than this maximum per week.

Total disability benefits are paid if you are not able to work at all, in any capacity or any job. Partial disability benefits are paid if your income-potential is reduced as a result of your work injury. For instance, if you were working in construction and making $1,000 per week and you suffered a work injury making it impossible to work in construction, you might be able to get a different light-duty job making only $500 per week. In this case, you would experience lost wages equal to $500 per week- the difference between what you made before your work-injury and what you can make now that you are impaired or disabled. Because you can work but are partially disabled, you would receive workers’ compensation benefits equal to a portion (60 percent) of the difference between what you made before the work accident and what you are making after.

Total disability benefits, on the other hand, are paid if your injury or work-related illness has made it impossible for you to work at all.

Permanent disability benefits are benefits paid if you have an ongoing medical condition that is never going to improve and that impairs you in some way from earning the money you made before the condition or injury occurred. Once you have reached maximum medical improvement and are not getting any better, you can be considered permanently disabled if you are still not in optimal health and ready to resume your prior work.

If you are temporarily disabled, on the other hand, then you may still be improving and may be able to resume work or to resume more demanding work soon. You can receive temporary disability benefits until you are ready to go back to work or until your time limit of seven to ten years has passed.

You may be able to settle your workers’ compensation claim for a lump sum payment. Many people prefer this option so as not to continue an ongoing relationship with a workers’ compensation insurer or as a result of a dispute regarding what an insurance company’s obligations are. Before you settle your case, however, you need to determine if the lump sum settlement offer is fair. Never feel pressured into settling or accepting a settlement and be sure to have an experienced attorney read over any potential settlement that you might be considering in order to be sure you do not accept less compensation than you deserve and should receive.

Insurance companies are not required to offer a lump sum settlement to settle workers’ compensation cases. If you wish to settle and the insurance company is unwilling to offer a settlement, it may be helpful to work with an experienced Boston workers’ compensation lawyer to negotiate with the insurance company on your behalf.

If you settle your workers’ compensation claim for a lump sum, then the insurer may still continue to pay your ongoing medical bills and costs. However, this is not necessarily the case in every situation since each settlement agreement may have its own unique terms and provisions. If you have ongoing medical problems, it is especially important to speak with a lawyer before you settle your case so you make sure these future medical costs are covered.

If you are injured at work and your medical problem or disability has caused an impairment preventing you from returning to your old job, you may be entitled to receive vocational counseling and training to help to retrain you for a new possession. Your insurance company can be required to pay for vocational testing; job counseling; assistance with job placement; workplace modifications; and job training. You may also seek help from the Office of Educational and Vocational Rehabilitation (OEVR).

Neither the state government in Massachusetts nor the federal government tax workers’ compensation benefits.

Workers’ compensation provides broad and ongoing coverage of medical costs. This means that essentially all reasonable and customary medical benefits are covered including surgeries, emergency care or hospital visits. Your medical bills should be sent right to your insurance company and there should not be a co-pay associated with receiving treatment covered by workers’ compensation.

Workers’ compensation benefits do not provide compensation for pain and suffering and you may not sue your employer for a work-related injury. However, for certain types of injuries including blindness, deafness, disfigurement, loss of a limb, paralysis or other serious and life-changing conditions, you may receive a designated cash payment in addition to your other workers’ compensation benefits.

If you have suffered certain types of personal injuries, you receive a designated amount of compensation based on the nature and the severity of the injury you face. A Boston workers’ compensation lawyer can help you to determine if your work injury qualifies you to receive additional compensation.

Benefits can potentially continue indefinitely for the rest of your life. While some benefits, such as temporary disability benefits, have a designated endpoint, others don’t. Insurers, for example, may have to pay total disability benefits to a person from the time he is injured until the time that he dies.

Workers’ compensation benefits can stop if you have recovered fully, no longer need medical treatment and can return to work. Workers’ compensation benefits can also stop or be reduced if you do not comply with certain requirements. For instance, if you are required to submit to an independent medical examination because the workers’ compensation insurer is investigating your claim or level of improvement and if you refuse to submit, then your benefits can be stopped.

As long as you meet the distinct eligibility requirements for both workers’ compensation and social security disability benefits, you may collect both. However, your social security disability benefits may be reduced based on the amount of workers’ compensation benefits you are receiving.

Workers’ compensation was created to protect every worker. If you are not getting the benefits you deserve and that you are entitled to under Massachusetts’ law, you need to contact an experienced legal team at Jeffrey Glassman Injury Lawyers today. Schedule a free consultation to learn how we can help.