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Appealing the denial of a workers' compensation claim

Any Massachusetts worker who suffers an injury or illness whose cause is related to the worker's occupation can obtain benefits through the state's workers' compensation system. Unfortunately, some claims are disputed by the employer and are totally denied or granted only in part. If a person's claim is denied by the employer or the employer's workers' compensation insurer, the employee has the right to appeal this decision and seek its reversal. An employer also has the right to seek a modification or cancellation of the award.

The appeal must be filed with the Department of Industrial Accidents (DIA). The DIA will schedule an informal meeting of the employer and employee, which normally takes place within 12 business days of the filing of the notice of appeal. If the claim is not settled at this meeting, the DIA will refer it to a conference conducted by an administrative law judge (ALJ). After the conference, the ALJ will issue an order either affirming the denial or reversing the denial and ordering the employer or its insurer to pay the claim. An employee who disagrees with this order may file a request for hearing before an ALJ. This request must be filed within 14 days of the date of the order from the Conference. If this appeal is based on medical issues, the employee must pay a fee that is used to retain an independent medical expert to evaluate the evident.

The hearing is a formal legal proceeding in which the Massachusetts Rules of Evidence will determine what information is allowed to be placed in the record. The presiding ALJ is usually the same ALJ that conducted the conference. The ALJ will render a decision after hearing all of the evidence. If either party disagrees with the ALLJ's decision, it may file an appeal to the Industrial Accidents Reviewing Board. The board will examine the transcript and exhibit that were considered by the ALJ. The board can affirm the ALJ's order, reverse the order, or remand the case to the ALJ for further findings.

The board's order can be appealed by either or both parties by filing an appeal in the Massachusetts Court of Appeals. While the state's workers' compensation system is designed to allow injured or sickened workers to file their own cases without the aid of a lawyer, a lawyer is usually essential in preparing and handling any level of appeal.

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