Section 65. (1) There is hereby established a special revenue fund in the state treasury, known as the Workers' Compensation Special Fund, the proceeds of which may be expended by the department, subject to appropriation, for the operating expenses of the department.
(2) There is hereby established a trust fund in the state treasury, known as the Workers' Compensation Trust Fund, the proceeds of which shall be used to pay or reimburse the following compensation: (a) reimbursement of adjustments to weekly compensation pursuant to section thirty-four B; (b) reimbursement of adjustments to weekly compensation pursuant to section thirty-five C; (c) reimbursement of certain apportioned benefits pursuant to section thirty-seven; (d) payment of vocational rehabilitation benefits pursuant to section thirty H; (e) payment of benefits resulting from approved claims against employers subject to the personal jurisdiction of the commonwealth who are uninsured in violation of this chapter; provided, however, that (i) the claimant is not entitled to workers' compensation benefits in any other jurisdiction; (ii) no benefits pursuant to section twenty-eight and no interest pursuant to section fifty shall be payable out of the trust fund; (f) reimbursement of benefits pursuant to section twenty-six; and (g) reimbursement of certain apportioned benefits pursuant to section thirty-seven A. No reimbursements from the Workers' Compensation Trust Fund shall be made under clauses (a) to (g), inclusive, to any non-insuring public employer, self-insurer or self-insurance group which has chosen not to participate in the fund as hereinafter provided.
The reasonable and necessary costs of administering and representing the Workers' Compensation Trust Fund may be paid out, without appropriation, of said trust fund. Such costs shall include, but not be limited to: the taking of depositions, the hiring of private investigators, the filing and service of summonses and subpoenas and other associated court costs, the retention of outside legal counsel and medical providers, and the provision of services relating to the management of the fund. Revenues for the special fund and the trust fund established herein shall be raised by an assessment on all employers subject to this chapter.
No private employer with a license to self-insure and no private self-insurance group shall be required to pay assessments levied to pay for disbursements under clauses (a) to (g), inclusive, and neither the commonwealth, nor any city, town, or other political subdivision of the commonwealth or public employer self-insurance group shall be required to pay assessments levied to pay for disbursements under clause (a), (b), (c), (d), (e), (f) or (g) if such employer or group has given up an entitlement to reimbursement under said clauses by filing a notice of non-participation with the department. Such notice shall be made to the commissioner on or before March first of any year in order to be effective as of July first of that year. Notice of non-participation shall be irrevocable and shall be signed by the chief executive officer or board of trustees of the employer or group. Non-participation shall not be allowed any employer or group that has not paid all assessments due at the time of the department's receipt of notice of non-participation. No private employer or group shall be relieved of the requirement to pay assessments levied to fund disbursements under clause (d) or (e).
A public employer which has a policy with a workers' compensation insurer shall have the ability to file a notice of non-participation as specified above; provided, however, that its insurer shall not be entitled to reimbursement from the Workers' Compensation Trust Fund, and the insured public employer shall be required to reimburse its insurer for any payments the insurer makes on its behalf that would otherwise be subject to reimbursement under clauses (a) to (g), inclusive.
(3) Each insurer authorized to write workers' compensation in the commonwealth, each self-insurer, each self-insurance group, and the commonwealth shall report to the department annually on or before May first, the assessment base amount for employers subject to this chapter. The Massachusetts workers' compensation rating bureau shall report aggregate base amount data for employers insured by its members. The assessment base amount for all employers shall be the losses paid under this chapter for the preceding twelve month period beginning January first and ending on the last day of December.
If an insurer, self-insurer, or self-insurance group fails to report such base amounts to the department on or before May first, the department may assess a one thousand dollar fine for each month or part thereof that its report is late and may estimate a base amount, until the actual base amount is determined, by taking into consideration the actual base amount last reported for the assessment payor; provided, however, that no estimated base amount shall be greater than one hundred and twenty per cent of the actual base amount reported.
(4) The department shall determine the special fund and trust fund assessment rates pursuant to the following procedures:
(a) The sum of the following two amounts shall be known as the special fund budget: (i) the total amount of funds appropriated each year to pay the operating expenses of the department pursuant to subsection (1); and, (ii) the total amount of funds estimated to be expended from the General Fund in the fiscal year for indirect and fringe benefit costs attributable to compensation of state personnel of the department, as determined by the commissioner of administration, who shall reduce, or increase, his estimate by the actual amount of such indirect and fringe benefit costs over-assessed, or under-assessed, by the department in the prior fiscal year.
