Massachusetts Notification of Workers' Compensation Injury - Illness

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Multi-State
Control #:
US-294EM
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Word; 
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Description

This form is used to inform a worker's compensation firm of an injury or illness of sustained by an employee while on duty.

How to fill out Notification Of Workers' Compensation Injury - Illness?

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FAQ

Can You Lose Your Job While on Workers' Compensation in Massachusetts? Legally, you cannot lose your job. Again, your workers' compensation is your right as an employee in Massachusetts. And so, your employer or employers should not terminate your appointment because you were demanding your rights.

Your employer may require you to see a preferred provider for the first visit only. After this first visit, you can go to your own doctor. You can change your own doctor one time without permission from the Workers' Compensation insurance company.

Workers' comp helps pay for any necessary medical care for work-related injuries or illnesses. It also helps partially compensate employees for lost wages after the first five calendar days of a disability. The Department of Industrial Accidents (DIA) administers Massachusetts workers' compensation law.

What are the benefits? The maximum weekly benefit is 75% of your weekly total temporary benefits. (Temporary total benefits are 60% of your gross average weekly wage).

In Massachusetts, the maximum weekly benefit percentage is 60% of your average weekly wage according to what you earned in the previous year. If you usually receive $1,000 per week, for example, you would only be eligible to receive $600 in workers' compensation replacement wage benefits for time missed.

You have 7 calendar days (except for Sundays and legal holidays) after the injured worker's 5th day of full or partial disability to report the injury to the DIA. You need to file the Form 101- Employer's First Report of Injury/Fatality electronically.

You have 7 calendar days (except for Sundays and legal holidays) after the injured worker's 5th day of full or partial disability to report the injury to the DIA. You need to file the Form 101- Employer's First Report of Injury/Fatality electronically.

The amount they may receive is set at 75% of their temporary total disability rate. The maximum amount of time these benefits will be paid is five years.

Massachusetts Workers' Compensation RequirementsCompanies with one or more employees are required to buy workers' compensation insurance. Even companies who employ only family members are still required to have coverage.

Action Steps for Injured WorkersReport the injury to your employer.Get medical treatment right away - see an occupational clinician, if possible.Document the problem.Seek an attorney, if the workers' compensation provider rejects your claim.More items...

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Massachusetts Notification of Workers' Compensation Injury - Illness