Denial Of A Massachusetts Workers Comp Claim

Following an accident at work, you may be confused by the procedure if you are new to the process.  You are unsure what do and who to turn to for help.  Unfortunately, you discover your claim is denied.  Denial of a Massachusetts workers comp claim happens frequently.

As a Boston workers compensation lawyer, we see insurance companies constantly denying valid and legitimate claims.

This post is intended to let you know what to do if your workers compensation claim is denied.

If you missed five days from work (they don’t need to be consecutive) your employer needs to fill out and send in a Form 101 -Employer’s First Report of Injury/Fatality to its insurance company.  After that, the insurance company has 14 days from when they receive the Form 101 to either deny or pay your claim.

If your Massachusetts workers compensation claim is denied, you will receive a Form 104 – Insurer’s Notification Of Denial.

Denial of a workers compensation claim

Reasons Why Your Workers Compensation Claim Is Denied

The Form 104 will likely list many reasons why your claim was denied.  It may be denied for failure to report the injury, or that you were outside the scope of employment at the time of injury.  It may also state you were not injured, or that your injury stems from a preexisting injury.  Regardless of why it was denied, if your claim is legitimate, you need to appeal the denial.

What Needs To Be Done To Appeal The Denial

Once you receive the Form 104 (which needs be sent via certified mail, return receipt requested), the next step is to file a Form 110 – Employee Claim.  This form need to be filled out completely and accurately.  You also must attach a medical record documenting the injury to the Form 110.

It must then be filed with the Massachusetts Department of Industrial Accidents, and must be sent to the insurance company via certified mail, return receipt.  At this stage it really helps to hire a Massachusetts workers compensation lawyer to help you during this dispute process.

What Comes Next

Once the Form 110 is filed, the next step will be the Conciliation.  That is an informal meeting between you (if you have an attorney he will attend this for you) and the attorney for the insurance company.  If enough proof is presented your claim will be sent forward to Conference.  At this stage you really should have a lawyer on your side.

At Conference your attorney will present your case to the judge, and the insurance company lawyer will present his case to the judge.  A few days later you will receive the judge’s order.  That order can be appealed by either party, and then your case will head to Hearing.

If you have Massachusetts workers compensation questions, contact us for your free, no-obligation consultation.  We would be happy to help you with your Massachusetts workers comp claim.