There are any number of reasons why workers’ compensation benefits might be denied for a particular workplace injury or disabling condition. Fundamentally, it’s important to remember that a workers’ compensation insurer may deny your claim, in essence, simply “because it can.” The insurer can refuse to pay benefits unless you come forward with specific proof establishing your work-related injury.
As an injured employee, it’s your burden under Massachusetts workers’ compensation law to prove the essential facts necessary to establish a case warranting the payment of compensation. If you believe your workers’ compensation claim was wrongfully denied, the workplace injury lawyers at Kantrovitz & Associates, P.C offer free case evaluations.
Contact us online or call us toll free at (800) 367-0871 to speak with an experienced workers’ compensation attorney at Kantrovitz & Associates, P.C. We have more than 20 years of experience fighting for the rights of individuals injured in the course of their employment.
Based in Boston, Massachusetts, the workplace injury lawyers at Kantrovitz & Associates, P.C. help injured workers across Massachusetts, including but not limited to Boston, Essex, Middlesex, Norfolk, Suffolk, Plymouth and Merrimack River. We also represent Rhode Island and New Hampshire residents whose injuries occurred in Massachusetts or who were hired in Massachusetts but who were injured out of state.
Why Workers’ Compensation Claims May Be Denied
Experience shows that many benefits denials fall within one of several broad categories. Among them:
1. An Employee Doesn’t Properly Report An Injury Or Illness
It’s imperative that an employee report a workplace injury or disabling condition to his or her employer in writing promptly, fully, and accurately. Failing to do so can jeopardize the prospects of receiving the workers’ compensation benefits for which the employee is eligible under Massachusetts law.
Reporting a work-related injury or disabling condition invokes an employer’s responsibility to give notice of the injured employee’s condition to its workers’ compensation insurer, which in turn sets the deadline for the insurer either to begin paying, or to deny, benefits to the employee.
If an employee doesn’t report a workplace mishap or illness promptly, it also becomes more difficult to gather facts about what happened. Memories fade, documents can get misplaced, and physical evidence related to the accident or condition can be lost.
So, no matter how small your injury, report it in writing – promptly, fully, and accurately – to your employer. Note how you were injured, where you were when the injury occurred, what you were doing, and what you think caused the mishap to occur. Also provide the names of any witnesses to your injury. Failure to do so can only put your right to receive workers’ compensation benefits at risk.
2. The Workers’ Compensation Insurer Says An Injured Employee’s Condition Is Not Work-Related
An injured employee is eligible for workers’ compensation in Massachusetts when his or her injury arose out of the course of their employment. Thus a workers’ compensation insurance company may deny benefits on the basis that a particular worker’s injury or condition is not related to the employee’s work.
The insurer may claim, for instance, that the employee suffers from a pre-existing condition unrelated to the employee’s job. This might include a prior injury that the employee experienced, or an ongoing medical condition with which the employee was diagnosed at some earlier time.
Or, the insurer might say that the employee has a naturally-occurring degenerative condition not related to his or her job. Examples might include degenerative disc disease or other joint problems such as arthritis, which often occur as otherwise healthy individual’s age. In many cases, workers develop such conditions over a number years, experiencing no symptoms or other difficulties, and thus a worker may not even realize that an underlying condition exists.
If you receive a denial of benefits from your employer’s workers’ compensation insurer that claims your condition is not work-related, that’s not the end of the story, and you may still be eligible for benefits.
It’s true that pre-existing conditions and degenerative conditions unrelated to work are not compensable under the workers’ compensation system. But, you’re eligible for workers’ compensation benefits if your work-related accident or illness aggravates your pre-existing condition, or if it aggravates your degenerative condition to the point that you begin to suffer symptoms from the formerly non-bothersome condition. Further, the aggravation need not happen due to a single, identifiable mishap at your job; you may be eligible for workers’ compensation benefits if the aggravation of your condition is due to a series of events or the routine demands of your job. This includes repetitive motion injuries such as carpal tunnel syndrome, for example.
3. The Workers’ Compensation Insurer Says The Injured Worker Isn’t A Covered “Employee”
In Massachusetts, workers’ compensation benefits are available to almost anyone who earns a salary or wages from their employer, whether employed full-time or part-time.
What happens, though, when a hurt worker is denied workers’ compensation benefits because the insurance company says the worker is an independent contractor? Independent contractors are not considered “employees,” with the result that they fall outside the mandatory workers’ compensation benefits scheme.
The insurance company’s or your employer’s view of a worker’s status as an independent contractor is often wrong. The Massachusetts Independent Contractor Law imposes a standard for determining whether a person qualifies as an independent contractor. The law presumes that there exists an employer-employee relationship unless someone challenging that status can show three things: (1) the worker must be free from the presumed employer’s control and direction in performing the worker’s service, both according to the parties’ contract and in fact; (2) the service provided by the worker must be of a type outside the employer’s usual course of business; and (3) the worker must be customarily engaged in an independent trade, occupation, profession or business of the same type as that involved in the service that the worker is performing.
Thus someone labeled as an “independent contractor” by a workers’ compensation insurance company or their employer should not assume that he or she can’t get workers’ compensation benefits for an on-the-job injury, without investigating further.
In each of these cases, overcoming an initial denial of workers’ compensation benefits can be a difficult process. Going it alone is a daunting task in which an injured worker and loved ones must fight for benefits in a complex benefits system, all while being opposed by a skilled attorney employed by a workers’ compensation insurer. If you find yourself in that situation, consider retaining a knowledgeable workers’ compensation attorney who can advocate on your behalf with the benefit of years of experience representing injured workers in Massachusetts.
Injured on the Job? Contact Our Workplace Accident Lawyers
The Massachusetts’ workers’ compensation system is designed to ensure that workers who are injured on the job receive paid medical treatment and compensation for lost wages after being fully or partly disabled for five days or more. The experienced workers’ compensation lawyers at Kantrovitz & Associates, P.C., based in Boston, Massachusetts, can help you obtain your full benefits after a workplace accident.
For a free case evaluation of your workers’ compensation claim, please contact us online or call us toll free at (800) 367-0871 to speak with an experienced workers’ compensation attorney at Kantrovitz & Associates, P.C. We have more than 20 years of experience fighting for the rights of individuals injured in the course of their employment.
Our workplace injury lawyers at Kantrovitz & Associates, P.C. help injured workers across Massachusetts, including but not limited to Boston, Essex, Middlesex, Norfolk, Suffolk, Plymouth and Merrimack River. We also represent Rhode Island and New Hampshire residents whose injuries occurred in Massachusetts or who were hired in Massachusetts but who were injured out of state.
