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How many days must you wait before claiming workers’ comp benefits?

On Behalf of | Nov 15, 2023 | Workers' Compensation

While workers’ compensation helps pay for the medical expenses of workers suffering from work-related injuries or occupational illnesses, there’s more to the insurance system. It can also provide benefits to workers as they recover, covering their lost wages or incapacity to return to work.

Usually, before a worker can apply for benefits, their medical condition should cause five full or partial calendar days of disability. But five days might be a bit too long for some injuries, which can be patched up in a couple of days. Does this rule effectively prevent workers from claiming benefits?

Five-day requirement doesn’t have to be consecutive

According to Massachusetts’ Department of Industrial Accidents (DIA), workers don’t need to spend five straight days of disability before filing a claim for benefit; the disability days don’t need to be consecutive. So, for instance, a medical condition causes three days of disability, and then another three later, the affected worker can apply for benefits.

However, the DIA also noted that if an injury or illness disables a worker for under five full or partial days, they can claim only medical benefits.

Insurer can still turn down claims

But even if a worker doesn’t have to spend five straight days incapacitated to file a claim for benefits, there’s no guarantee their employer – and, by extension, the employer’s insurer – would accept the claim.

There are various reasons why a workers’ compensation insurer would turn down a claim. They include:

  • The worker failed to seek immediate medical care
  • The worker failed to report their injury or illness
  • The work-related injury or occupational disease occurred while the worker was drunk
  • The worker missed the deadline to file a claim
  • The claim form wasn’t properly filled out

If this happens, workers can appeal the claim denial to the DIA. The department will hold an informal hearing between the worker and the insurer’s attorney. This procedure is incredibly complicated, so workers may have to seek the help of a legal professional.

In conclusion, workers must experience five days of disability before filing for workers’ compensation benefits – but those days don’t need to be sequential. However, their employer and their employer’s insurer still have to review those claims, so workers should be ready to appeal a claim denial.

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