If the insurer denies the claim, stops or reduces payment once it has been initiated, the employee can file an Employee Claim form (Form 110) to request a hearing. In order to give the insurance company sufficient time to investigate the claim, an employee claim cannot be accepted until 30 days have passed from the alleged onset of disability, or the insurer has denied the claim by certified mail. There are several proceedings that can take place in this situation.
- The first proceeding scheduled on a contested claim is an informal conciliation, which is held within a few weeks of the claim being received by the DIA. At conciliation an attempt is made to settle the issues in dispute. If an agreement is not reached, the claim is referred to a conference before an Administrative Judge.
- The Industrial Accident Board is made up of the DIA`s Administrative Judges, who rule on disputed workers` compensation claims. The conference is the first proceeding before a judge. The insurer and the employee must be present at the conference. Following the conference, the Judge will issue an order of payment or denial. Either side may appeal this within 14 days. If the case is appealed it will proceed to the hearing stage.
- At a full hearing the same Administrative Judge who presided at the conference considers all the evidence. Rules of evidence now apply, and witnesses can be subpoenaed. After reviewing all the information available, the Judge will then issue a written decision. If either party to the case believes the Judge made an error of fact, or exceeded his/her authority with the ruling, the party has 30 days from the filing date of the decision to file an appeal to the Reviewing Board.
For more information regarding denied or suspended claims you can contact the Department of Industrial Accidents at one of the following numbers.
Boston: (617) 7274900;
Lawrence: (978) 6836420;
Fall River: (508) 6763406;
Worcester: (508) 7532072;
Springfield: (413) 7841133
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