What Benefits are Available in Massachusetts?

Glossary Check

If you're getting up to speed on workers' compensation in the Bay State, and you're wondering what terms like "temporary total" and "temporary partial" mean, a good place to turn is Simply Research.

But we'll help get you up to speed here.

Temporary Total Disability (TTD)/Section 34

A worker may be eligible if she has missed more than five full or partial days of work due to the injury/illness. This benefit is calculated at 60% of the worker's gross (pre-tax/pre benefits) average weekly wage. The AWW includes overtime, and bonuses for 52 weeks prior to the date of injury. If the worker has not been employed with the employer for a full 52 weeks prior to the date of injury, divide the total gross earnings by the number of weeks of employment in the prior year to determine the average weekly wage. Multiply the AWW by 60%.

Sample calculation: $800.00 x .60 = $480.00

The weekly benefit amount cannot exceed the State Average Weekly Wage (SAWW) at the time of the
injury. TTD benefits cannot exceed 156 weeks/3 years. Compensation begins on the sixth day of disability
unless the worker has been out of work for more than 21 days. The days of disability do not need to be
consecutive.

Temporary Partial Disability (TPD)/Section 35

The worker may be eligible if you are still working but lose partial earning capacity due to the injury/illness. The maximum compensation cannot exceed more than 75% of the weekly benefit paid under Temporary Total Disability (TTD).

Sample calculation: $440.00 per week (TTD) x .75=$330.00

Total Partial Disability benefits cannot exceed 260 weeks/five years. The combination of TTD and TPD cannot exceed 364 weeks/7 years.

Permanent Total Disability (PTD)/Section 34A

A worker may be eligible if he is permanently and totally disabled from performing any type of work due to the work injury/illness. The benefit is calculated at two thirds (2/3) of your AWW before the injury, up to a maximum of the SAWW. You may also be eligible for an annual cost-of-living adjustment (COLA). The benefits continue as long as you are disabled from performing any type of work.

Medical Benefits/Section 13 and Section 30

The worker may be eligible for benefits if the work-related injury/ illness requires medical attention.

Medical care must be reasonable, necessary, and causally related to the work injury/illness.

Prescription medication and mileage reimbursement for travel to and from medical appointments may also be covered as well.

An employer may designate care for the employee's first doctor/hospital after the injury/illness. After the initial treatment, the employee has the right to choose her own medical provider. The insurer has the right to send the employee to a doctor of its choice for an independent evaluation of the employee's injury/illness/incapacity.

Utilization Review/Treatment Requests

After the first 12 weeks of the injury, workers’ compensation insurers are required to undertake
utilization review for all medical services that are provided to injured workers.

The employer’s workers’ compensation insurance company will provide the name and phone number to
the appropriate utilization review agent.

Loss of Function-Disfigurement/Section 36

An employee may be eligible if a work-related injury or illness results in a permanent loss of function of a specific body part, or if he suffers scarring or disfigurement on your face, neck, or hands. This is a one-time payment and would be in addition to benefits for lost wages or mileage reimbursement. The amount paid depends on the location and severity of the scarring, disfigurement or loss of function.

Survivor-Dependent Benefits/Section 31

The benefits are paid to the spouse or child of an employee who has died as the result of a work-related
injury/illness.

The surviving spouse may be eligible for a weekly benefit equal to two-thirds (2/3) of the deceased
worker’s average weekly wage, up to the maximum of the SAWW in place at the time of their injury/illness.

The surviving spouse may be eligible for yearly cost of living adjustments (COLA) beginning two years after the date of the injury or illness. If the spouse remarries, $60 a week is paid to each eligible
dependent(s) child.

The total weekly amount paid to dependent children cannot exceed the amount that would be paid to the surviving spouse. The benefits may continue for as long as they remain dependent (as determined by a judge) and do not remarry. A child is eligible only if under age 18, a full-time student, or unable to work because of physical or mental disabilities.

Burial Expenses/Section 33

The insurer shall pay reasonable burial expenses, not exceeding eight times the AWW in Massachusetts.

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