Code of Massachusetts Regulations › 452 CMR - DEPARTMENT OF INDUSTRIAL ACCIDENTS › Title 452 CMR 1.00 - Adjudicatory Rules of the Industrial Accident Board › Section 1.02 - Definitions

Current through Register 1525, July 5, 2024
Actual Employment
as used in M.G.L. c.
				152 and
				452 CMR 1.00 shall include any
				job for which the employee receives earnings.
Additional Compensation
as used in
				M.G.L. c. 152, § 8(5), shall mean compensation due pursuant to an order or
				decision finding that prior compensation was illegally discontinued.
All Payments Due an Employee
as used
				in M.G.L. c. 152, § 8(1), shall mean, in regard to past due or retroactive
				benefits only, the sum certain payable to the employee after the determination
				of the amount due a lien holder in satisfaction of any lien filed pursuant to
				M.G.L. c. 152, § 46A. Unless otherwise agreed, the parties shall make
				reasonable efforts to expedite the determination of the amount due the M.G.L.
				c. 152, § 46A lien holder, but in no event shall payment be delayed beyond
				60 days of the insurer's receipt of the order, decision, arbitrator's decision,
				approved lump sum or other agreement indicating that such payments are required
				to be made. All other payments due an employee shall be made by the insurer
				within the timeframe set forth in M.G.L. c. 152, § 8(1).
Amount Payable to the Employee Within the First
				Month from the Date of the Voluntary Payment, Order or Decision
as
				used in M.G.L. c. 152, §13A(10), shall mean any future weekly benefits
				pursuant to M.G.L. c. 152 due the employee for the first 30 days subsequent to
				the date of execution of a voluntary payment or the issuance of an order or
				decision.
Cash Award
as used in M.G.L. c. 152,
				§13A(10), shall mean any weekly benefits payable under M.G.L. c. 152,
				§ 36 or § 36A and any weekly benefits payable under M.G.L. c. 152 of
				an amount that exceeds the weekly amount being paid the employee for the week
				immediately prior to the date of the voluntary payment, order or
				decision.
Disputes over Medical Issues
as used
				in M.G.L. c. 152, § 11A(2), shall not include any case in which:
(a) the parties disagree solely regarding the entitlement to
				weekly benefits concerning a specific period or periods of disability, or death
				which occurred prior to the hearing scheduled pursuant to M.G.L. c. 152, §
				11;
(b) the parties disagree regarding the liability of the named
				insurer for any claimed injury; provided, however, that the parties agree that
				no impartial physician's report is required;
(c) the parties agree upon both the nature of the impairment
				and the causal relationship between the impairment and the employment;
				provided, however, that the parties agree that no impartial physician's report
				is required;
(d) based upon the information submitted at a Conference
				pursuant to M.G.L. c. 152, § 10A, the administrative judge determines that
				there is no dispute over medical issues. The judge's determination, and reasons
				therefor, shall be stated in the M.G.L. c. 152, § 10A Conference
				order.
Experience Modified Insured
as used in
				M.G.L. c. 152, § 48(1), shall mean any named employer in a proposed lump
				sum settlement which has an experience modification in effect at the time of
				the lump sum settlement that, under the terms of a rating plan approved by the
				commissioner of insurance, could be affected by the proposed lump sum
				settlement.
Factual Basis for an Insurer's Refusal to Pay
				Compensation
as used in M.G.L. c. 152, §§ 7 and 8, shall
				be a short and plain statement of the specific facts supporting the grounds for
				said refusal.
Filed
as used on M.G.L. c. 152,
				§§10A and 11C as used in
				452 CMR 1.11(1)
				 and
				1.15(1)
				 shall mean placement of the appeal in the
				mail to the Department postmarked, or sent electronically, no later than
				midnight on the 14th day when appealing a conference
				order under M.G.L. c. 152, § 10A, and the 30th
				day when appealing the decision of an administrative judge pursuant to M.G.L.
				c. 152, § 11C. Unless otherwise indicated, where the words "file" or
				"filed" appear, they shall mean through placement in the email or electronic
				transmittal to the Department.
Insurer
as used in M.G.L. c. 152,
				§ 45 shall include the Workers' Compensation Trust Fund.
Interest
as used in as used in M.G.L.
				c. 152, § 50, shall be calculated using the Department-provided formula
				available on its website. The parties may utilize other formulas but when a
				discrepancy exists the amount of interest in the Department formula will
				prevail for all purposes.
Mid-term Notice of Cancellation
as
				used in M.G.L. c. 152, § 55A, shall mean any notice of policy
				discontinuance during the term of the policy where such discontinuance is
				initiated by the insurer, and shall not include discontinuances initiated by
				insureds.
Necessary Expenses
as used in M.G.L.
				c. 152, § 13A, shall mean all reasonable out-of-pocket costs, as the
				Department may set, to a claimant's attorney incurred by said attorney in
				prosecuting a claim for benefits or contesting a complaint filed by the
				insurer, including the cost of obtaining relevant medical records, doctor's
				reports, private investigator fees, constable charges, expert witness charges,
				interpreter fees and scientific testing costs, but specifically excluding
				telephone expenses, parking fees, postage, stationery, photocopies, meals,
				automobile expenses, and ordinary legal office overhead. Filing fees and
				impartial physician deposition costs required by M.G.L. c. 152, § 11A,
				which are paid by claimant's counsel, shall not be submitted as necessary
				expenses but shall be reimbursable directly from the insurer against whom the
				claimant prevails at hearing.
Payment of Compensation
as used in
				M.G.L. c. 152, § 41, shall include payments made without prejudice to the
				rights of either party.
Toll
as used in M.G.L. c. 152, §
				41, shall mean permanently satisfies.