Massachusetts Department of Industrial Accidents Forms

81
total templates

Documents

81

Form A-1 "Statement of Eligibility to Serve on Roster of Impartial Physicians" - Massachusetts

Rate (4.5 / 5) 32 votes
Size: 202 KB
2 pages

Form 19 "Section 19 Agreement" - Massachusetts

Rate (4.5 / 5) 76 votes
Size: 167 KB
2 pages

Form 114 "Notice of Change/Appearance of Counsel" - Massachusetts

Rate (4.7 / 5) 33 votes
Size: 154 KB
1 page

Form 123 "Agreement Under Section 37 or 37a" - Massachusetts

Rate (4.5 / 5) 91 votes
Size: 169 KB
1 page

Form 160 "Employee Biographical Data" - Massachusetts

Rate (4.6 / 5) 89 votes
Size: 101 KB
2 pages

Form 161 "Employee's Hearing Memorandum" - Massachusetts

Rate (4.7 / 5) 66 votes
Size: 128 KB
2 pages

Form 107 "Insurer's Notification of Acceptance, Resumption, Termination or Modification of Weekly Compensation" - Massachusetts

Rate (4.5 / 5) 10 votes
Size: 169 KB
2 pages

Form 131 "Request for Speedy Conference Because of Hardship" - Massachusetts

Rate (4.5 / 5) 16 votes
Size: 89 KB
2 pages

Form 151 "Individual Written Rehabilitation Program" - Massachusetts

Rate (4.4 / 5) 60 votes
Size: 187 KB
2 pages

Form 125 "Motion for Expedited Conference" - Massachusetts

Rate (4.3 / 5) 18 votes
Size: 185 KB
2 pages

Form 115 "Third Party Claim/Notice of Lien" - Massachusetts

Rate (4.6 / 5) 14 votes
Size: 154 KB
2 pages

Form 153 "Affidavit of Exemption for Certain Corporate Officers or Directors" - Massachusetts

Rate (4.5 / 5) 28 votes
Size: 38 KB
2 pages

Form 132 "Affidavit in Support of Employee's Request for Speedy Conference Because of Hardship" - Massachusetts

Rate (4.8 / 5) 16 votes
Size: 165 KB
2 pages

Form 108 "Insurer's Complaint for Modification, Discontinuance or Recoupment of Compensation" - Massachusetts

Rate (4.5 / 5) 103 votes
Size: 152 KB
2 pages

Form 130 "Complaint of Improper Claims Handling Against an Insurer" - Massachusetts

Rate (4.8 / 5) 22 votes
Size: 131 KB
1 page

Form 136 "Affidavit of Indigence and Request for Waiver of 11a(2) Fees" - Massachusetts

Rate (4.6 / 5) 11 votes
Size: 178 KB
2 pages

Form 117 "Lump Sum Settlement Agreement for Injuries on or After 11/1/1986" - Massachusetts

Rate (4.8 / 5) 20 votes
Size: 204 KB
2 pages

Form 121 "Appeal of Conference Proceeding" - Massachusetts

Rate (4.5 / 5) 81 votes
Size: 148 KB
2 pages

Form 127 "Average Weekly Wage Computation Schedule" - Massachusetts

Rate (4.6 / 5) 66 votes
Size: 129 KB
2 pages

Form 152 "Amendment, Suspension, or Closure of Vocational Rehabilitation Plan" - Massachusetts

Rate (4.7 / 5) 12 votes
Size: 189 KB
2 pages

Form 170 "Affidavit of Employee in Application for Trust Fund Benefits" - Massachusetts

Rate (4.5 / 5) 90 votes
Size: 130 KB
1 page

Form 109 "Notification of Withdrawal of Claim or Complaint" - Massachusetts

Rate (4.4 / 5) 9 votes
Size: 139 KB
1 page

Form 112 "Appeal to Reviewing Board" - Massachusetts

Rate (4.4 / 5) 71 votes
Size: 158 KB
2 pages

Form 141 "Last Best Offer at Conference" - Massachusetts

Rate (4.6 / 5) 22 votes
Size: 158 KB
1 page

Form 140 "Conference Memorandum" - Massachusetts

Rate (4.5 / 5) 77 votes
Size: 172 KB
2 pages

Form 122 "Request for Section 37 or 37a Proceeding" - Massachusetts

Rate (4.4 / 5) 115 votes
Size: 187 KB
2 pages

Form 154 "Verification of Massachusetts Workers' Compensation Coverage for out-Of-State Employers Operating in Massachusetts" - Massachusetts

Rate (4.6 / 5) 57 votes
Size: 140 KB
2 pages

Form 105 "Agreement to Extend 180 Day Payment Without Prejudice Period" - Massachusetts

Rate (4.5 / 5) 22 votes
Size: 148 KB
1 page

Form 162 "Insurer's Hearing Memorandum" - Massachusetts

Rate (4.5 / 5) 75 votes
Size: 134 KB
2 pages

Form 110 "Employee's Claim" - Massachusetts

Rate (4.7 / 5) 10 votes
Size: 202 KB
2 pages

Form 113 "Agreement to Pay Compensation" - Massachusetts

Rate (4.8 / 5) 56 votes
Size: 76 KB
2 pages

Form 19A "Section 19a Medical Mediation Agreement" - Massachusetts

Rate (4.7 / 5) 100 votes
Size: 32 KB
1 page