Workers' Compensation Claim Denied in Massachusetts

Why Workers' Compensation Claims Are Denied

Massachusetts workers' compensation claims are denied for a variety of reasons: the employer or insurer disputes that the injury occurred at work, challenges the severity of the injury, argues that the condition is pre-existing, claims that required notice was not given, or contends that the treatment sought is not medically necessary. A denial does not mean your claim lacks merit, it means the insurer has decided not to pay voluntarily. Attorney Jeffrey C. Lavey represents denied claimants throughout Massachusetts and challenges every improper denial.

The Massachusetts DIA Process

Denied workers' compensation claims in Massachusetts are contested before the Department of Industrial Accidents (DIA). The process begins with a conciliation, where both sides meet informally to attempt resolution. If conciliation fails, a conference before an administrative judge follows. The judge can issue an order at the conference stage. If either party is dissatisfied, a formal hearing before the administrative judge is scheduled, at which witness testimony and exhibits are presented. Appeals from the formal hearing go to the DIA Reviewing Board and ultimately to the Massachusetts Appeals Court.

The Importance of Medical Evidence

The central issue in most denied workers' compensation claims is the medical evidence. The employer's insurer typically conducts an Independent Medical Examination (IME) with a physician of their choosing, who often disputes the severity of the injury, the causal relationship to work, or the ongoing need for treatment. Attorney Lavey challenges IME reports with the treating physician's own records, with independent medical evaluations by physicians he selects, and with cross-examination of the insurer's medical expert at the formal hearing.

Common Reasons to Fight a Denial

• The injury clearly occurred at work and was reported promptly as required
• Treatment recommended by your physician has been unreasonably denied as not medically necessary
• A work-related aggravation of a prior condition is being dismissed as entirely pre-existing
• Wage replacement benefits have been terminated without adequate medical justification
• The employer claims you refused appropriate light duty without justification
• The insurer is conducting inadequate or improperly conducted IMEs

What Attorney Lavey Does in a Denied Claim

Attorney Lavey files the required claim forms with the DIA, manages all deadlines, prepares the medical and factual record for DIA proceedings, represents his clients at conciliation, conference, and formal hearing, cross-examines the insurer's medical experts, and pursues appeals when necessary. He advises every denied claimant honestly on the strength of their case and pursues every available avenue of recovery. His fee is contingent on success, there are no upfront legal fees.

Frequently Asked Questions