reglab/statecodes huggingface dataset:
Code of Massachusetts Regulations › 452 CMR - DEPARTMENT OF INDUSTRIAL ACCIDENTS › Title 452 CMR 1.00 - Adjudicatory Rules of the Industrial Accident Board › Section 1.08 - Conciliation

Current through Register 1525, July 5, 2024
(1) A conciliation held pursuant to M.G.L. c.
			 152, § 10, shall be presided over by a conciliator within the Division of
			 Dispute Resolution. The conciliation shall be informal. The conciliator shall
			 meet with the parties jointly and may, in his discretion, meet with each party
			 separately.
(2) A party to a
			 conciliation may be represented by counsel of record or any person bearing
			 written authority to sign agreements as to compensation for such party. Any
			 person who is not a party or who does not bear such authority may attend a
			 conciliation only with the consent of all parties.
(3) No conciliator shall be called to testify
			 at any proceeding within the Division of Dispute Resolution regarding any issue
			 which has come before him as a conciliator.
(4) Before a conciliator can refer an
			 insurer's complaint to modify or discontinue compensation benefits to the
			 Industrial Accident Board, the insurer must have provided to the employee or
			 the employee's designee, a copy of the wage schedule upon which weekly benefits
			 are being paid. Alternatively, the insurer shall furnish an affidavit signed by
			 a representative of the insurer stating that the wage schedule has been
			 requested by the insurer, but the insured would not or could not produce such a
			 wage schedule. The employee or the employee's attorney may waive such
			 requirement.
(5) Claims and
			 complaints filed without substantial compliance with the requirements of
			 452 CMR 1.07(2)
			  shall be withdrawn by the conciliator
			 without prejudice at conciliation unless waived by the opposing party at or
			 before the conciliation.
(6) Claims
			 for reimbursement under M.G.L. c. 152, §§ 37 and 37A will be
			 scheduled for conciliation in the Boston Office unless the parties agree in
			 writing, at the time of the filing, that it is to be adjudicated at a specified
			 regional office.
Code of Massachusetts Regulations › 452 CMR - DEPARTMENT OF INDUSTRIAL ACCIDENTS › Title 452 CMR 1.00 - Adjudicatory Rules of the Industrial Accident Board › Section 1.09 - Assignment to Division of Dispute Resolution

Current through Register 1525, July 5, 2024
(1) An insurer who is aggrieved by the
			 assessment of a referral fee of 130% of the average weekly wage in the
			 Commonwealth pursuant to M.G.L. c. 152 § 10(5) may seek an administrative
			 review by the conciliation manager within 30 days of the issuance of the bill
			 and shall include any relevant documentation with such request.
(a) A conciliator's assertion that an insurer
			 was absent for a scheduled conciliation shall be final, and the review shall be
			 limited to the issues of whether the higher assessment was a mistake and, if
			 not a mistake, whether the absence of the insurer was beyond such insurer's
			 control. Said manager shall make a finding within 30 days of receipt of a
			 documented request for review.
(b)
			 An insurer who is aggrieved by the finding of said manager shall have 14 days
			 from receipt of said finding to request a hearing before the Director or the
			 Director's designee, who shall schedule such hearing in Boston within 30 days
			 of receipt of such request. The issues at such hearing shall be limited to
			 those that may be considered in the administrative review. The hearing shall
			 not be subject to rules of evidence.
(c) No insurer shall be granted more than one
			 administrative review for any referral of a case to the Division of Dispute
			 Resolution.
(d) An insurer's
			 obligation to pay a referral fee shall not delay the forwarding of the claim
			 and the case to the Industrial Accident Board.
Code of Massachusetts Regulations › 452 CMR - DEPARTMENT OF INDUSTRIAL ACCIDENTS › Title 452 CMR 1.00 - Adjudicatory Rules of the Industrial Accident Board › Section 1.10 - Conferences

Current through Register 1525, July 5, 2024
(1) The administrative judge shall preside
			 over the conference held pursuant to M.G.L. c. 152, § 10A. Such conference
			 shall be informal, and inquiries and investigations shall not be subject to the
			 rules of evidence applied in this Commonwealth.
(2) The parties shall prepare for submission
			 at the outset of a conference a memorandum setting forth the benefits claimed
			 and the issues in dispute, the facts stipulated, the exhibits to be marked for
			 identification, the names of witnesses to be presented, a summary of their
			 anticipated testimony, the estimated length of the hearing, and such other
			 matter as may be allowed or required. Such memorandum may be amended by the
			 parties, with the leave of the administrative judge, at or before the hearing.
			 At a conference involving a medical issue, the parties shall also identify to
			 the administrative judge as part of the required memorandum:
(a) the medical issue(s) in dispute requiring
			 the filing of the requisite fee;
(b) a list of documents to be included in the
			 medical records to be sent to an impartial physician; any hypotheticals or
			 disclosure questions to be submitted to the impartial physician upon the
			 judge's approval; identification of a specialty or the names of up to three
			 impartial physicians in order of preference if agreed upon; and the names of
			 any additional physicians anticipated to be requested at hearing to be
			 deposed;
(c) any objections to the
			 documents included in the medical records and hypotheticals to be submitted to
			 the impartial physician.
Code of Massachusetts Regulations › 452 CMR - DEPARTMENT OF INDUSTRIAL ACCIDENTS › Title 452 CMR 1.00 - Adjudicatory Rules of the Industrial Accident Board › Section 1.11 - Hearings

