Injured workers may be eligible for some or all of the following benefits:
In addition, in some cases, employees' dependents and widows can receive benefits. Compensation benefits are not taxable.
Workers' compensation insurers (and self-insurers) must pay for all medical costs associated with the treatment of work-related injuries. This obligation continues as long as treatment is needed; if necessary, for the duration of the worker's life. The insurer pays the medical provider directly. Covered benefits include the cost of hospitalization, office visits to doctors, prescriptions, surgical procedures, x-rays, therapy, travel to and from treatment, and all other medical services. The maximum amount providers can charge is set by the state.
Temporary Total Disability Benefits An employee who is unable to engage in any gainful employment due to a work-related injury is considered totally disabled under the Workers' Compensation Act.
To be eligible for disability benefits, the employee must be disabled for five calendar days. The days do not have to be consecutive. (The days lost must be for the same injury.) Weekends also count, whether or not work is scheduled. If incapacity extends for a period of twenty-one days or more, compensation shall be paid from the date of onset of incapacity. If incapacity extends for a period of at least five but less than twenty-one days, compensation shall be paid from the sixth day of incapacity.
Weekly Rate The weekly rate for total disability is 60% of the employee's average weekly wage up to a maximum amount. The maximum is set at 100% of the statewide average weekly wage in Massachusetts at the time of injury. The Massachusetts average weekly wage is determined annually on October 1st by the Division of Employment Security, and remains in effect until September 30th of the next year.
Employee's Average Weekly Wage An employee's average weekly wage is based on total earnings for the 52 weeks prior to injury. Total earnings (including overtime, commissions and bonuses) are divided by 52. Total earnings also include income from a second job worked at the time of injury if the employee is also disabled from working that job. If a worker has been with an employer less that 52 weeks at the time of the injury, the average is calculated by dividing total earnings by the number of weeks worked. Extremely short-term employees can use the average wage of a worker in the same job with the same employer or within the same industry.
Maximum Rates Injury On or After Maximum Weekly Benefit
10/01/2001 $890.94 10/01/2002 $882.57 10/01/2003 $884.46 10/01/2004 $918.78 10/01/2005 $958.58 10/01/2006 $1,000.43 10/01/2007 $1,043.54 10/01/2008 $1,093.27 10/01/2009 $1,094.70
Note: The minimum benefit is 20% of the state average weekly wage.
Maximum Duration Total disability benefits are payable for up to three years (156 weeks). After that, the employee is considered either partially or permanently and totally disabled. Partial disability benefits are payable for up to five years (260 weeks). Under most circumstances, the maximum period of total disability benefits plus partial disability is seven years (364 weeks). However, these periods may be extended under certain circumstances. An employee should consult an attorney if his or her period of benefits expires.
Partial Disability Benefits Partially disabled employees are workers who are able to perform some duties from the date of injury, or who were totally disabled but have improved to the point where they can work part-time. In either case, they are unable to earn their previous wages. These employees are eligible to receive weekly cash benefits equal to sixty percent of their lost earning capacity up to the maximum set by the statewide average or, in case of initial total disability being replaced by partial, up to 75 percent of the previous total disability rate.
As suggested above, partial disability benefits are payable whether or not time is lost from work. Other examples include: injuries that cause an employee to reduce piece-rate earnings, and injuries that cause a reduction in hours worked.
Total and Permanent Disability Benefits Totally and permanently disabled employees are those whose injuries prevent them from ever working any job on a full-time or near full-time basis. They can receive compensation benefits for the rest of their lives. These total and permanent disability benefits are available after other disability benefits are exhausted. The benefits rate is two-thirds of the employee's average weekly wage with the addition of a cost of living adjustment beginning two years after the injury date. However, this cost of living increase is not available to the extent that it reduces Social Security Disability Insurance benefits received by the employee.
Loss of Function Benefits In addition to weekly cash payments for loss of earning capacity, employees whose injuries include permanent (total or partial) loss of a body part or sense are entitled to a one-time cash payment. This benefit is paid according to a schedule of rates based on multiples of the statewide average weekly wage at the time of injury. Partial loss of function is paid as a percentage of the scheduled rates.
Disfigurement Benefits Disfigurement - such as permanent scarring if it is on the face, neck or hands - is also compensable according to guidelines established by the Department of Industrial Accidents (DIA). Normally, this benefit will not be paid until at least six months from the date of injury and/or the last surgery. The amount paid depends on such factors as the location, length, width and severity of scarring or disfigurement.
Vocational Rehabilitation Benefits The insurer must pay the cost of vocational rehabilitation of employees whose injuries prevent a return to their previous occupations. This includes vocational counseling, placement assistance, and possible retraining for a different occupational field. If retraining is appropriate, these benefits include tuition, books and transportation expenses. The Department of Industrial Accidents (DIA) determines if vocational rehabilitation is called for. Employee participation is voluntary. However, weekly compensation benefits may be reduced by fifteen percent if the employee refuses the service or fails to cooperate with rehabilitation services deemed appropriate.
Double Compensation Benefits If an employee's injuries are the result of the employer's "serious and willful misconduct," he or she may recover double the benefits discussed above. These cases are difficult to establish, since they require proof that the employer or supervisor acted deliberately, or knowingly disregarded an established safety standard.
Death Benefits If an employee's death results from a work-related injury, his or her spouse and dependent children will receive weekly death benefits. The spouse is entitled to weekly benefits at a rate similar to that of total and permanent disability benefits. These death benefits last five years or longer if the spouse is not fully self-supporting. If at any time the surviving spouse remarries, the benefits terminate automatically. However, minor or handicapped children may continue to receive up to sixty dollars per week per child.