When you're injured at work, the path forward can seem confusing and overwhelming, clouded by stress and uncertainty. You're not just dealing with physical pain but also the pressing questions of how to pay your bills and secure your family's future. If this is your reality, please know you are not alone. According to the U.S. Bureau of Labor Statistics, private industry employers in Massachusetts reported 55,400 nonfatal workplace injuries and illnesses in 2023 alone. This figure highlights a shared experience among thousands of workers who, like you, suddenly find themselves navigating a system they never expected to be a part of.

This is a critical time, and unfortunately, it is a period often filled with misinformation that can prevent you from receiving the full benefits you are legally owed. We will cut through the common falsehoods and confusing jargon to provide a clear understanding of your rights and the realities of the Massachusetts workers' compensation process.

Myth #1: If the Accident Was My Fault, I Can’t Get Benefits

Reality: Massachusetts is a "no-fault" state for workers' compensation, meaning your own negligence generally does not disqualify you from receiving benefits.

A frequent and damaging misconception is that if you made a mistake or your actions contributed to your injury, you forfeit your right to workers' compensation. This is fundamentally untrue. The Massachusetts Workers' Compensation Act was designed to provide benefits to injured workers without getting bogged down in lengthy, expensive legal battles over who was at fault. The only questions that matter are, were you an employee, and were you injured in the course of your employment? If the answer to both is yes, you are typically covered. Whether the injury resulted from a slippery floor, a machine malfunction, a moment of inattention, or your own simple mistake, the no-fault principle ensures you have access to the medical care and wage benefits you need to recover. The only significant exceptions are rare cases involving serious, willful misconduct or intoxication on the part of the employee.

Myth #2: I Can Sue My Employer for Pain and Suffering

Reality: The workers' compensation system is almost always the "exclusive remedy," meaning you cannot file a separate lawsuit against your employer for a work-related injury.

When you are injured outside of work due to someone else's negligence, you can often sue them for damages, including pain and suffering. However, the workplace operates under a different legal framework. The workers' compensation system was established as a trade-off: in exchange for providing guaranteed, no-fault benefits for medical bills and lost wages, employers are shielded from personal injury lawsuits. This means you cannot sue your employer for things like physical pain, emotional distress, or loss of enjoyment of life related to the work injury. The primary exception to this rule is if your employer broke the law by failing to carry workers' compensation insurance. In that specific circumstance, the door may open for you to file a civil lawsuit. It's also important to note that if your injury was caused by a negligent third party (e.g., a careless driver while you were making a delivery or a faulty piece of equipment made by another company), you may have a separate personal injury case against that third party in addition to your workers' comp claim.

Myth #3: My Employer Can Fire Me for Filing a Workers’ Compensation Claim

Reality: It is illegal under Massachusetts General Laws Chapter 152, Section 75B for an employer to retaliate against you for filing a workers' compensation claim.

Fear of losing one's job is one of the most significant reasons why injured workers hesitate to report an injury. You must know that the law is on your side. Your employer cannot legally fire you, demote you, reduce your hours, or otherwise discriminate against you simply because you were injured and sought the benefits to which you are entitled. While the law does not require your employer to hold your specific position open for you forever, they must give you preference in rehiring for any open position for which you are qualified once your doctor clears you to return to work. If you are terminated shortly after filing a claim, it may be considered retaliatory, and you could have grounds for legal action against your employer.

Myth #4: I Have to Use the Doctor the Insurance Company Chooses

Reality: After an initial visit, you have the absolute right to choose your own treating physician.

When you are first injured, the workers' compensation insurer can direct you to a provider within their network for your first scheduled appointment. However, this is the limit of their control. After that initial visit, the choice of your ongoing treating physician is entirely yours. This is a critical right. Being treated by a doctor you trust, who listens to your concerns, and who will advocate for the care you truly need is essential for both your physical recovery and the success of your claim. Your chosen doctor's medical reports and opinions on your ability to work will carry significant weight in your case, so choosing a supportive and thorough physician is essential.

Myth #5: I Can’t Get Benefits If I Had a Pre-Existing Condition

Reality: You are eligible for benefits as long as the work-related incident was a "major cause" of your current disability or need for treatment, even if it aggravated a pre-existing condition.

Insurance companies often try to deny claims by pointing to a pre-existing condition, such as prior back problems or arthritis. However, the law in Massachusetts is clear: you do not need to be in perfect health before your work injury to qualify for benefits. If the demands of your job or a specific incident at work made a pre-existing, underlying condition worse—or made a previously asymptomatic condition become symptomatic—you are entitled to coverage. The legal standard is whether the work injury was "a major cause" of your disability. This doesn't mean it has to be the sole cause or even the primary cause, just a major contributing factor.

Myth #6: I Have to Be Injured in a Single, Sudden Accident to Qualify

Reality: Workers' compensation covers not only traumatic injuries but also "wear and tear" injuries and occupational illnesses that develop over time.