Current through Register 1525, July 5, 2024
(1) Unless a late appeal is permitted by the
			 Director, as provided by M.G.L. c. 152, § 10A, any appeal from an order of
			 an administrative judge must be filed with the department, on a form prescribed
			 by the department, not later than 14 calendar days from the filing date of said
			 order.
(a) Where the appointment of an
			 impartial examiner is required, a party has up to ten calendar days following
			 the filing of the appeal to pay the Department the requisite fee. A request for
			 a waiver of the requisite fee based on indigence shall be filed with the
			 Director on a form prescribed by the Department not later than ten calendar
			 days following the filing of the appeal. Where more than one party files an
			 appeal, each shall file timely either the requisite fee or a request for waiver
			 on the prescribed form. The Department shall designate the first check received
			 as the requisite fee required to schedule an examination by an impartial
			 physician. All other checks will be returned.
(b) In a multiple insurer claim, all the
			 individual appeal forms shall accompany a cover sheet approved by the
			 Department which identifies all insurers and states the board number of each
			 claim. One check payable to the Department in the amount of the requisite fee
			 appended to the multiple appeal cover sheet with all individual appeal forms
			 presented in a timely manner shall perfect all appeals.
(c) Pursuant to M.G.L. c. 152, § 11, the
			 parties may at the discretion of the administrative judge, agree in writing or
			 on the record that an impartial physician is not required if such agreement has
			 not been reached at conference;
(d)
			 In any hearing in which the insurer raises the applicability of the fourth
			 sentence provisions of M.G.L. c. 152, § 1(7 A), governing combination
			 injuries, the insurer must state the grounds for raising such defense on the
			 record or in writing, with an appropriate offer of proof.
Code of Massachusetts Regulations › 452 CMR - DEPARTMENT OF INDUSTRIAL ACCIDENTS › Title 452 CMR 1.00 - Adjudicatory Rules of the Industrial Accident Board › Section 1.13 - Medical Reports and Records

Current through Register 1525, July 5, 2024
Pursuant to M.G.L. c. 152, § 30A, on the written request
				of a party, the Department shall, on receipt of records kept or compiled under
				M.G.L. c. 111, § 119, cause them to be impounded under seal apart from the
				main file, to be used only by the administrative judge or Reviewing Board in
				connection with a proceeding under M.G.L. c. 152. Where such records become
				evidence in any proceeding, they shall be incorporated in the report by
				reference only, and in the event of certification under M.G.L. c. 152, §
				12, shall be certified and impounded under seal.
Code of Massachusetts Regulations › 452 CMR - DEPARTMENT OF INDUSTRIAL ACCIDENTS › Title 452 CMR 1.00 - Adjudicatory Rules of the Industrial Accident Board › Section 1.14 - Impartial Physicians

Current through Register 1525, July 5, 2024
(1) If within ten
			 calendar days of filing the appeal the parties have not selected, or an
			 administrative judge has not appointed, a physician from the impartial
			 physician roster to examine the employee, the impartial unit shall choose a
			 physician as directed by the Senior Judge.
(2) Once the impartial physician has been
			 selected or appointed, the administrative judge shall submit to the impartial
			 unit all approved medical records, any hypothetical fact patterns and any
			 stipulations of fact for transmission to the impartial physician. No party or
			 representative may initiate direct,
ex parte
communication
			 with the impartial physician and shall not submit any form of documentation to
			 the impartial physician without the express consent of the administrative
			 judge.
(a) The impartial physician may not
			 communicate with the parties unless authorized to do so by the administrative
			 judge, except that a party who wishes to engage the impartial physician to be
			 deposed for the purposes of cross examination may contact the physician or his
			 office for the purpose of scheduling a deposition.
(b) The impartial physician may contact the
			 impartial scheduling unit to request medical records and reports from providers
			 who have treated the employee prior to the date of the selection or appointment
			 of the impartial physician. Providers of diagnostic services and testing shall
			 send these records directly to the impartial physician upon request of the
			 impartial physician or of the impartial unit. The administrative judge shall
			 give all parties the opportunity to review the additional medical records, and
			 rule on any objection raised by the parties to submission of the additional
			 records to the impartial physician.
(c) Except by leave of the administrative
			 judge, hypothetical questions to the impartial physician must be submitted to
			 the administrative judge within 14 days of the appeal of the conference
			 order.
Code of Massachusetts Regulations › 452 CMR - DEPARTMENT OF INDUSTRIAL ACCIDENTS › Title 452 CMR 1.00 - Adjudicatory Rules of the Industrial Accident Board › Section 1.15 - Reviewing Board

