Navigating a workers' compensation claim in Massachusetts should be a straightforward process—after all, the system was designed to protect employees injured on the job. However, many workers are caught off guard when their claim is unexpectedly denied. Understanding the reasons behind these denials can help you avoid common mistakes and improve your chances of securing the benefits you need.

This article breaks down the key reasons why Massachusetts workers’ comp claims are denied and how to respond if it happens to you.

You Missed the Reporting Deadline

In Massachusetts, workers are required to report their workplace injury to their employer as soon as possible. While the law allows up to four years to file a claim with the Department of Industrial Accidents (DIA), failing to notify your employer promptly after an injury occurs can raise red flags.

Insurance companies may argue that the delay suggests your injury didn’t happen at work or that it wasn’t serious enough to require benefits. To avoid this issue:

• Report your injury to your supervisor immediately or as soon as practical.
  
• Submit written documentation to create a paper trail.
  

The Injury Didn't Happen on the Job

For a workers’ comp claim to be valid in Massachusetts, the injury must have occurred within the course and scope of employment. If your injury happened while commuting, during a lunch break offsite, or while engaged in personal activities unrelated to work, your claim may be denied.

However, there are gray areas. For example, if you were injured while running an errand for your boss or attending a mandatory work event, you may still be covered. In such cases, legal guidance is often necessary to prove work-relatedness.

Inconsistent or Incomplete Medical Records

One of the most common reasons a claim is denied is insufficient medical evidence. If your doctor’s records don’t clearly link the injury to your job or fail to outline the extent of your disability, the insurer might use that as grounds for denial.

Tips to strengthen your claim:

• See a doctor as soon as possible after the injury.
  
• Follow all medical instructions and attend scheduled appointments.
  
• Ask your physician to clearly note that the injury is work-related.
  

Your Employer Disputes the Claim

Sometimes, your employer may challenge your version of events. They might argue that:

• The injury didn’t happen at work.
  
• It was caused by horseplay or rule violations.
  
• It’s part of a pre-existing condition.
  

Massachusetts law does allow benefits even if a pre-existing condition was aggravated by work. However, proving this usually requires detailed medical testimony and sometimes expert witnesses. Employers and insurers often look for any basis to reduce their liability.

You Were Under the Influence or Violated Company Policy

If your injury occurred while you were impaired by drugs or alcohol, or if you were breaking safety rules or committing a serious violation of company policy, your claim could be denied.

Under Massachusetts law, injuries that occur due to willful misconduct or intoxication are not eligible for workers’ comp benefits. For example, if you were injured while operating machinery under the influence, the insurer can legally deny your claim.

You Didn't File the Claim Properly

Filing errors can be surprisingly common. Even a minor mistake on your Form 110 (the claim form used in Massachusetts) can delay or jeopardize your benefits. Missing information, incorrect dates, or vague descriptions of how the injury happened may trigger a denial.

Be sure to:

• Complete the DIA’s Form 110 thoroughly and accurately.
  
• Include all required documents, such as medical reports and incident details.
  
• Consider working with an attorney if the process feels overwhelming.
  

The Injury Wasn't Serious Enough

Insurers may deny claims on the basis that the injury does not meet the standard for wage-loss benefits or medical treatment. For instance:

• If your injury required no time off work.
  
• If the insurer believes treatment was unnecessary or excessive.
  

In these cases, an independent medical evaluation (IME) might be used by the insurance company to support the denial. However, you’re also entitled to present your own medical evidence to challenge the IME’s conclusions.

Surveillance or Social Media Conflicts

In recent years, insurers have increasingly used video surveillance and social media to investigate claims. If you say you can’t lift heavy objects due to a back injury, but a video shows you carrying groceries, your credibility—and your claim—could suffer.

To protect your case:

• Be honest about your limitations.
  
• Avoid posting photos or updates related to physical activity online.
  
• Assume your activity might be monitored while the claim is active.
  

You Quit or Were Fired After the Injury

Leaving your job soon after a workplace injury can create suspicion, especially if it looks like you were planning to leave the company anyway. Insurers may argue that the injury was exaggerated to collect benefits after quitting or being terminated.

Although quitting your job doesn’t automatically invalidate your claim, it can make the process more difficult. It's best to consult an attorney before making any major employment decisions while your claim is pending.

Appealing a Denied Claim in Massachusetts

If your claim is denied, you still have options. In Massachusetts, you can:

• File a claim with the Department of Industrial Accidents (DIA).
  
• Request a conciliation—an informal meeting between you, the insurer, and a DIA conciliator.
  
• Move forward with a formal hearing if conciliation fails.
  

The appeals process can be complex and time-sensitive. An experienced workers’ compensation attorney can help you gather the right documentation, meet deadlines, and represent you at hearings.

Conclusion

Workers’ comp denials in Massachusetts can stem from missed deadlines, weak medical evidence, employer disputes, or even administrative mistakes. Knowing these potential pitfalls helps you avoid them and increases your chances of securing benefits.

Injured? The Office of Brandon J. Broderick, Workers Compensation Lawyers, Can Help

If the unfortunate happens and you’ve been injured in an accident, don’t go at it alone. An experienced lawyer can advocate for your best interest and pursue fair compensation for your damages. At Brandon J. Broderick, Attorney at Law, you can count on us to work tirelessly for your quality of life. Our long track record of success has helped people like you move forward after sustaining an injury caused by another’s negligence. 

Contact us now for a free legal review.