An Act Increasing Injured Workers’ Access to Medical Care and Workers’ Compensation Benefits

Fact Sheet:
An Act Increasing Injured Workers’ Access to Medical Care and Workers’ Compensation Benefits (HB1684)
Lead sponsors:  Rep. Garrett Bradley, Senator James Eldridge

Background: 
Workers compensation is a lifeline for workers who suffer a workplace injury or illness.  For low wage workers without a safety net – such as a spouse with an income or primary care health insurance, ensuring that injured workers can obtain medical treatment quickly and efficiently, and sufficient wage replacement benefits, is even more essential.
 
What the bill will do:
 An Act Increasing Injured Workers’ Access to Medical Care and Workers’ Compensation Benefits: seeks to improve the workers compensation law in several ways:
1.     Helping improve the process and reducing barriers so low wage workers can receive their medical treatment and wage benefits more quickly,
2.     Increasing the wage benefits for low wage workers to help reduce the financial hardship that takes place when workers become injured.
 
In order to help workers obtain their benefits more quickly and with fewer barriers, the bill proposes:
·       Making it possible for workers and their attorney to request an expedited hearing (a hearing that takes place sooner) if the worker was denied workers compensation because the employer denies that the worker was an employee or they disagree about the wage amount.

·       Requiring the workers compensation insurer, including the states’ Trust Fund, to take into consideration information from the employee, not just the employer. 

·       Requiring the state’s Trust Fund to pay up front for medical and wage replacement benefits when multiple employers and insurance companies disagreeing about who is responsible. 

·       Requiring insurers, including the Trust Fund, to pay for interpretation, provided by qualified interpreters for conciliations, hearings and other essential meetings, and for transportation for medical care upon the request of the employee or health care provider.

·       Requires employers to provide printed notice of key workers compensation information and information on illegal employer retaliation and fraud.  It also adds a requirement that multilingual information be included in this Notice.

In order to ensure that low wage workers have adequate wage benefits to prevent grave financial hardship, the bill proposes:
·       Creating a sliding scale of wage replacement benefits to help create a safety net for the lowest income injured workers:
 
·       Ensuring that when the wage replacement benefits are calculated, all evidence of wages earned are considered, and that minimum wage  and overtime laws are considered when determining the wages.

Summary of Proposed Regulations:
When calculating the average weekly wages, if it is determined that the injured employee has been paid less than the wages required by law, then the computation of average weekly wages may be considered to be impracticable due to the nature or terms of that employment, as provided under M.G.L. c. 152, § 1(1), and the injured employee’s past earnings may be considered to be the wages required to be paid by law, taking into account the applicable minimum wage, overtime, and other wage-related statutes and regulations. 

Deletes from the regulations from making the person who files the DIA claim be responsible for paying for interpretation:
Puts the responsibility on the insurance company to pay for interpretation, transportation, and other services necessary to allow the claimant to obtain effective and timely health care services.  The insurer, except in cases where the insurer is the Trust Fund or the Commonwealth, shall arrange and pay directly for such services upon the request of the claimant, claimant’s attorney, treating health care professional, or other similarly interested party.  Transportation services provided under this section shall include door-to-door regulated taxi services where a claimant is not readily able to provide his or her own transportation or does not have reasonably convenient and feasible public transportation alternatives.

In making an initial determination of whether to approve or deny a claim, the insurer shall consider all information available from both the employer and the claimant.  An insurer shall not fail to commence payment on grounds that the insured employer has not responded or provided information; in such circumstances, the insurer must make its determination based on the information provided by the claimant, provided, however, the insurer does not waive any defenses if it thereafter commences such payment.