Current through Register 1525, July 5, 2024
(1)
Notice of Appeal
. Any appeal from a decision of an
			 administrative judge must be filed with the Department on the form prescribed
			 by the Department not later than 30 days from the filing date of the decision,
			 unless a late appeal is permitted by the Director as provided by M.G.L. c. 152,
			 § 11C. A copy of the appeal shall be served by mail or in hand on counsel
			 for each party or on each unrepresented party.
(2)
Filing Fee
. The
			 filing fee or a request for its waiver shall be submitted to the Reviewing
			 Board with the notice of appeal. The filing fee prescribed by M.G.L. c. 152,
			 § 11C shall be 30% of the average weekly wage in the Commonwealth at the
			 time of payment. Any request for a waiver of the filing fee based on indigence
			 shall be filed on a form prescribed by the Department.
(3)
Reviewing Board
.
			 An administrative law judge may require counsel or
pro se
litigants to appear for a conference to consider waiver of the filing
			 fee, simplification of the issues on appeal, whether oral argument will be
			 held, and any other matters that may aid in the disposition of the
			 appeal.
(4)
Briefs
. Unless otherwise ordered by the Reviewing
			 Board, a brief shall be filed by the appellant in all cases in accordance with
			 the following provisions:
(a)
Content
. The brief of the appellant shall contain
			 under appropriate headings and in the order here indicated:
1. A statement of the issues presented for
			 review; stated with particularity. A statement that the decision on review is
			 beyond the scope of the administrative judge's authority, arbitrary or
			 capricious, or contrary to law, without more, shall not constitute a proper
			 statement of the issues presented for review;
2. A statement of the case, which shall first
			 indicate briefly the nature of the case, the course of proceedings and its
			 disposition following conference and hearing. There shall follow a brief
			 statement of the facts relevant to the issues presented for review, with
			 appropriate references to the record;
3. The argument, which shall contain the
			 contention of the appellant with respect to the issues presented, supporting
			 rationale and citations to the authorities, statutes, rules, regulations and
			 parts of the record on which the party relies. The Reviewing Board need not
			 decide questions or issues not argued in the brief. If oral argument is
			 permitted nothing argued in the brief shall be deemed to be waived by a failure
			 to argue the issue orally;
4. A
			 short conclusion stating the precise relief sought; and
5. The names, addresses and telephone numbers
			 of counsel and their firms.
Code of Massachusetts Regulations › 452 CMR - DEPARTMENT OF INDUSTRIAL ACCIDENTS › Title 452 CMR 1.00 - Adjudicatory Rules of the Industrial Accident Board › Section 1.16 - Copies of Orders, Decisions, and Memoranda of Agreements

Current through Register 1525, July 5, 2024
A request for a certified copy of an order or decision of an
				administrative judge or the Reviewing Board, or a memorandum of agreement, and
				all papers in connection therewith required by M.G.L. c. 152, § 12, shall
				be accompanied by a payment of no less than $10.00 when the actual cost of
				copying said documents exceeds $10.00, the party requesting said copies shall
				be billed for the additional cost and shall remit the additional
				charge.
Code of Massachusetts Regulations › 452 CMR - DEPARTMENT OF INDUSTRIAL ACCIDENTS › Title 452 CMR 1.00 - Adjudicatory Rules of the Industrial Accident Board › Section 1.17 - Ex Parte Communications

Current through Register 1525, July 5, 2024
No party or representative of a party involved in a proceeding
				before an administrative judge or Reviewing Board shall submit to the
				administrative judge or Reviewing Board any information, evidence, argument, or
				advice, whether written or oral, regarding any matter at issue in such
				proceeding unless such submission is part of the record or made in the presence
				of all parties. When a party to a proceeding submits a letter or any writing to
				an administrative judge or the Reviewing Board, a copy shall be served by mail
				or in hand on counsel for each other party or directly on each other party if
				not represented.
Code of Massachusetts Regulations › 452 CMR - DEPARTMENT OF INDUSTRIAL ACCIDENTS › Title 452 CMR 1.00 - Adjudicatory Rules of the Industrial Accident Board › Section 1.18 - Practice Before the Department

Current through Register 1525, July 5, 2024
(1) Any attorney
			 admitted to practice before the courts of the Commonwealth may practice before
			 the Department.
(2) In any
			 proceeding before the Department, any person not admitted to practice before
			 the courts of the Commonwealth may appear and act for himself, or for a
			 partnership of which he is a member, or for a corporation of which he is an
			 officer, or for anybody from whom he has written authorization to represent on
			 file with the Department on a form prescribed by the Department.
(3) An attorney, or other authorized
			 representative may, without leave, withdraw as representative by filing a
			 written notice of withdrawal, with copies to all parties, provided that such
			 notice is accompanied by the appearance of a successor representative. Under
			 all other circumstances, leave of the administrative judge, or administrative
			 law judge having jurisdiction over an active proceeding must be obtained. In
			 cases where no judge has active jurisdiction leave must be obtained from the
			 office of the Senior Judge.
(4)
			 Whenever an attorney appears at a proceeding, who:
(a) is not the attorney of record;
			 or
(b) is not an attorney who,
			 pursuant to his or her registration with the Board of Bar Overseers, shares the
			 same business/professional address as the present attorney of record;
the attorney must file a written notice of appearance on a form
				prescribed by the Department prior to addressing the board in the proceeding.
				Where more than one attorney has filed an appearance for a party, all notices
				will be sent to the attorney who most recently appeared. In all cases, any
				attorney or qualified representative so appearing, is representing to the
				Department that she or he possesses full authority to handle any and all
				aspects of the matter presently pending at the Department.
Code of Massachusetts Regulations › 452 CMR - DEPARTMENT OF INDUSTRIAL ACCIDENTS › Title 452 CMR 1.00 - Adjudicatory Rules of the Industrial Accident Board › Section 1.20 - Joinder

Current through Register 1525, July 5, 2024
(1) An administrative judge before whom a
			 proceeding is pending may join, or any party to such proceeding may request the
			 administrative judge to join, as a party, on written notice and a right to be
			 heard, an insurer, employer, or other person who may be liable for payment of
			 compensation to the claimant.
(2) A
			 party to be joined shall not be allowed to raise a defense of late claim if the
			 original claim was filed timely, but shall be allowed to raise any and all
			 other reasonable defenses which would have been available to him had the
			 claimant filed an original claim against the party to be joined, provided that
			 the party requesting joinder, in the absence of mistake or inadvertence, made a
			 reasonable attempt to ascertain the identity of the correct party or parties
			 before the filing of the original claim.
(3) When it is decided, after proper hearing
			 of a request to join, that the subject of such request shall be joined, the new
			 party shall be allowed a reasonable period of time to prepare a defense. Such
			 period shall not exceed 45 calendar days from the date of joinder, unless the
			 administrative judge who orders the joinder finds that additional time to
			 prepare a defense is needed.
Code of Massachusetts Regulations › 452 CMR - DEPARTMENT OF INDUSTRIAL ACCIDENTS › Title 452 CMR 1.00 - Adjudicatory Rules of the Industrial Accident Board › Section 1.21 - Third Party Liability