(b) On or before July first of each year the department shall estimate the total amount of funds required to make payments during the following twelve months for the compensation payable pursuant to subsection (2) of this section. The total amount of this estimate, subject to the approval of the secretary of labor and workforce development, shall be known as the trust fund budget. The trust fund budget shall be reviewed by the advisory council. Upon the affirmative vote of at least seven voting members, the advisory council may submit its own estimate of the trust fund budget to the secretary of labor and workforce development. The department's estimate shall separately state that portion of projected disbursements pursuant to subsection (2) that is attributable to expected claims against (i) private employers and (ii) the commonwealth and its political subdivisions subject to this chapter. The separately stated estimate for private employers shall be known as the private employer trust fund budget. The separately stated estimate for the commonwealth and its political subdivisions shall be known as the public employer trust fund budget.
(c) If the balance of the special fund at the end of the fiscal year exceeds thirty-five per cent of the previous year's disbursements from that fund, the budget for that fund, for the purpose of calculating the fund assessment rate, shall be reduced by that part of the balance in excess of thirty-five per cent of the previous year's disbursements. If the balance of either the private employer portion or the public employer portion of the trust fund at the end of the fiscal year, exceeds thirty-five per cent of the previous year's disbursements from that portion of the fund, as reported pursuant to subsection (9), the budget for that portion of the fund, for the purpose of calculating the fund assessment rate shall be reduced by that part of the balance for that portion of the fund in excess of thirty-five per cent of the previous year's disbursements, reported pursuant to subsection (9). Additional assessments may be levied by the commissioner, subject to the approval of the secretary of labor and workforce development, if he finds such assessments necessary in order to make disbursements for any expenses or compensation payments in the fiscal year which exceed the revenue generated by the assessments for the fiscal year levied pursuant to subsection (5). Any additional assessment proposed by the commissioner shall be reviewed by the advisory council. Upon the affirmative vote of at least seven voting members, the advisory council may submit its estimate of the necessary additional assessment to the director of labor and workforce development.
(d) For each assessment payor, except for the commonwealth and any of its political subdivisions subject to this chapter, the assessment rate shall be determined by dividing the sum of the special fund and the total of those portions of the private employer trust fund and the total of those portions of the private employer trust budget from which such payor is entitled to seek reimbursement pursuant to subsection (2) by the sum of the base amounts reported by such assessment payors pursuant to subsection (3). For the commonwealth and any of its political subdivisions subject to this chapter, the assessment rate shall be determined by dividing the total of those portions of the public employer trust fund budget from which such payor is entitled to seek reimbursement pursuant to subsection (2) by the sum of the base amounts reported by such assessment payors pursuant to subsection (3).
(5) Each self-insurance group shall pay to the treasurer of the commonwealth a sum assessed by the department equal to the product of its standard premium and the assessment rates determined pursuant to subsection (4), multiplied by the total base amount for all self-insured groups divided by the estimated total standard premiums for all self-insured groups for the next twelve-month period beginning January first and ending on the last day of December. For each insured employer, the assessment shall be equal to the product of its standard workers' compensation premium and the assessment rate determined pursuant to subsection (4), multiplied by the ratio of the aggregate base amount for all insured employers as reported pursuant to subsection (3), to the aggregate written estimated premium for these said employers for the next twelve-month period beginning January first and ending on the last day of December. Such aggregate written estimated premiums shall be based on currently applicable rates as approved by the commissioner of insurance. The Rating Bureau shall compute said ratio and submit it to the division of industrial accidents by May first of each year for review and approval. Insurers shall bill and collect assessments on insured employers. Such assessments shall be separately stated amounts on all premium notices, and shall not be reported as premiums for any tax or regulatory purposes under chapter sixty-three, one hundred and seventy-five, or any other law. Assessment rates for insured employers shall apply to standard premiums for policy years beginning on or after July first following the determination of such rates. The assessment for each self-insurer shall be equal to the product of the assessment rate and the self-insurer's imputed premium multiplied by the total base amount for all self-insurers, divided by the total imputed premium for all self-insurers as determined by the department. Insurers shall transmit assessments collected during each quarter, and self-insurers and self-insurance groups shall pay assessments due each quarter, to the state treasurer no later than one month after the end of the quarter.