Many injuries do not happen in a single, dramatic moment. They are the result of performing the same motions or being exposed to the same physical stresses day after day. These are known as repetitive stress injuries. Conditions like carpal tunnel syndrome from typing, tendonitis from repeated lifting, or back problems from years of manual labor are all potentially coverable. Similarly, occupational diseases that result from exposure to harmful substances or environments at work, such as lung disease or hearing loss, are also covered under Massachusetts workers' compensation law.

Myth #7: I Can Just Use My Own Health Insurance for a Work Injury

Reality: You should never use your personal health insurance for a work-related injury. The workers' compensation insurer is legally the primary and sole payer.

This is a critical point that can cause significant problems if handled incorrectly. If you use your private health insurance, you may be responsible for co-pays and deductibles that you otherwise wouldn't be. More importantly, your health insurer could later deny coverage or seek reimbursement once they learn the injury was work-related, leaving you with unexpected medical bills. When you see a doctor, you must inform them that your injury happened at work so they bill the correct workers' compensation insurance carrier directly.

Myth #8: Small Injuries Aren’t Worth Reporting

Reality: You must report every injury, no matter how minor it seems at the time, to protect your future rights.

What feels like a minor tweak in your back, a small strain in your wrist, or a slight bump to the head can escalate into a serious medical condition days, weeks, or even months later. If you do not report the initial incident to your supervisor promptly, the insurance company will likely fight your claim later on, arguing that the injury must not have happened at work. Reporting the injury immediately creates a formal record of the incident, which is key evidence for protecting your access to benefits should you need them down the road.

Myth #9: Workers’ Compensation Will Replace 100% of My Lost Wages

Reality: Wage benefits are calculated as a percentage of your pre-injury earnings and are subject to state-mandated maximums.

Workers' compensation is designed to provide a critical financial safety net, but it does not replace your entire paycheck. The benefit amounts are set by law. If you are deemed temporarily and totally unable to work, you will receive 60% of your gross average weekly wage. If you are able to return to work in a limited or part-time capacity and earn less than before, you may be eligible for partial disability benefits, which typically cover 75% of the difference between your old and new wages. These payments are tax-free, which helps offset some of the difference, but it's important to have realistic expectations about the level of wage replacement you will receive.

Myth #10: If My Claim Is Denied, It’s Over

Reality: A denial from the insurance company is simply their initial position; it is not the end of the process. You have a well-defined right to appeal.

It is incredibly common for initial claims to be denied by insurance carriers, often for minor or unsubstantiated reasons. Do not be discouraged. A denial is the starting point of the dispute resolution process at the Massachusetts Department of Industrial Accidents (DIA). You can appeal this decision by filing an Employee's Claim (Form 110), which will move your case through a formal system designed to resolve these disputes, starting with conciliation and, if necessary, moving to a conference and hearing before an administrative judge. This is the stage where having an experienced attorney becomes most critical to fight for your rights and navigate the legal system on your behalf.

Tips for Managing Workers' Compensation Claims in Massachusetts

• Report Your Injury Immediately Immediately report any work-related injury to your supervisor in writing to create a formal record and protect your claim. Massachusetts law requires injuries to be reported within 30 days of the incident. Failure to do so may result in a denial of benefits.
• Prioritize Medical Attention Seek prompt medical attention after an accident and inform the doctor that your injury is work-related to ensure proper documentation.
• Choose Your Own Doctor Know that after an initial insurer-directed evaluation, you have the legal right to choose your own trusted doctor for all ongoing medical care.
• Keep Detailed Records Maintain a detailed file containing all injury reports, medical records, witness information, and correspondence from the insurer.
• Follow All Medical Advice Strictly follow your doctor's treatment plan and attend all medical appointments to support both your recovery and your legal claim.
• Avoid Recorded Statements Avoid giving a recorded statement to an insurance adjuster before speaking with an attorney, as it can be used against you.
• Understand Critical Deadlines Be aware of the strict legal deadlines, including the four-year statute of limitations for filing your claim with the Department of Industrial Accidents.
• Bill the Correct Insurer Ensure all medical bills are submitted directly to your employer's workers' compensation insurance, not your personal health insurance.
• Beware of Quick Settlements Be skeptical of quick settlement offers from the insurer, as they are often far less than the full value of your claim.
• Consult an Experienced Attorney Consider hiring an experienced workers' compensation attorney to navigate the complex legal system and protect your rights against the insurer's lawyers.

Brandon J. Broderick Is Ready to Assist You with Your Massachusetts Workers' Compensation Claim Today

We understand that the moments following a workplace accident in Massachusetts are filled with pain, anxiety, and a profound sense of uncertainty. The path ahead can feel intimidating as you face a complex claims process while trying to focus on your recovery. Please know that you do not have to walk this path alone. The team at Brandon J. Broderick, Attorney at Law, is here to stand with you, to be your advocate, and to carry the legal burden so you can dedicate your energy to healing. We see the person behind the case file and are committed to being by your side, offering not just our legal expertise but our genuine compassion and unwavering support through every step. Let us be your voice and your shield; contact us today for a free consultation so we can begin this journey together.