Current through Register 1525, July 5, 2024
(1) When an
			 employee who claims or receives benefits under M.G.L. c. 152 seeks damages from
			 some other person or entity other than the employer or its workers'
			 compensation insurer, within the meaning of M.G.L. c. 152, § 15, the
			 employee shall immediately notify the insurer by certified mail of the
			 commencement of the action. Where the workers' compensation insurer proceeds to
			 enforce the liability of such third person, it shall notify the employee in the
			 same manner.
(2) Where the employee
			 or the workers' compensation insurer recovers judgment or reaches a settlement
			 in a civil action in any court, the terms of such judgment or settlement shall
			 be reported immediately to the Department as well as to the appropriate rating
			 bureau as required by M.G.L. c. 152, § 53A(4).
(3) When the parties elect to submit to the
			 jurisdiction of the Department, the settlement by agreement shall be in writing
			 and in conformity with the guidelines and format prescribed by the Department.
			 Approval authority statutorily residing in the Reviewing Board and the Board
			 may be delegated to an individual administrative law judge or administrative
			 judge by the Senior Judge.
(4) A
			 hearing on the merits of the proposed settlement will be held if requested by
			 the parties. In the alternative, the parties may waive their right to a hearing
			 and submit the executed settlement agreement to the designated judge for review
			 and disposition, except when a third party settlement is conditioned upon the
			 approval of a lump sum settlement. In that circumstance, a hearing on the
			 merits of both agreements must be heard by the same judge.
Code of Massachusetts Regulations › 452 CMR - DEPARTMENT OF INDUSTRIAL ACCIDENTS › Title 452 CMR 1.00 - Adjudicatory Rules of the Industrial Accident Board › Section 1.22 - Amendments to Claims and Complaints

Current through Register 1525, July 5, 2024
(1) Pursuant to
			 M.G.L. c. 152, § 49, a party may amend his or her claim or complaint as to
			 the time, place, cause, or nature of the injury, as a matter of right, at any
			 time prior to a conference, with written notice to all parties. At the time of
			 a conference or thereafter, a party may amend such claim or complaint only by
			 filing a motion to amend with an administrative judge. Such a motion shall be
			 allowed by the administrative judge unless the amendment would unduly prejudice
			 the opposing party.
(2) As to a
			 party to the original action, a party may amend a claim or complaint in writing
			 with notice to all parties as a matter of right at any time prior to a
			 conference whenever the controversy created by the amended claim or complaint
			 arose out of conduct, incident, or series of occurrences set forth or attempted
			 to be set forth in the original claim or complaint.
(3) No amendment to a claim or complaint may
			 be made except as provided by M.G.L. c. 152 and
			 452 CMR 1.00. Any party shall
			 be allowed a reasonable period of time to prepare a defense to an amended claim
			 or complaint. Such period shall not exceed 45 calendar days from the date of
			 notice of the amendment, unless an administrative judge finds that additional
			 time to prepare a defense is needed.
Code of Massachusetts Regulations › 452 CMR - DEPARTMENT OF INDUSTRIAL ACCIDENTS › Title 452 CMR 1.00 - Adjudicatory Rules of the Industrial Accident Board › Section 1.23 - Recoupment of Overpayment

Current through Register 1525, July 5, 2024
Where an employee is receiving weekly benefits by agreement or
				by an order or decision, and a subsequent order or decision filed pursuant to
				M.G.L. c. 152 authorizes retroactive reduction of the weekly compensation rate,
				but does not terminate weekly benefits, the order or decision shall
				specifically address the manner or method of recoupment of such overpayment by
				the insurer.
Code of Massachusetts Regulations › 452 CMR - DEPARTMENT OF INDUSTRIAL ACCIDENTS › Title 452 CMR 3.00 - Workers' Compensation Trust Fund › Section 3.01 - Scope and Authority

Current through Register 1525, July 5, 2024
452 CMR 3.00 is promulgated pursuant to M.G.L. c. 152, § 5
				for the purpose of carrying out the provisions of M.G.L. c. 152. The Workers'
				Compensation Trust Fund (Trust Fund) established by M.G.L. c. 152, § 65,
				shall be administered, and compensation paid, in accordance with 452 CMR 3.00
				and with periodic Circular Letters issued by the Department.
Code of Massachusetts Regulations › 452 CMR - DEPARTMENT OF INDUSTRIAL ACCIDENTS › Title 452 CMR 3.00 - Workers' Compensation Trust Fund › Section 3.02 - Payment of Benefits for Disabilities Subject to Latency

