Massachusetts Department of Industrial Accidents Forms

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Documents:

97

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This form is used for extending the 180-day payment period without prejudice in Massachusetts.

This document is used by builders, contractors, electricians, and plumbers in Massachusetts to provide an affidavit for workers' compensation insurance coverage.

This document is used for appealing the cancellation or termination of an insurance policy in Massachusetts.

This document is a notice for employees in Massachusetts written in Haitian Creole. It provides important information or instructions that employees need to be aware of.

This form is used for medical mediation agreement in Massachusetts under Section 19-a.

This form is used for requesting a waiver of fees for individuals who are unable to afford them. It is specifically related to Massachusetts law.

This document is for employees in Massachusetts who are requesting a speedy conference due to hardship. It is used to provide an affidavit in support of their request.

This Form is used for amending, suspending, or closing a vocational rehabilitation plan in Massachusetts.

This form is used for filing a complaint against an insurance company in Massachusetts for mishandling claims.

This document is used for providing an addendum to a lump sum agreement in Massachusetts, specifically regarding the vocational rehabilitation status.

This Form is used for employees in Massachusetts who want to file a claim. The form is available in Haitian Creole language.

This form is used for employees in Massachusetts to file a claim for post-lump sum medical mediation.

This form is used by insurers in Massachusetts to notify the acceptance, resumption, termination or modification of weekly compensation for workers' compensation claims.

This document is used for submitting the final and best offer during a conference in Massachusetts.

This Form is used for notifying the withdrawal of a claim or complaint in the state of Massachusetts.

This form is used for notifying the court of a change in legal representation or appearance of counsel in Massachusetts.

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