Each failure to pay an assessment within thirty days of the payor's receipt of any bill from the department shall result in a separate fine in the amount of five percent of the balance of any such overdue assessment. The commissioner may establish a commonwealth lien on any employer to collect assessments and fines for which such employer is liable under this section. Similar fines and liens may be imposed on insurers for failure to transmit assessments collected under this section.
In the case of self-insurers or self-insurance groups that have been operating for less than twelve months, the department shall establish procedures under which the assessments to be paid by the self-insurer or self-insurance group shall be related to the prior status of such employers.
(6) The revenue received from assessments levied under this section shall be kept in the special fund or the trust fund separate and apart from all other monies received by the commonwealth; provided, however, that revenues received from assessments on account of indirect and fringe benefit costs determined pursuant to clause (ii) of paragraph (a) of subsection (4), and any interest thereon, shall be credited to the General Fund. The proceeds from any fine or fee imposed pursuant to this chapter shall be kept in the special fund. The treasurer of the commonwealth shall be the custodian of the special fund and trust fund, and revenues received shall be deposited in each fund proportional to that fund's share of the total budget. For the purposes of determining the proportional shares of amounts to be deposited in the special fund and trust fund, the special fund budget and the total budget shall be reduced by the amount of said indirect and fringe benefit costs. The monies in the special fund and trust fund shall be invested by the treasurer in accordance with law; provided, however, that the treasurer shall make no investments that prevent the treasurer from making timely payment of disbursements pursuant to subsections (1) and (2). Interest income and dividends from such investments shall be credited to the fund from which the interest or dividends accrue.
(7) The treasurer shall make payments from accounts of the trust fund on the submission of a warrant listing all payments to be made and the accounts to be debited, which has been approved in writing by the director of labor and workforce development or his designee.
(8) If the trust fund pays compensation to a claimant pursuant to clause (e) of subsection (2), it may seek recovery from the uninsured employer for an amount equal to the amount paid on behalf of the claimant under this chapter, plus any necessary and reasonable attorney fees. Any action by the trust fund to seek recovery from the uninsured employer shall be commenced within twenty years of the claimant's filing a claim for benefits under this chapter against the trust fund.
(9) The treasurer shall, on or before October first of each year, submit to the advisory council, the governor, the clerk of the senate, and the clerk of the house of representatives, an annual report for the previous fiscal year. The report shall include a statement of the revenues and disbursements of the special fund and trust fund for the fiscal year, the balance existing at the beginning and the end of the fiscal year for each fund, and any other information the treasurer deems appropriate. The report shall include a statement of revenues, disbursements, and the balance existing at the beginning and end of the fiscal year for private employers and a separate statement of these amounts for the commonwealth and its political subdivisions subject to this chapter.
(10) The books and records of the special fund and trust fund shall be subject to an audit by the state auditor, in accordance with generally accepted government auditing standards, as often as the state auditor determines is necessary.
(11) The intent of the separate financial reports and assessment calculations for public employers under this section is to prevent said employers from bearing inappropriate costs. Nothing in this section shall be construed to prohibit the rights of any political subdivision of the commonwealth to rescind acceptance of this chapter pursuant to section sixty-nine; provided, however, that any such rescinding political subdivision shall be deemed to be an uninsured person and shall be subject to the provisions of section sixty-six.
(12) The commissioner shall supervise, monitor and establish procedures for all aspects of the assessment of insured and self-insured employers and self-insurance groups including but not limited to the proper reporting of base amounts; the determination of proper assessment rates; the calculation, billing and collection of assessment payments; proper accounting; reporting and transmittal by insurers of assessment payments by insured employers; and all other matters necessary to assure proper compliance with this section; and may issue regulations and conduct hearings for this purpose. He also shall establish procedures for the review and adjudication of grievances by employers with respect to the propriety and accuracy of assessed payment.
