Temporary total incapacity benefits
Who qualifies?
- You qualify if your injury or illness leaves you unable to work for 6 or more full or partial calendar days
- The days don’t have to be consecutive
What are the benefits?
- 60% of your gross average weekly wage of the 52 weeks prior to your injury date
- The maximum you can receive per week is the state’s average weekly wage (SAWW) at the time of your injury
For how long?
- You can receive benefits for 156 weeks
- Compensation begins on the 6th day of disability. You will not be paid for the first 5 days unless you can’t work for 21 calendar days or more.
- The days don’t have to be consecutive
Temporary partial incapacity benefits
Who qualifies?
- You are able to work but earn less because of your injury or illness
- This may include any injury that forces you to take a lower paying job or work fewer hours
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).
- For example, if you received $440 a week as a total temporary benefit, the most you could receive if you collected partial benefits would be $330 a week ($440 x .75 = $330)
For how long?
- You can receive benefits for up to 260 weeks
Permanent and total incapacity benefits
Who qualifies?
- You are totally and permanently unable to do any kind of work as a result of a work-related injury or illness
- You do not have to exhaust your temporary benefits before applying for permanent benefits
What are the benefits?
- 66% of your gross average weekly wage
- The minimum you can collect is 20% of the state average weekly wage (SAWW) at the time of your injury
- The maximum you can collect is the SAWW at the time of your injury
- You also get an annual Cost-Of-Living Adjustment (COLA)
For how long?
- You can receive benefits for as long as you are disabled
Medical benefits
Who qualifies?
- You suffer a work-related injury or illness that requires medical attention
What are the benefits?
- Adequate and reasonable medical care
- Prescription reimbursement
- Mileage reimbursement for travel to and from medical visits
- For your first visit to the doctor or hospital, your employer has the right to send you to a health care provider of their choice
- You have the right to choose your own health care providers after being seen by your employer’s health care provider
- The insurer has the right to send you periodically to see its doctor for an evaluation
For how long?
- As long as medical services are required due to your injury or illness
- The insurance carrier has the right to deny or stop treatment it believes isn’t reasonable or necessary
- You can appeal a denial of treatment with the DIA
Once your claim has been reported to the workers’ compensation insurer, it must issue you an insurance card with a claim number and contact information on it.
- Give the claim number to your doctor so they can bill the insurer directly and get pre-approval for treatment
If you do not get this card promptly, contact the insurer and get the number as most medical providers will not treat you without the claim number.
Scarring and permanent loss of function and disfigurement
Who qualifies?
- A work-related injury or illness results in a permanent loss of certain specific bodily functions, scarring, or disfigurement
- The scars must be located on your face, neck or hands
What are the benefits?
- You receive a one-time payment for your disfigurement or scarring
- This benefit is in addition to other payments like medical bills, or lost wages
- The amount paid depends on the location and severity of the disfigurement or function loss
- If you were injured or suffered an illness prior to Dec. 24, 1991, you have slightly different benefits
For how long?
- It is a one-time payment
If you do not have an attorney, you can contact our conciliation unit at (617) 727-4900 once the insurer has made an offer for your scarring or disfigurement. The conciliator can give you an idea of whether the offer falls within the established guidelines for scarring, loss of function, and disfigurement.
Survivors’ and dependents’ benefits and burial costs
Who qualifies?
- You are the spouse or child of an employee who has died as a result of a work-related injury or illness
- Children are eligible only if they are under age 18, are full-time students, or are unable to work because of physical or mental disabilities
What are the benefits?
- Surviving spouses can receive weekly benefits equal to 66% of the deceased worker's average weekly wage, up to the maximum of the state average weekly wage (SAWW) at the time of their injury or illness
- Surviving spouses become eligible for yearly cost-of-living-adjustments two years after the date of the injury or illness
- If the spouse remarries, $60 a week is paid to each eligible child. The total weekly amount paid to dependent children cannot exceed the amount the spouse had been receiving.
- Burial costs up to 8 times the SAWW in place at the time of death
For how long?
- Surviving spouses can receive these benefits for as long as they remain dependent and do not remarry
Lump Sum Settlements
A lump sum is a settlement or contract between you, the insurer, and in some cases your employer. This one-time payment may be made in place of your weekly compensation checks and certain other benefits. In accepting a settlement, you give up certain rights, so you must carefully consider whether or not settling your case is in your own best interest. No one is entitled to a lump sum; you and the insurance company must agree to it.
We have Lump Sum Brochures further explaining your rights; if you can not download it from our website, please call (857) 321-7470 or email info2@mass.gov, and request we send you one through regular mail or email.