Four Reasons Why Your Workers’ Compensation Claim May have Been Denied

To you, it seems absolutely clear: you were injured on the job or have a work-related medical condition and your employer carries workers’ compensation insurance. You apply for workers’ comp and expect to receive the benefits. Then you get the dreaded Form 104—the Insurer’s Notification of Denial.

So, why were you denied? The notification—which is from your employer’s insurer, not the state—will spell it out. In fact, of the 2,506 workers’ comp Part B and E claims filed in Massachusetts in 2018, 962 (more than one-third) were denied. There may be a number of reasons, but these four are among the most common:

1. Missed deadlines

When you are injured at work, you should notify your employer immediately. An injury or incident report is completed and typically, your employer files your workers’ compensation claim. Massachusetts law requires that a Form 101, the Employer’s First Report of Injury or Fatality, be filed within seven days following the fifth day of your inability to work because of an injury. If the employer fails to do so, or if your claim has been denied, you must complete and file a Form 110, Employee’s Claim.

The statute of limitations for filing a workers’ compensation claim in Massachusetts is “within four years from the date the employee first became aware of the causal relationship between his disability and (his) employment.”

2. Disputes about whether your injury was actually work-related

If you are an employee who was injured at work, or while performing a task or completing a duty that was for your employer’s benefit, chances are you have a legitimate claim. That is also true if you have a medical condition that is a direct result of your employment (for instance, carpal tunnel syndrome or mesothelioma). In short, a condition or injury “arising out of employment and occurring during the course of employment” should be covered. Injuries that occurred during commuting to and from work are not covered, but if you were traveling for business reasons and were injured, they are. While some medical conditions may be clearly the result of the work environment or job, such as black-lung disease among coal workers, lung cancer may not be easily attributable to your employment.

3. Massachusetts guidelines are not met

If you are an independent contractor, you are not eligible for workers’ compensation coverage by the business or company for whom you are providing services. An independent contractor is defined as doing work that is outside of the employer’s direction and control; is performed outside the employer’s usual course of business; and is done by someone who has their own, independent business or trade doing that kind of work.

Other workers who are not typically covered include seaman engaged in interstate or foreign commerce, salespeople who work on commission or buy/sell basis other than in a retail establishment, with a written contract stating they are not treated as an employee under federal tax law; and Persons engaged in interstate/foreign commerce who are covered by federal law for compensation for injury or death.

4. Files claimed after leaving a job

Even legitimate claims are viewed with suspicion by insurers when they are filed after an employee quits, is laid-off or fired from a job. It’s always important to have a written statement about any injury for which you file a claim, including medical reports and corroborating statements from coworkers who witnessed the accident.

When should you seek legal advice?

Workers’ compensation laws can be confusing. If your claim has been denied, a Beverly workers’ compensation attorney can offer valuable assistance in sorting through the red tape and helping to resolve your claim.

Contact a knowledgeable Massachusetts workers’ compensation lawyer today

At Chisholm Law LLC, we are dedicated to helping injured workers obtain compensation throughout the Beverly, Massachusetts area. For a consultation, contact us online, or call (978) 703-0700 to speak with an experienced lawyer today.

About the Author: Eric Chisholm
J. Eric Chisholm practices in the areas of Personal Injury, Workers' Compensation and Social Security Disability. He is a member of the Massachusetts Bar Association & a frequent lecturer on the topic of workers' compensation law at Massachusetts Continuing Legal Education seminars.