Current through Register 1525, July 5, 2024
(1) For purposes of M.G.L. c. 152, §
			 35C, for claims involving compensation pursuant to M.G.L. c. 152, §§
			 34, 34A or 35, applicable benefits on the first date of eligibility for
			 benefits shall be based on the employee's average weekly wage as of such first
			 date of eligibility for benefits, or, if the employee is not employed on that
			 date, it shall be based on the employee's average weekly wage as of the
			 employee's last date of employment.
For claims involving compensation pursuant to M.G.L. c. 152,
				§ 31, applicable benefits on the first date of eligibility for benefits
				shall be based on the employee's average weekly wage as of such first date of
				eligibility, or, if the employee is not employed on that date, it shall be
				based on the minimum compensation rate provided in M.G.L. c. 152, §
				31.
(2) Payment of benefits
			 under M.G.L. c. 152, §§31, 34, 34A, or 35 within five years of the
			 date of injury shall preclude applicability of M.G.L. c. 152, §
			 35C.
(3) For purposes of M.G.L. c.
			 152, § 65(2)(b), "adjustments to compensation pursuant to M.G.L. c. 152,
			 § 35C" shall mean any increase in benefits paid to an employee as a result
			 of the applicability of the first subsection of M.G.L. c. 152, §
			 35C.
Code of Massachusetts Regulations › 452 CMR - DEPARTMENT OF INDUSTRIAL ACCIDENTS › Title 452 CMR 3.00 - Workers' Compensation Trust Fund › Section 3.03 - Reimbursement of Cost of Living Adjustments

Current through Register 1525, July 5, 2024
(1) A
			 person entitled to receive yearly increases in benefits under M.G.L. c. 152,
			 § 31, pursuant to St. 1982, c. 663, § 1, shall continue to receive
			 said benefits on or after November 1,1986 and shall not be eligible for
			 benefits pursuant to M.G.L. c. 152, § 34B. For the purposes of M.G.L. c.
			 152, §65(2)(a), ''adjustments to compensation pursuant to M.G.L. c. 152,
			 §34B" shall not include benefits which are paid under M.G.L. c. 152,
			 § 31, pursuant to St. 1982, c. 663, § 1. Any overpayment by an
			 insurer or self insurer resulting from the promulgation of 452 CMR 3.00 shall
			 be recovered only through the use of future credits and not through a reduction
			 of benefits currently paid.
(2) The
			 initial increase in benefits under M.G.L. c. 152, § 34B shall be payable
			 on the first October 1st subsequent to the date
			 marking the 24-month anniversary of the date of injury. If the date marking the
			 anniversary falls on a review date, the increase is payable as of that review
			 date.
(3) A party requesting
			 reimbursement pursuant to M.G.L. c. 152, § 65(2)(a) or § 65(2)(b),
			 shall file a form prescribed by the Department, received and date stamped by
			 the Department no later than two calendar years from the date on which the
			 benefit payment, for which the reimbursement request being filed, was
			 due.
(4) An employee receiving
			 benefits under M.G.L. c. 152, §§ 31 or 34A, who has received a
			 written request from an insurer, shall cooperate with the insurer in obtaining
			 or providing any information from the Social Security Administration necessary
			 to the calculation of any adjusted benefits that may be due under M.G.L. c.
			 152, § 34B. No insurer shall be required to pay adjusted benefits until
			 all necessary information is available, provided that the insurer has made a
			 good faith effort to obtain that information.
Code of Massachusetts Regulations › 452 CMR - DEPARTMENT OF INDUSTRIAL ACCIDENTS › Title 452 CMR 3.00 - Workers' Compensation Trust Fund › Section 3.05 - Reimbursement of Benefits for Second Injuries

Current through Register 1525, July 5, 2024
An insurer or self-insurer may file a claim for reimbursement
				under M.G.L. c. 152, § 10 with the Division of Claims Administration to
				resolve any controversy arising under M.G.L. c. 152, §§ 37 and 37A,
				on a form prescribed by the Department as provided in
				452 CMR
				1.07(2)(1).
Code of Massachusetts Regulations › 452 CMR - DEPARTMENT OF INDUSTRIAL ACCIDENTS › Title 452 CMR 4.00 - Vocational Rehabilitation › Section 4.01 - Scope and Authority

Current through Register 1525, July 5, 2024
452 CMR 4.00 is promulgated pursuant to M.G.L.c. 152, §
				1(12) for the purpose of carrying out the requirements of M.G.L. c. 152
				relative to the provision of appropriate vocational rehabilitation services as
				overseen by the Office of Education and Vocational Rehabilitation
				(OEVR).
Code of Massachusetts Regulations › 452 CMR - DEPARTMENT OF INDUSTRIAL ACCIDENTS › Title 452 CMR 4.00 - Vocational Rehabilitation › Section 4.03 - Qualifications and Standards of Providers

Current through Register 1525, July 5, 2024
(1)
			 Vocational rehabilitation services may be provided to injured employees only by
			 organizations approved by OEVR as qualified providers. Requests for such
			 approval may be submitted to OEVR by:
(a) any
			 state vocational rehabilitation agency or employment and training agency which
			 delivers vocational rehabilitation services or placement services to
			 handicapped persons, or
(b) any
			 insurer, self-insurer, or private vocational rehabilitation organization,
			 including corporations, partnerships, and sole proprietorships engaged in the
			 provision of vocational rehabilitation services or placement of handicapped
			 persons in employment.
Code of Massachusetts Regulations › 452 CMR - DEPARTMENT OF INDUSTRIAL ACCIDENTS › Title 452 CMR 4.00 - Vocational Rehabilitation › Section 4.04 - Evaluation, Suspension and Removal of Providers

