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Permanent and Total Incapacity in Boston Disability Claims

When you are injured on the job in Boston, if you wish to be compensated for your time, you cannot work, and, to pay for your past and future medical bills, you will need to file a workers’ compensation claim with your employer.

workers' compensation lawyer BostonThere is a process established in Chapter 152 of the Massachusetts General Laws (MGL), which makes up the Workers’ Compensation Act (WCA).  Pursuant to the various sections of Chapter 152 of the MGL, you must first report the injury to your employer and make sure it generates an accident report. If you are in need of medical attention or missing work as a result of the workplace accident, or both, you must file a workers’ compensation claim with your employer.

Once you file a claim for workers’ compensation in Boston, your employer must submit that claim to its workers’ compensation insurance company. If the employer fails to do so, you can file a claim with the Massachusetts Department of Industrial Accidents (DIA).

Once your employer has filed a claim with its workers’ compensation insurance company, it has around two weeks (depending on the type of claim) to notify you that they will honor the claim and start paying workers’ compensation benefits, or deny your claim.  If they honor your claim, they will assign you what is known as a disability rating. While most jurisdictions use the term disability, the Commonwealth uses the term incapacity, but the way the rating works is that you will either be considered totally incapacitated or partially incapacitated.

As the name implies, with a total incapacity rating, you cannot work at all as a result of your on- the-job injury.  You can also get workers’ compensation for an illness that is related to your employment, but, in the Boston area, the vast majority of workers’ compensation benefits are paid for workplace injuries instead of work related illness. One reason for this is likely because we do not see that many industrial jobs that use harsh chemicals that cause illness left in our city.  However, decades ago, this was certainly not the case, as Boston was the home to many industrial giants and a large ship building industry.

With respect to your disability rating, if you are given a rating of a partial impairment, it means that you cannot work in the same job or for the same number of hours and are thus making less money but still working.  In a case such as this, you will be entitled to benefits calculated as a percentage of the difference between your pre-injury wage and your post-injury wage. The reason it is a percentage and not the entire difference is because the insurance companies lobbied lawmakers around the country to believe that if they paid the actual amount of lost wages, it would encourage people to sit at home and collect a check when they could be working.  In reality, it is not about that but rather the insurance company wanting to make more money by paying out less in benefits, and, while that is not at all fair, it is not likely to change in the near future.

If you are denied benefits, or you disagree with your disability rating and thus the amount of money being awarded, you can file a claim with DIA, and they will first schedule what is known as a conciliation. This is an informal meeting between the insurance company, the claimant, and a person known as a conciliator. You are not required to have a Boston workers’ compensation lawyer at this meeting, but even DIA strongly recommends you have one at the meeting, because an attorney will likely represent the insurance company and that would put you at a disadvantage if you are not represented.  If you are worried about not being able to afford an attorney, that should not be a problem, because there is no fee unless you are successful in obtaining workers’ compensation benefits.

At this meeting, the conciliator can work to reach a settlement among the parties, but he or she has no authority to order any particular workers’ compensation award or to make the parties reach a settlement.  If you are not able to reach a settlement, then you can request a hearing before an administrative judge (AJ) with DIA.  However, before you are granted a hearing, you will need to have a conference with an AJ.  At this conference, it is still somewhat informal, but you can present evidence and at the conclusion or the conference, the AJ will be able to review the evidence and submit an order. This order is temporary, in that you can challenge it if you do so within the appropriate time.

Quast v. Utah Labor Commission

In Quast v. Utah Labor Commission, a case from the Supreme Court of Utah, a claimant was awarded workers’ compensation benefits on grounds that established her claim that she was permanently and totally disabled. However, the employer appealed the administrative law judge’s (ALJ) award of benefits on grounds that there was not sufficient evidence to establish her claim. The commission agreed with the employer and set aside her award of workers’ compensation benefits. She then appealed to the court of appeals, and that court concluded that the ALJ’s original order should stand and awarded her benefits. However, at this point, the employer appealed to the state supreme court.  At this level of appeal, the court concluded the ALJ was incorrect and that she had not established her claim of disability benefits.

While this is not the answer most claimants want to hear, it goes to the show the extent to which an employer, or more likely the employer’s workers’ compensation issuance company will go to deny paying benefits in many cases. As we said before, the insurance company is trying to maximize profits by paying as little in claims as possible.  For that reason, the best thing you can do is make sure you have an experienced workers’ compensation attorney as early in the process as possible, so you can increase the chances that things will be done right in the beginning, rather than having to go back and correct things that have not gone as well as you would have liked.

If you or someone you love has been injured a Boston work accident, call for a free and confidential appointment at 1-888-367-2900.

Additional Resources:

Quast v. Utah Labor Commission, July 26, 2017, Utah Supreme Court

More Blog Entries:
Report: Three Workers Burned in Natural Gas Explosion, Feb. 18, 2017, Boston Workers’ Compensation Lawyer Blog