(13) Claims against the Workers' Compensation Trust Fund for payment of compensation pursuant to clause (e) of subsection (2) shall be handled in accordance with section ten; provided, however, that no penalty pursuant to section seven shall be levied against the fund and no referral fee pursuant to section ten or filing fee pursuant to section eleven A or eleven C shall be required of the fund. No voluntary payment for any period of time shall alone be held to foreclose the fund from defending any issue involved in a claim for compensation. On a motion of a claimant or representative of the fund, an administrative judge may join the uninsured employer as a party.
Structure Massachusetts General Laws
Part I - Administration of the Government
Title XXI - Labor and Industries
Chapter 152 - Workers' Compensation
Section 2 - Powers and Duties of Department; Investigation of Causes of Injuries
Section 2a - Application of Amendments of Statute
Section 5 - Rules and Regulations
Section 6 - Notice of Injuries; Forms; Additional Reports; Statistical Summaries
Section 6a - Informational Brochures; Monitoring of Benefits; Resolution of Disputes
Section 6b - Disposition of Fines
Section 7 - Commencement of Payments
Section 7a - Presumptions; Employee Unable to Testify
Section 7f - Record of Filing Fees, Penalties and Attorneys' Fees
Section 7g - Documentation Attached to Claims
Section 8 - Termination or Modification of Payments
Section 9a - Physicians Engaged to Testify or Depose for Employee; Fees Paid by Insurer
Section 10a - Assignments of Cases; Conferences; Orders; Appeals
Section 10b - Arbitration; Agreements; Proceedings
Section 10c - Collective Bargaining Agreements; Binding Obligations and Procedures
Section 11 - Hearings; Evidence; Continuances
Section 11a - Impartial Medical Examiners
Section 11b - Procedure for Hearings; Depositions; Record of Proceedings
Section 11c - Appeals to Reviewing Board
Section 11d - Earnings Reports by Employees; Recovery of Overpayments
Section 12a - Award of Costs and Attorney's Fees
Section 13a - Attorney's Fees for Employees
Section 14a - Employee Leasing Companies
Section 15 - Liability of Person Other Than Insured
Section 15a - Controversy as to Which of Two or More Insurers Is Liable
Section 16 - Subsequent Findings Discontinuing Compensation; Finality
Section 17 - Enforcement of Orders or Decisions
Section 18 - Independent and Sub-Contractors; Liability of Insurer and Others
Section 19 - Agreements by Parties
Section 20 - Hospital Records as Evidence; Medical Records and Reports Open to Inspection
Section 20a - Copies of Reports of Medical Examinations Furnished Employees; Reports as Evidence
Section 20b - Medical Reports of Disabled or Deceased Physicians as Evidence
Section 21 - Notice by Insured to Employees
Section 22 - Notice by Insured to New Employees; Notice of Cessation of Insurance; Filing Copy
Section 23 - Release of Claims or Demands at Common Law
Section 24 - Waiver of Right of Action for Injuries
Section 25 - Insurer's Liability on Judgment for Employee
Section 25a - Purchase of Insurance; Self-Insurance; Reinsurance; Deductibles
Section 25d - Service Companies; Investigation, Adjustment or Settlement of Claims for Self-Insurers
Section 25e - Self-Insurance Groups; Definitions
Section 25f - Certification to Act as Self-Insurance Group
Section 25g - Application for Certificate; Requirements; Issuance
Section 25h - Termination of Certificate
Section 25j - Boards of Trustees
Section 25l - Solicitation of Membership by Licensed Agents
Section 25m - Misrepresentations or Omissions in Solicitations of Membership
Section 25n - Performance Reports; Statements of Financial Condition
Section 25q - Premium Payment Plans; Loss Reserves; Bad Debt Reserves
Section 25r - Deficiencies; Assessments; Liquidation of Groups
Section 25t - Cease and Desist Orders
Section 25u - Revocation of Certificates of Approval
Section 25v - Applicability of Chapter 176v to Groups Governed by Secs. 25e to 25u
Section 26 - Injuries Arising Out of and in Course of Employment
Section 26b - Concurrent Service of Two or More Employers; Joint and Several Liability of Insurers
Section 27 - Willful Misconduct of Employee
Section 27a - False Representation of Physical Condition by Employee; Right to Benefits
Section 29 - Required Period of Incapacitation; Personnel Actions