Current through Register 1525, July 5, 2024
(1) Pursuant to M.G.L. c. 152, § 30H,
			 each rehabilitation provider which offers services to workers' compensation
			 recipients shall be evaluated periodically by OEVR. The evaluation shall focus
			 on the quality of services provided based on file audit and/or a review of
			 monthly progress reports and IWRPs, interactions with OEVR staff and injured
			 workers, the costs of such services, and the results achieved by such services
			 as determined by number of clients returned to employment. OEVR will also
			 consider the providers record relative to the avoidance of conflicts of
			 interest in the provision of vocational rehabilitation services. In conducting
			 such an evaluation, OEVR shall monitor and evaluate each individual written
			 rehabilitation program implemented by the provider, documenting the injured
			 employee's utilization of services and achievement of program goals.
(2) OEVR shall notify in writing any
			 rehabilitation provider who, according to the periodic evaluation, fails to
			 meet service or cost effectiveness standards. Such notice shall state
			 specifically the reasons for OEVR's finding of sub-standard performance. In
			 order to satisfy OEVR that a performance deficiency has been corrected, each
			 such provider shall submit any documentation required by OEVR to monitor and
			 evaluate corrective actions taken by the provider. Unless the provider corrects
			 each stated performance deficiency within 30 calendar days from the receipt of
			 such notice, said provider may be suspended or removed by the commissioner from
			 OEVR's list of approved providers. In the event that the provider is removed
			 from the approved list of providers, an appeal may be submitted in writing to
			 the Director of the Department within 14 days of such providers receipt of
			 notice of removal or suspension.
(3) Certified providers performing any type
			 of claims functions apart from vocational rehabilitation services, including
			 hypothetical labor market surveys and earning capacity evaluations, shall be
			 prohibited from providing vocational services to the same injured
			 employee.
Code of Massachusetts Regulations › 452 CMR - DEPARTMENT OF INDUSTRIAL ACCIDENTS › Title 452 CMR 4.00 - Vocational Rehabilitation › Section 4.05 - Mandatory Meeting

Current through Register 1525, July 5, 2024
(1) Whenever an
			 insurer makes payments pursuant to a memorandum submitted to the department
			 pursuant to
			 452 CMR
			 1.05(2), or pursuant to an
			 order or decision of an administrative judge, OEVR may contact the injured
			 employee, to determine whether an initial interview is appropriate.
(2) Information gathered by OEVR at the
			 initial interview shall be used to determine whether rehabilitation services
			 are necessary and feasible. Such information shall include, but need not be
			 limited to the injured employee's:
(a)
			 functional limitations;
(b)
			 employment history;
(c)
			 transferrable skills;
(d) work
			 habits;
(e) vocational
			 interests;
(f) pre-injury
			 earnings;
(g) financial needs;
			 or
(h) medical
			 information.
Code of Massachusetts Regulations › 452 CMR - DEPARTMENT OF INDUSTRIAL ACCIDENTS › Title 452 CMR 4.00 - Vocational Rehabilitation › Section 4.06 - Notice to Insurer of Suitability

Current through Register 1525, July 5, 2024
OEVR shall notify the insurer in writing of its determination
				of suitability and whether vocational rehabilitation has been found to be
				necessary and feasible for an injured employee. Within ten working days of
				receipt of such notification, the insurer shall provide to OEVR all pertinent
				medical records on the injured employee if not previously submitted. If the
				insurer fails to produce the requested medical information and the treating
				physician is unable to provide a current medical report, OEVR shall order an
				impartial medical examination, the reasonable cost of which shall be reimbursed
				by the insurer. Otherwise, OEVR will determine suitability based on the
				information submitted.
When the injured employee, on the date of such determination,
				has not been referred to an approved provider, OEVR will request in writing
				that the insurer provide vocational rehabilitation services to the injured
				employee through an approved provider as outlined in
				452 CMR
				4.03 within 30 days of the receipt of the
				request.
If the insurer fails to assign an approved provider after they
				have received a second request from OEVR to do so, OEVR will assign an approved
				provider who will initiate services and, if appropriate, develop an IWRP. The
				cost of such services and program shall be assumed by the Workers' Compensation
				Trust Fund under M.G.L. c. 152, § 65(2)(d) and the insurance company will
				be assessed pursuant to M.G.L. c. 152, § 30H upon the attainment of a
				successful rehabilitation as defined in
				452 CMR
				4.02.
Code of Massachusetts Regulations › 452 CMR - DEPARTMENT OF INDUSTRIAL ACCIDENTS › Title 452 CMR 4.00 - Vocational Rehabilitation › Section 4.07 - Design of Individual Written Rehabilitation Program

Current through Register 1525, July 5, 2024
(1) In the event that OEVR determines that
			 vocational rehabilitation services are necessary and feasible for an injured
			 employee, and a certified provider has been assigned, OEVR shall proceed as
			 follows:
(a) The qualified provider must
			 provide progress reports every 30 days beginning 30 days after the first
			 meeting with the injured worker.
(b) An individual written rehabilitation plan
			 shall be developed for injured employees found suitable for services within 90
			 days of the qualified provider's receipt of the referral from the insurer or
			 OEVR. If circumstances do not allow for such a plan to be developed within such
			 time then OEVR shall be notified of the delay, in writing by the provider, as
			 soon as possible but no later than 30 days after the original due date of the
			 IWRP. That written notice from the qualified provider shall note the reasons
			 for the delay and a proposed timeline for submission of the written
			 plan.
Code of Massachusetts Regulations › 452 CMR - DEPARTMENT OF INDUSTRIAL ACCIDENTS › Title 452 CMR 4.00 - Vocational Rehabilitation › Section 4.08 - Amendment, Suspension or Termination of the Rehabilitation Program

