Denied Workers’ Compensation Claims in Massachusetts

Having a workers’ compensation claim denied can feel devastating, especially when you are dealing with a serious injury and mounting medical bills. Unfortunately, denial is common — nearly half of all workers’ compensation claims in Massachusetts are initially disputed or denied. At Shea Culgin Law, our experienced workers’ compensation attorneys have helped countless injured workers in Brockton and throughout southeastern Massachusetts fight back against denied claims and secure the benefits they deserve.

Why Are Workers’ Compensation Claims Denied?

Insurance carriers and employers deny workers’ compensation claims for many reasons. Understanding why your claim was denied is the first step toward a successful appeal. Common reasons for denial include:

• Late reporting: Massachusetts law requires you to report your injury to your employer promptly. If you delayed reporting, the insurer may argue the injury is not work-related.
• Disputed work-relatedness: The insurer may claim your injury or illness did not arise out of or in the course of your employment.
• Pre-existing conditions: Employers and insurance companies frequently argue that your condition existed before the workplace incident and is not covered.
• No witnesses: Claims involving injuries that occurred without witnesses are sometimes denied on credibility grounds.
• Missed deadlines: Failing to file the proper forms within the required timeframes can result in denial.
• Independent contractor status: The employer may claim you were an independent contractor rather than an employee, putting your claim outside the workers’ compensation system.

The Massachusetts Workers’ Compensation Appeals Process

When you appeal a denied claim in Massachusetts, your case goes through a multi-step process at the Department of Industrial Accidents:

Step 1: Conciliation

The first step is an informal conciliation meeting with a DIA conciliator. The goal is to resolve the dispute without a formal hearing. If the parties cannot agree, the case moves forward.

Step 2: Conference

An administrative judge holds a conference to review the dispute. The judge may issue an order requiring benefits to be paid while the case is fully litigated. This is a critical stage where having an experienced attorney makes a significant difference.

Step 3: Formal Hearing

If either party appeals the conference order, a formal hearing is held before an administrative judge — more like a trial, with witnesses, medical experts, and legal arguments. Our attorneys have extensive experience presenting compelling cases at formal DIA hearings.

Step 4: Reviewing Board and Courts

Further appeals go to the DIA’s Reviewing Board, and beyond that to the Massachusetts Appeals Court. Our firm has the experience to represent clients at every level of appeal.

Common Workers’ Compensation Benefits You May Be Owed

Even after a denial, you may be entitled to substantial benefits, including:

• Temporary Total Disability (TTD) — 60% of your average weekly wage if you cannot work at all.
• Temporary Partial Disability — Up to 75% of your TTD rate if you can work but earn less than before your injury.
• Permanent and Total Disability — 66% of your average weekly wage for as long as you remain permanently disabled.
• Medical Benefits — All reasonable and necessary treatment related to your work injury.
• Permanent Loss of Function — Compensation for permanent impairment of a body part.
• Lump Sum Settlements — A one-time settlement to close your claim.

How Shea Culgin Law Fights Denied Claims

When insurance companies deny valid claims, they are counting on injured workers not knowing their rights or lacking the resources to fight back. Our attorneys will:

• Conduct a thorough investigation of the facts surrounding your injury
• Obtain and organize medical records, expert opinions, and supporting evidence
• Identify the specific weaknesses in the insurer’s denial
• File all necessary paperwork and meet every deadline
• Represent you at every stage of the DIA appeals process
• Negotiate aggressively for the maximum benefits you are owed

We work on a contingency fee basis — you pay nothing unless we win your case. Attorney fees are limited by Massachusetts law to no more than 20% of the recovery.

Frequently Asked Questions

How long do I have to appeal a denied claim?

The general statute of limitations for workers’ compensation claims in Massachusetts is four years from the date of injury. Do not wait — evidence becomes harder to gather over time. Contact us immediately after a denial.

Can I be fired for filing a workers’ compensation claim?

No. Massachusetts law strictly prohibits retaliation against employees for filing workers’ compensation claims. If your employer fires or demotes you in response to your claim, you may have additional legal remedies.

What if my employer says I was an independent contractor?

Massachusetts uses a strict three-part test to determine worker status. Our attorneys can help you establish that you were legally an employee entitled to coverage.

Contact Our Attorneys Today

If your claim has been denied, call Shea Culgin Law at 617.674.0408 or 508.510.5107 for a free consultation. We serve injured workers throughout Brockton, Taunton, New Bedford, Fall River, Quincy, and throughout Bristol, Norfolk, and Plymouth Counties. You pay nothing unless we win.