Untangling the Workers’ Compensation web

The basic premise of workers’ compensation is that the employer provides wage replacement and payment of medical expenses for employees in relation to work-related injuries, illnesses, or death. In exchange, employees must agree to forego their right to sue the employer for damages in connection with the injury, illness, or death. Every state has its own Workers’ Compensation laws. For example, in Massachusetts, employers are required by law to have workers’ compensation insurance, and claims for benefits must be filed with the Department of Industrial Accidents (DIA.)

Employers must file a “First Report of Injury or Fatality” form (Form 101) with their insurer and the DIA within seven calendar days of notification of an incident. Failure to do so is a violation of the Massachusetts Workers’ Compensation statute. Three violations in the same year will result in a fine of $100 per violation, which employers must pay or appeal within thirty calendar days. If the insurer fails to pay or contest payment of a claim in a timely manner, a $200 fine may be assessed, payable to the injured worker. Further delays may result in fines payable to the Workers' Compensation Trust Fund.

If your employer fails to send the Form 101 to their insurer, you should report your claim to the insurance company yourself or complete the DIA’s “Employee’s Claim Form” (Form 110.) When the DIA has received your Form 110, it will schedule Conciliation (informal meeting between you and your employer’s insurer) in the department office closest to your home. The agreement that you reach during Conciliation will be non-binding unless you agree to be so bound.

If the conciliator refers your case to an administrative judge, an informal conference will be scheduled in which the judge will issue a temporary order regarding compensation. Both the employee and the employer’s insurer retain the right to appeal the decision within fourteen days of its filing date. At that point, it will go to a formal hearing similar to a trial. If still unsatisfied, you may appeal to the review board within thirty days of the decision. Keep in mind, however, that the decision is only subject to reversal if it was beyond the judge’s authority, in conflict with the law, or unjustified.