Current through Register 1525, July 5, 2024
(1) Whenever significant change in the life
			 circumstances of the injured employee such as a medical reversal occurs, the
			 IWRP shall be amended, suspended or terminated. Any amendment shall document
			 the changed life situation and reflect appropriate medical, vocational or
			 environmental intervention of the injured employee. Although an amendment may
			 be substantive, such as a change in the employment goal or scope of service,
			 the insurer shall not be liable for the cost of multiple or successive
			 rehabilitation programs as defined by OEVR.
(2) In any circumstance in which OEVR
			 determines that the health or well-being of the injured employee is
			 jeopardized, OEVR may order that services be terminated immediately.
Code of Massachusetts Regulations › 452 CMR - DEPARTMENT OF INDUSTRIAL ACCIDENTS › Title 452 CMR 4.00 - Vocational Rehabilitation › Section 4.09 - Notification and Authorization to Insurers Relative to Refusal of Vocational Services

Current through Register 1525, July 5, 2024
(1) If it is
			 determined by OEVR that an initial interview is appropriate, OEVR shall
			 schedule the mandatory meeting of said injured employee at a mutually
			 convenient time as soon as practicable. If the injured employee fails to appear
			 at the scheduled interview, OEVR shall reschedule by certified letter, however,
			 if the injured employee fails to appear again, OEVR shall notify the insurer in
			 writing, pursuant to M.G.L. c. 152, § 30G, that the injured employee is
			 not entitled to weekly compensation during the period of such refusal to attend
			 the mandatory meeting.
(2) When an
			 injured employee is determined suitable for vocational rehabilitation services
			 by OEVR and refuses such services, the insurer may request written
			 authorization from OEVR for a 15% reduction in weekly benefits for the time
			 such injured employee refuses vocational services. In accordance with M.G.L. c.
			 152, § 8(2)(f), OEVR will confirm authorization for reduction for refusal
			 of such services in writing after the following:
(a) where OEVR holds a team meeting of all
			 parties to resolve vocational issues and obstacles in the process;
			 and/or
(b) where a certified letter
			 is sent to the injured employee instructing s/he to contact OEVR within five
			 working days;
Reinstatement will be authorized by OEVR when an injured
				employee actively resumes services or otherwise justifies to the satisfaction
				of OEVR the appropriateness of the refusal.
Code of Massachusetts Regulations › 452 CMR - DEPARTMENT OF INDUSTRIAL ACCIDENTS › Title 452 CMR 4.00 - Vocational Rehabilitation › Section 4.10 - OEVR Consent to Lump Sum Settlements

Current through Register 1525, July 5, 2024
Where an injured employee who has been deemed suitable for
				vocational rehabilitation services by OEVR but has not completed an appropriate
				rehabilitation program requests the consent of OEVR to a proposed lump sum
				settlement, a letter must be submitted to the Director of OEVR at least two
				weeks prior to the lump sum conference. The letter must include the following
				information:
(a) employee
			 name;
(b) DIA board
			 number;
(c) date and region of lump
			 sum conference; and
(d) reason why
			 a review for consent is being requested.
Code of Massachusetts Regulations › 452 CMR - DEPARTMENT OF INDUSTRIAL ACCIDENTS › Title 452 CMR 4.00 - Vocational Rehabilitation › Section 4.11 - OEVR Director and Rehabilitation Review Officers

Current through Register 1525, July 5, 2024
No Vocational Rehabilitation Review Officer or OEVR Director
				shall be called to testify at any proceeding within the Division of Dispute
				Resolution regarding any vocational issue which has come before him or her as
				the Director or as the Vocational Review Officer.
Code of Massachusetts Regulations › 452 CMR - DEPARTMENT OF INDUSTRIAL ACCIDENTS › Title 452 CMR 5.00 - Self Insurers › Section 5.01 - Scope and Authority

Current through Register 1525, July 5, 2024
452 CMR 5.00 is promulgated pursuant to M.G.L. c. 152, § 5
				for the purpose of carrying out the provisions of M.G.L. c. 152. The regulation
				of insurers and self insurers by the Department of Industrial Accidents shall
				be in accordance with 452 CMR 5.00.
Code of Massachusetts Regulations › 452 CMR - DEPARTMENT OF INDUSTRIAL ACCIDENTS › Title 452 CMR 5.00 - Self Insurers › Section 5.03 - Reinsurance, Surety Bond and Securities Deposit

Current through Register 1525, July 5, 2024
(1) As a condition precedent to the issuance
			 of a license to self insure, the employer shall either deposit securities or
			 furnish a surety bond with the state treasurer in an amount determined by the
			 Department, together with satisfactory evidence that the reinsurance required
			 by the Department under M.G.L. c. 152, § 25A(2)(c), is in effect. Such
			 deposit of securities or surety bond shall be in an amount equal to the
			 applicant's liabilities both incurred and to be incurred, as shall be
			 determined by the Office of Insurance, provided that the minimum deposit or
			 bond shall be $100,000.00.
(2) The
			 deposit required by M.G.L. c. 152, § 25A(2)(a), or the securities to be
			 deposited with the state treasurer after demand made by the Department in
			 conformity with the provisions of a surety bond furnished by a self insurer as
			 provided in M.G.L. c. 152, § 25A(2)(b) shall be in the form of cash or
			 such bonds, notes or other negotiable obligations which may be legal
			 investments for savings banks in this Commonwealth as determined from time to
			 time by the commissioner of banks of this Commonwealth. Registered securities
			 shall be registered as follows: "Treasurer and Receiver General of the
			 Commonwealth of Massachusetts in trust for the benefit and security of the
			 employees of the self insurer". Any securities deposited shall be accompanied
			 by an agreement in the form approved by the Department and deposited with the
			 securities in the Office of the State Treasurer.
Code of Massachusetts Regulations › 452 CMR - DEPARTMENT OF INDUSTRIAL ACCIDENTS › Title 452 CMR 5.00 - Self Insurers › Section 5.04 - Criteria for Self Insurance

