JOHN BENA III ATTORNEY AT LAW
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MA Workers Comp Benefits

                  THE MASSACHUSETTS WORKERS' COMPENSATION SYSTEM

State workers' compensation statutes were originally designed to provide employees an alternative to filing a law suit against their employer. The primary purpose of the law is to provide weekly disability checks and prompt payment of medical bills for injured workers. In Massachusetts, if you are totally disabled, you are entitled to payment in the amount of sixty percent (60%) of your average gross pay. If you have worked for at least a year, the fifty-two (52) weeks immediately preceding your injury should be used to calculate your average weekly wage. There can be exceptions to this rule. If you have lost more than two (2) weeks of work during the preceding year, some weeks may be subtracted from the calculation of your weekly rate, in order to increase the average earnings calculations and your weekly benefit check. Many individuals are injured at work before they have been employed a full year. There are special rules that apply to such individuals. A personalized review of your situation by an attorney is often helpful to make certain that you are receiving the highest weekly check allowed by law. 

Factors other than your average pre-injury wage can influence your weekly benefit entitlement.  If you are receiving unemployment compensation, the Massachusetts law states that you are disqualified from receiving total disability benefit payments (although not necessarily partial disability) for the same weeks.  Applying for or receiving unemployment benefits can adversely impact your workers' compensation payments, as you will be representing to unemployment that you are capable of working and actively seeking a job.  It is important to discuss such issues with a qualified attorney before deciding to accept unemployment or other benefits that may impact your case. 

If you are eventually determined to be permanently and totally disabled, your weekly check will be payable at two-thirds (2/3) the amount of your pre-injury average earnings. If you qualify for this category of benefits, your weekly rate may be subject to yearly Cost of Living Adjustments (COLA). With the exception of permanent and total disability benefits, which can be paid for life, weekly benefits can only be collected for limited periods of time detailed by the law. It is therefore important to plan your approach to what is a complicated benefit system.

Given what has been said, it is easy to understand that employee and insurance companies often end up fighting each other. For example, the Massachusetts law allows insurance companies to begin payment to an employee and then terminate benefits within the first six (6) months of disability. The insurer can do this without your permission or the permission of a court or agency. Your benefits can be terminated despite the fact that you continue to have serious medical problems which prevent you from working. This often leaves an employee without a weekly check and with no way to pay for ongoing bills and treatments. When this occurs, it is important that medical and other evidence be organized as quickly as possible and that a claim for further benefits be filed with the Department of Industrial Accidents. Proving such a claim requires experience with legal procedures of the Departmentand knowledge of the medical and legal questions involved. It also requires experience in the presentation of the case at trial.


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          MEDICAL COVERAGE

An important benefit provided to injured workers is the insurer's payment of reasonable and related medical bills. Many insurers systematically review proposed services before they will approve payment. This is called Utilization Review. If the service is approved, treatment usually occurs without difficulty. However, should the insurer question the reasonableness of the treatment or the relationship of the treatment to your injury, there may be a legal dispute that can only be resolved by filing a claim before the Department of Industrial Accidents. Your case will eventually be schedule for a Conference before an Administrative Judge of the Commonwealth. It is helpful, if not essential, to have an experienced compensation attorney organize all medical exhibits to persuade the judge to issue an order mandating payment of your medical treatment. Failure to prevail at a conference can delay medical treatment indefinitely, while a full hearing (administrative trial) is completed.
    PERMANENT LOSS OF FUNCTION

An employee who suffers a permanent loss of physical function or permanent disfigurement, is entitled to additional payments from the insurance company. In order to qualify for such benefits, the insurance company typically requires proof of such a loss by formal medical opinions. These opinions must state the percentage of functional loss (using AMA Guidelines), the causal relationship of such loss to the work injury and state that such loss will not improve with further time or treatment. Many companies do not inform injured employees that they are entitled to these payments. It is often best to obtain the necessary doctors opinions with the assistance of an attorney familiar with the specialized guidelines, in order to maximize the amount of money recovered.

No professional fee will be charged for discussing your initial questions and concerns.

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