Massachusetts' system of workers' compensation is compulsory, meaning that employers are required to provide workers' compensation insurance to their employees. Workers' compensation insurance may be provided through private insurance carriers or self-insurance. Waivers may be permitted to exclude certain employees from coverage, including corporate officers and sole proprietors.
Exemptions from coverage may apply to certain employees, including certain part-time domestic employees, casual labor, and professional athletes. Police officers and firefighters are covered by a separate compensation system.
Medical Benefits are provided to employees entitled to workers' compensation benefits, with medical care subject to a fee schedule set by the state. Benefits are normally payable for up to four years from the date that the worker learns of the work-related injury.
The employee makes the initial choice of treating physician. The employee may ordinarily make one change of physician, with any subsequent change being subject to approval by the employer or insurance agency.
Indemnity benefits are payable to injured workers to help make up for lost income. There is a waiting period of 5 days before a worker is eligible for indemnity benefits, but if the worker's disability lasts more than 21 days indemnity benefits become retroactive to the date of the injury.
Benefits available to injured workers include the following:
Temporary Total Disability (TTD)
Temporary total disability (TTD) benefits are paid to workers who are unable to work due to injury, but who are expected to make full or partial recovery such that they may return to work. Benefits are based upon 60% of the injured worker's average pre-injury weekly wage, subject to a cap, and continue for up to 156. Offsets may apply for unemployment insurance, and benefits may be subject to child support liens.
Permanent Total Disability (PTD)
When a worker is not expected to recover from a total disability caused by a work-related injury, and as a result suffers a total loss of earning capacity, the worker becomes eligible for permanent total disability (PTD) benefits. In Massachusetts PTD benefits are calculated based upon 2/3 of the injured worker's pre-injury weekly wage, subject to a cap, and may continue indefinitely. Benefits are periodically adjusted for inflation. Offsets may apply for Social Security benefits.
Permanent Partial Disability (PPD)
Once an injured worker has recovered to the maximum possible extent, the worker may be able to return to employment but nonetheless remain partially disabled, and in most states may potentially qualify for permanent partial disability (PPD) benefits. Massachusetts does not follow the standard approach, instead providing for the payment of temporary partial disability (TPD) benefits, with additional compensation potentially available for for permanent loss of bodily function and permanent bodily scarring and disfigurement. Where an injured worker suffers a loss of 75% of more of an important body function or sense, has contracted a permanently life-threatening condition, or has contracted a permanently disabling, physical occupational disease, the worker may be eligible to receive benefits for up to 364 months or, with the consent of the insurance company or by order, up to 520 weeks.
Temporary Partial Disability (TPD)
When a worker suffers an injury that limits his ability to return to work, resulting in a reduction of income as a result of reduced hours or wages, the injured worker may be eligible to receive a benefit based on the difference between the worker's pre-injury earnings and their reduced, post-injury earnings. In Massachusetts, TPD benefits are paid based upon 60% of the difference between the injured worker's pre-injury and post-injury wage, subject to a cap. Benefits may be received for up to 260 weeks, or for up to 364 weeks in combination with a TTD claim.
For some, more serious injuries, workers' compensation indemnity benefits may be paid according to a statutory schedule, instead of following the standard model of the weekly benefit based on the duration of the disability. Scheduled injuries include such injuries as the amputation of an arm, the loss of a dominant hand, the loss of a leg, the loss of a foot, the loss of an eye, or loss of hearing in an ear.
Coverage may be available for cumulative trauma, disfigurement, mental stress and occupational hearing loss.
When a worker dies as the result of a work-related injury, workers' compensation pays additional benefits, including a burial allowance, and benefits for a surviving spouse and dependents. Survivor benefits are calculated based on 2/3 of the worker's average weekly wage, subject to a cap in amount and duration. Benefits may continue for minors until the age of 18, or indefinitely in the event of disability, subject to the cap.
Attorney fees are limited by statute to 20% of a lump sum settlement or award. If liability is not established, the attorney fees are limited to 15% of the lump sum settlement. Attorney fees are subject to review by the Department of Industrial Accidents.
This article provides a quick overview of the benefits available to injured workers, but the full formulas used for assessment of benefits, coordination of different types of benefits, and assessment of injuries and disability ratings can quickly complicate the determination of benefits. Also, states frequently revise their workers' compensation laws. Most workers who suffer a significant injury or wage loss as the result of a workplace injury will benefit from consulting a workers' compensation lawyer.
The state agency responsible for workers' compensation is:
Massachusetts Executive Office of Labor and Workforce Development
Department of Industrial Accidents
1 Congress Street, Suite 100
Boston, MA 02114-2017
(617) 727-4900 or 1-800-323-3249