Current through Register 1525, July 5, 2024
(1) The Department
			 may decline to approve an application for self insurance if the applicant is
			 unable to demonstrate that it will be able to meet all obligations and
			 requirements of M.G.L. c. 152 and 452 CMR 5.00. The following factors shall be
			 used in determining if the applicant can meet these obligations:
(a) Ratio of tangible net worth to annual
			 self insurance retention;
(b) Ratio
			 of current assets to current liabilities;
(c) Ratio of debt to tangible net
			 worth;
(d) Profit and loss
			 history;
(e) Organizational
			 structure and management background;
(f) Compensation loss history and proposed
			 excess insurance coverage;
(g)
			 Source and reliability of financial information;
(h) Ratio of net worth to annual compensation
			 premium;
(i) Number of
			 employees;
(j) Excess
			 reinsurance;
(k) Guarantee by
			 parent company;
(l) Surety bond or
			 other security;
(m) Claims
			 administration arrangements; and
(n) SEC Form 10K or 10Q, where
			 applicable.
Code of Massachusetts Regulations › 452 CMR - DEPARTMENT OF INDUSTRIAL ACCIDENTS › Title 452 CMR 5.00 - Self Insurers › Section 5.05 - Parent and Subsidiary Corporations as Self Insurers

Current through Register 1525, July 5, 2024
A parent corporation may add a subsidiary to its license only
				at the time of the original license application or when said license is renewed
				or on 60 days notice, if the self insurer amends its most recent filings,
				unless it is a subsidiary without employees, in which case, ten days notice is
				required. The parent corporation must be the sole owner of any subsidiary or
				other legal entity it wishes to include under its license. In applying for an
				original license, or a license renewal, which would cover one or more
				subsidiaries, the parent corporation shall provide information on each
				subsidiary on a form prescribed by the Department. The parent corporation must
				guarantee the liability of their subsidiaries on a form prescribed by the
				Department which must be signed, sealed and duly accepted by the Department.
				Where there is a parent/subsidiary combination, the requirements of
				452 CMR
				5.04 shall apply to the combined
				entity.
Code of Massachusetts Regulations › 452 CMR - DEPARTMENT OF INDUSTRIAL ACCIDENTS › Title 452 CMR 5.00 - Self Insurers › Section 5.06 - Cessation of Business as a Self Insurer

Current through Register 1525, July 5, 2024
(1)
			 Any employer who has obtained a license as a self insurer under the provisions
			 of M.G.L. c. 152, § 25A(2)(a) who thereafter ceases to be a self insurer
			 under M.G.L. c. 152, § 25A(2)(a), shall not be entitled to the return of
			 the deposit for a period of at least six months following the date it ceases as
			 a self insurer as aforesaid, unless it furnishes a single premium
			 non-cancelable policy as set forth in
			 452 CMR
			 5.05.
(2) An employer holding a license as a self
			 insurer who proposes to cease doing business in this Commonwealth, or proposes
			 to dispose of, by sale or otherwise, the controlling interests of the business
			 for which the license was issued shall notify the Department in writing of such
			 proposed action.
Code of Massachusetts Regulations › 452 CMR - DEPARTMENT OF INDUSTRIAL ACCIDENTS › Title 452 CMR 5.00 - Self Insurers › Section 5.07 - Insurer and Self Insurer Claims Practices

Current through Register 1525, July 5, 2024
Every self insurer shall file with the Department the names and
				addresses of all persons or attorneys, at least one of whom shall reside in
				this state, engaged by it to investigate, settle or adjust claims arising under
				M.G.L. c. 152, and any such person or attorney appearing before the Department
				shall have full power and authority to act for the self insurer in any matter
				before the Department.
Code of Massachusetts Regulations › 452 CMR - DEPARTMENT OF INDUSTRIAL ACCIDENTS › Title 452 CMR 5.00 - Self Insurers › Section 5.08 - Revocation or Denial of Renewal of Self Insurance License

Current through Register 1525, July 5, 2024
(1) The failure of any self insurer to carry
			 out the terms of an approved agreement of the parties, or an order, decision or
			 other requirement of the Department; or the action of any self insurer in
			 knowingly furnishing the Department with inaccurate or misleading information,
			 shall be reasonable cause for revocation of, or refusal to renew the license of
			 a self insurer.
(2) Failure to pay
			 the Commonwealth, within 30 days from the time the Department certifies the
			 amount chargeable to any licensee for its proportionate share of the expense of
			 carrying out the provisions of M.G.L. c. 152 so far as they relate to self
			 insurers, shall be deemed reasonable cause for the revocation of, or refusal to
			 renew the license of a self insurer.
Code of Massachusetts Regulations › 452 CMR - DEPARTMENT OF INDUSTRIAL ACCIDENTS › Title 452 CMR 5.00 - Self Insurers › Section 5.09 - Appeals Process

Current through Register 1525, July 5, 2024
Any employer who is aggrieved by the actions of the Department
				in the application of 452 CMR 5.00 may file an appeal in accordance with the
				provisions of M.G.L. c. 152, § 25A.