Workers' Compensation
What
is Workers' Compensation?
Workers' Compensation is a system of insurance that protects employees
if they are injured while in the course and scope of employment or contract
a work-related illness.
MIT is required to provide Workers' Compensation insurance, which pays
for reasonable and necessary medical treatment and partial wage replacement,
if an employee is out of work and/or has incurred medical expenses as
a result of a work-related injury/illness.
Workers' Compensation is a "No-Fault System." This means that the employee
does not have to prove blame to collect wage and medical benefits. However,
the burden is on the employee to prove that the disability arose out of
and in the course and scope of employment.
When Should a Work-Related
Injury/Illness be Reported?
Immediately! The employee is required to immediately report all injuries
to his or her supervisor. In the event that a supervisor is not available
the employee should report to MIT Medical if physically able. If not physically
able then MIT Police should be called to the scene of the accident and
the employee should inform his/her supervisor as soon as possible.
It is the responsibility of the employee to report an accident during
his or her shift. Failure to do so may interfere and possibly jeopardize
Workers' Compensation coverage.
Use of Medical Providers
Initial medical treatment for a work-related injury/illness must be at
the MIT Medical Department. MIT Medical is the preferred provider for
initial treatment. If follow-up medical attention is needed, employees
may choose a clinic, hospital or your own health care provider. Employees
must let providers know they are being treated for a work related incident
and they will be paid at the rate set by the Department of Industrial
Accident.Employees should contact the Workers' Compensation
Office, when certain types of treatment/diagnostic tests/change in providers
become necessary. Providers will need to request Utilization Review approval
for these services. Providers should send all bills with records attached
to the Workers' Compensation Office to be processed.
Time Loss/Compensation
Benefits
- Temporary total disability benefits. An employee may
qualify for temporary total benefits if/when an injury/illness leaves
the employee unable to work for 6 or more calendar days. Temporary total
benefits are based on the employee's gross earnings over the 52 weeks
prior to the injury/illness. To determine weekly benefits, the employee's
actual gross earnings, including overtime, etc., are divided by the
number of weeks worked to compute his/her average weekly wage. The employee's
average weekly wage is multiplied by 60% for the weekly compensation
rate. Please note that there is a maximum that the employee can receive.
This limit is set at the State's Average Weekly Wage (SAWW) at the time
of the injury/illness. The SAWW is set annually by the Massachusetts
Division of Employment and Training.
- Partial disability benefits. An employee may qualify
for partial disability benefits if he/she can do some work, but loses
part of his/her earning capacity due to a work-related injury/illness.
Partial disability payments equal 60% of the difference between the
employee's average weekly wage prior to the injury/illness and the weekly
wage the employee is now capable of earning. The maximum compensation
under this section of the law is limited to 75% of what the employee
would receive if he/she were receiving total temporary benefits.
Determining
Compensability
The Workers' Compensation Office has 14 days from the date of notification
from any source such as the medical provider, supervisor or the employee
to make a determination on the compensability of the claim. A decision
will be made as quickly as possible; however, it may take the full 14
days. During this period, the Workers' Compensation Office may investigate
the claim, including interviewing supervisors and witnesses.
Once the Workers' Compensation Office has made a decision, a notice of
acceptance or denial is mailed to the employee.
Denied Claims
When determining the compensability of a claim, the Workers' Compensation
Office follows specific guidelines in accordance with Massachusetts General
Law, Ch. 152 and Chapter 4.8 of the MIT
Personnel Policy Manual. In addition, the Workers' Compensation Office
relies on information from medical providers. Claims may be denied for
a variety of reasons, including:
- No medical treatment
- Pre-existing conditions
- Inadequate medical documentation
For this reason, it is important to understand that Workers'
Compensation benefits are not guaranteed.
An injured employee may appeal a denied claim with the Department of Industrial
Accidents.
It is the responsibility of the injured employee to secure payment for
medical services and follow any referral guidelines set by the health
insurer once a claim has been denied. For example, many HMO plans require
a referral from the primary care provider to a specialist. If an employee
enrolled in an HMO plan seeks initial treatment from a specialist without
referral from the primary care provider, and the claim is denied, it is
possible that the HMO plan may also deny payment.
When Employee Benefits
May Be Stopped or Reduced
Benefits may be stopped or reduced for any of several common reasons,
including:
- Employee has returned to work.
- MIT has been given a medical report by the treating physician
or an impartial medical examiner stating that the employee is capable
of returning to work, and the supervisor has reported that a suitable
position is available.
- Employee is requested to attend an independent medical
examination for evaluation, and he/she fails or refuses to attend.
- Employee is requested to attend an evaluation by a Department
of Industrial Accidents Vocational Rehabilitation Review Officer and
refuses to attend or to cooperate with the provision of vocational rehabilitation
services.
- Medical documentation does not establish a causal relationship
between disability and employment.
The Workers' Compensation Benefits Office at MIT in accordance
with M.G.L. Ch. 152 and Chapter 4.8 of
the MIT Personnel Policy Manual administers Workers' Compensation benefits.
Any decision made that adversely affects the employee's benefits may be
contested with The Department of Industrial Accidents, 600 Washington
Street, Boston, MA 02111 Phone: (617) 727-4900.
For questions or concerns on how Workers' Compensation benefits interact
or affect all other benefits (sick time, FMLA, health insurance, etc.),
the employee should contact his/her supervisor or Human Resources representative.
Supervisor Instructions for Reporting Lost Time Injuries
- Complete the online injury report form (this link takes you to the EHS tab of SAPweb; the Injury Report Form is in the left-hand column).
- Report employee's absence due to an injury at work to the DLC Time Administrators in your department via the time entry system or time sheet. If you do not report the employee's hours please inform the appropriate person who does that you have an employee out on work related injury.
- The practice for paying the first 5 days of absence at 100% has not changed. On the 6th day of absence, the employee will be paid by Workers' Compensation Insurance at 60% of their gross pay. The employee has the option to use 40 % of their sick leave to supplement their payments and bring them to 100% pay. The default will be to use the 40 % sick leave starting on day 6. If the employee elects not to use their sick leave to supplement their pay they must notify the appropriate person in their department of this decision.
- Notify the DLC Time Administrators when the employee returns to work in any capacity (full or part-time).
- If you have questions or supplemental information regarding a claim, you should contact the Workers' Compensation Administrator for assistance at MIT, Human Resources (617) 253-9496.
MIT Workers' Compensation
Office
77 Massachusetts Avenue
C/O Benefits, E19-215
Cambridge, MA 02139
Phone: (617) 253-4572 and (617) 253-9496
Fax: (617) 253-1502
Workers' Compensation Satellite
Office
MIT Lincoln Laboratory
LL-B-325
244 Wood Street
Lexington, MA 02420
Phone: (781) 981-2382
Fax: (781) 981-0145
