Massachusetts requires all employers to carry workers’ compensation insurance covering full and part-time employees. However, claim denials can happen for various reasons, leaving workers and their families unable to rely on this benefit.
Knowing how to proceed when an insurer refuses to pay your workers’ compensation can impact your injury recovery.
Why do insurers deny claims?
Insurers deny workers’ compensation claims for various reasons, including:
- Workers’ failure to report the injury to their employers
- Employers’ failure to file an incident report with the Massachusetts Department of Industrial Accidents
- Employers missing the filing deadline
- An injury is due to horseplay
- Employers claim that injuries are not work-related
- Employers categorizing workers as independent contractors
Unfortunately, insurers attempting to reduce claim payments and employers hoping to avoid premium increases impede workers from obtaining the benefits they deserve.
What are the steps for appealing a denial?
Workers’ compensation claim denials can be disheartening for those who cannot resume working due to their injuries and do not have alternative means of financial support. However, it is possible to appeal a claim denial.
First, employees submit paperwork, including injury details, pertinent medical records and witness testimony for use during a meeting with a DIA mediator and the insurer to resolve the matter. Parties who cannot reach an agreement go before a judicial judge who determines the claim’s validity. However, workers may still pursue a denial reversal at a hearing where both parties present evidence supporting their case. An additional appeal to the DIA Reviewing Board is usually the last step workers take to reverse claim denials but sometimes, cases go to the Massachusetts Appeals and Supreme courts.
Workers’ compensation claim denials are common but it is always in a worker’s best interests to pursue benefits through the appeals process.