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This version of the form is not currently in use and is provided for reference only. Download this version of
Form 133A
for the current year.
Form 133A Complaint Against Utilization Review Agent - Massachusetts
What Is Form 133A?
This is a legal form that was released by the Massachusetts Department of Industrial Accidents - a government authority operating within Massachusetts. As of today, no separate filing guidelines for the form are provided by the issuing department.
FAQ
Q: What is Form 133A?A: Form 133A is a complaint form used to raise issues against a Utilization Review Agent in Massachusetts.
Q: What is a Utilization Review Agent?A: A Utilization Review Agent is a person or entity hired by an insurance company to review medical treatment and services for necessity and appropriateness.
Q: Why would someone file a Form 133A?A: Someone would file a Form 133A if they have concerns about the actions or decisions made by a Utilization Review Agent regarding their medical treatment.
Q: What should I include in my complaint on Form 133A?A: You should include details about your specific situation, the actions or decisions you are complaining about, and any supporting documentation.
Form Details:
- Released on March 1, 2015;
- The latest edition provided by the Massachusetts Department of Industrial Accidents;
- Easy to use and ready to print;
- Quick to customize;
- Compatible with most PDF-viewing applications;
- Fill out the form in our online filing application.
Download a fillable version of Form 133A by clicking the link below{class="scroll_to"} or browse more documents and templates provided by the Massachusetts Department of Industrial Accidents.
Download Form 133A Complaint Against Utilization Review Agent - Massachusetts
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