What are My Benefits?
A work-related injury necessitating five or more days away from the job is compensable through the Massachusetts workers’ compensation system.
We know these benefits are critical to the financial well-being of our clients, and we will fight tirelessly to ensure the injured worker’s rights and interests are protected.
Knowing which benefits are available and which you are likely to receive can be helpful for injured workers and their families as they plan for the next chapter.How Long Must I be at My Job to be Covered by Workers’ Comp?
Virtually all employees – full and part-time – are covered under the Massachusetts Workers’ Compensation Act, codified in MGL ch. 152, and it covers workers from the moment they are hired.
There is no waiting period for workers to be covered under the law. In fact, there are numerous reported incidents – particularly in the construction industry – of workers who are hurt their very first day on the job. Often, this is a result of inadequate training or failure to give new workers the right equipment.
The only waiting period that exists for benefits is the five calendar days the employee must be out-of-work as a result of the job-related injury. Benefits will begin on that sixth day. However, if a person is out-of-work for longer than 21 days, the insurer will be required to pay for those first five days. Workers who miss more than five days but less than 21 days will not be reimbursed for those first five days off.How Long do Weekly Benefits Last?
The answer to this question depends on the severity of your injuries, as determined by your doctor, insurer or, in contested cases, the Department of Industrial Accidents or appellate court.
- A worker who is temporarily totally disabled may receive up to 60 percent of his or her weekly average wage for up to 3 years.
- A worker who is partially disabled can receive up to 60 percent of the difference between their wages pre-injury and their earning capability post injury for up to 5 years.
- The total amount of time a worker can receive partial and total disability benefits is capped at 7 years. In limited circumstances, it could be extended to 10 years.
- If the worker is rendered totally permanently disabled, he or she may receive benefits for life.
The determination of whether a worker is totally or partially disabled will depend on a host of different factors, including the injured worker’s:
- Work experience
- Fluency in spoken/ written English
- Extent of disabilities as a result of the occupational accident/ illness
Even when a doctor classifies a worker as “totally disabled” from a medical standpoint, an administrative law judge with the Department of Industrial Accidents will analyze all of these other elements to reach a conclusion about the worker’s earning capacity.
This involves not just looking at whether the person can do the job he or she held before the accident, but whether it is possible for him or her to do other types of work. If the judge determines other work is a possibility for the worker, a determination of total disability may not be granted.
This is one aspect of the process where an experienced workers’ compensation lawyer can have a huge impact. Proving to the judge the worker is unqualified or unable to perform other types of work requires a substantial amount of evidence, and usually the testimony of more than one expert witness. The answer is often subjective, so it comes down to which side makes the most compelling argument.Minimum/ Maximum Weekly Benefits
Every year on Oct. 1, the Commonwealth, via the Commissioner of the Division of Unemployment Assistance, sets the minimum/ maximum weekly compensation rate for workers’ compensation recipients.
As of December 1991, these benefits run for a maximum of 156 weeks. The available amount increases nominally each year.
For example, the minimum weekly compensation rate was raised from $234.61 in 2012 to $236.26 in 2013 to $243 in 2014.
Meanwhile, the maximum weekly compensation rate increased from $1,173.06 in 2012 to $1,181.28 in 2013 to $1,214.99 in 2014.How Are My Benefits Calculated?
The insurance company paying your benefits will calculate your average weekly wage by first obtaining your pay stubs, dividing your total gross wage (including bonuses and overtime) by the number of weeks worked.
Totally disabled workers are entitled to 60 percent of this figure. Partially disabled workers will receive 60 percent of the difference of what they would have made had they not been injured.Taxes
Workers’ compensation payments – unlike short-term and long-term disability and even Social Security Disability Insurance – are not taxable by either federal or state income tax laws.When do Benefits Checks Start?
Checks should be received within three-to-four weeks of the work-related injury or illness.
The first 180 days after the injury constitute the “Pay-Without-Prejudice” period. During this time, the insurance company can pay you benefits without making a final decision on the case or accepting liability.
Also during this time, an insurance company can stop or reduce your payments simply by issuing you a seven-day written notice. However, there must be reasons cited for this action. When insurance companies continue to pay workers after this time frame, they need permission from a judge to stop or reduce benefits.
Insurers can ask an administrative law judge to extend the “Pay-Without-Prejudice” time frame.
If you receive notice that the insurer intends to stop or reduce your workers’ compensation benefits, contact a lawyer immediately to determine your rights and obligations.
Contact the Law Offices of Jeffrey S. Glassman today for a free and confidential consultation.
Call (617) 367-2900 – NO FEE UNLESS SUCCESSFUL