Section 30 - Adequate and Reasonable Health Care Services; Preferred Health Care Provider
Section 30e - Development of Voluntary Agreements
Section 30f - Identification of Cases in Which Vocational Rehabilitation Services May Be Required
Section 30g - Meetings With Injured Employees Requiring Vocational Rehabilitation Services
Section 30h - Applications for Vocational Rehabilitation Services
Section 30i - Availability of New Jobs and Job Training Programs
Section 31 - Death; Compensation for Dependents; Hearings
Section 34 - Total Incapacity; Compensation
Section 34a - Permanent and Total Incapacity; Compensation
Section 34b - Review Date; Supplemental Benefits to Secs. 31 or 34a
Section 35 - Partial Incapacity; Compensation
Section 35b - Return to Work; Subsequent Injury; Rate of Compensation
Section 35c - Date of Eligibility; Benefits Applicable; Adjustments
Section 35d - Computation of Weekly Wage
Section 36 - Specific Injuries
Section 36a - Death Before Full Payment of Compensation for Specified Injuries; Brain Damage
Section 36b - Unemployment Compensation Benefits; Eligibility
Section 37 - Compensation for Disability Subsequent to Physical Impairment; Reimbursement
Section 37a - Compensation for Disabled War Veteran; Reimbursement
Section 38 - Consideration of Employee's Savings, Insurance and Other Benefits
Section 40 - Guardian or Next Friend Exercising Employee's Rights
Section 41 - Notice of Proceedings for Compensation; Limitation of Actions
Section 42 - Notice in General
Section 43 - Service of Notice
Section 44 - Inaccuracies In, and Want Of, Notice
Section 46 - Waiver of Rights to Compensation; Arbitration
Section 47 - Assignments; Attachments; Liability for Debts
Section 48 - Lump Sum Agreements
Section 50 - Interest on Unpaid Claims
Section 51 - Natural Increase Considered in Determining Weekly Wages
Section 51a - Decision in Compensation Case; Law in Effect
Section 52b - Priority of Premiums and Interest Charges Over Other Claims
Section 52d - Appeal From Action or Decision of Rating Organization; Rating Information
Section 52g - Partial Invalidity of Statute
Section 53 - Mutual Companies; Distribution of Risks Into Groups
Section 53a - Classification of Risks and Premiums; Distribution of Premiums Among Employers
Section 54a - Necessity of Insurance Contract Insuring Payment of Compensation
Section 55 - Approval of Policy by Commissioner; Review; Issuance of Policy in Violation of Statute
Section 55a - Mid-Term Notice of Cancellation
Section 56 - Joint and Several Policies
Section 57 - Deposits of Value of Outstanding Claims Under Contracts
Section 58 - Computation of Value of Claims
Section 60 - Effect of Appointment of Receiver on Order, Deposit or Payments; Deposit by Receiver
Section 60a - Review, Suspension and Reduction of Order Requiring Deposit
Section 61 - Bond for Foreign Company; Other Security
Section 62 - Deposits by Foreign Companies; Payment of Obligations
Section 65 - Special Fund; Trust Fund; Assessment Base; Assessment Rates; Payments; Reports; Audits
Section 65b - Cancellation or Termination of Policy; Review
Section 65d - Issuance of Policy to Employer Assigned to Another Insurer
Section 65g - ''losses Incurred'' Defined; Determination of Amounts to Be Paid
Section 65h - Adjustment of Payments
Section 65i - Primary Liability to Pay Benefits
Section 65j - Inspection of Risks; Rules
Section 65k - Appeal on Ground Premium Is Unreasonable or Discriminatory; Effect of Determined Rates
Section 65m - Review of Orders or Rulings; Time; Suspension and Stay of Order or Rulings
Section 65o - Employer's Choice of Insurance Agent or Broker; Commission Fees; Service Fees
Section 66 - Actions for Injuries Sustained by Employees; Limitations; Defenses
Section 68 - Applicability of Statutes Relating to Employers' Liabilities
Section 69b - Vouchers; Examinations and Investigations; Reports
Section 70 - Procedure and Jurisdiction; Compensation Paid by Commonwealth and Its Subdivisions
Section 71 - Liability of County, City, Town or District for Employee's Injuries
Section 72 - Employee Claiming or Waiving Rights Against County, City, Town or District
Section 73a - Employment of Partially Disabled Employee; Temporary Employment to Fill Vacancy
Section 75 - Agents Designated to Furnish Benefits and Carry Out Statutes