If your employer’s insurance company has denied your workers’ comp claim for a work-related injury or illness, you may be wondering how you can challenge that decision. This article explains common reasons that insurers deny claims and how to file an appeal with the Massachusetts Department of Industrial Accidents (DIA), the agency that oversees the state's workers’ comp system and reviews disputes.
Your workers’ comp claim can be denied if you delay in reporting your injury or illness. You should notify your employer immediately (or as soon as it's practical) after you're injured on the job or learn that you have an occupational disease. Once you've given this notice, your employer should file report of the injury with its insurance company and the DIA. But if your employer won't do that, you need to notify the insurer and DIA yourself by filing Form 110. (For more information, see How to File a Workers’ Compensation Claim in Massachusetts.)
The insurance company may also deny your claim if it decides your injury or illness doesn’t meet the requirements for “arising out of and in the course of employment.” This is legal jargon for injuries that were caused by your work and happened while you were doing your job. Here are a few situations in which workers’ comp won’t cover your injury in Massachusetts:
See Denied Workers Compensation Claims to learn about other common reasons that insurers deny workers’ comp claims.
You can file an appeal with the DIA if the insurance provider denies your workers’ comp claim. First, you need to file an official claim (Form 110) and include the following information:
the date of your injury, the date of your first day of missed work, and the date of your fifth day of missed work
the name of the insurance provider
your injuries and the benefits that you’re claiming
medical treatment you’ve received and the name of your doctor, and
how much work you expect to miss.
In addition, you must provide copies of unpaid medical bills, medical records, witness names and statements, and any documents that explain how the injury happened. You must file this claim form within four years after the date of your injury, the date you learned that your medical condition was related to work, or the date you received notice of the insurance company’s denial. If you haven’t already done so, you should also consider hiring a workers’ comp attorney to guide you through the appeals process.
There are several possible steps in the workers’ comp dispute resolution process in Massachusetts:
The workers’ comp appeals process can be complicated and requires detailed knowledge of Massachusetts workers’ comp law and the Department of Industrial Accidents. An experienced workers’ comp attorney can explain the legal procedures involved and guide you through the appeals process.