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Form 121A Agreement That No Impartial Physician Report Is Required - Massachusetts
What Is Form 121A?
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 121A?A: Form 121A is an agreement that states that no impartial physician report is required in Massachusetts.
Q: When is Form 121A used?A: Form 121A is used when both parties in a workers' compensation case agree that no impartial physician report is necessary.
Q: What does Form 121A indicate?A: Form 121A indicates that the parties agree on the extent of the disability and the need for treatment without the need for an impartial physician report.
Q: Are both parties required to sign Form 121A?A: Yes, both the employee and the employer (or their representatives) must sign Form 121A.
Q: Is Form 121A legally binding?A: Yes, Form 121A is a legally binding agreement between the parties.
Q: Can Form 121A be used in other states?A: No, Form 121A is specific to the state of Massachusetts.
Q: What happens after Form 121A is signed?A: After Form 121A is signed, it becomes part of the official workers' compensation record and eliminates the need for an impartial physician report.
Form Details:
- Released on July 1, 2019;
- 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 121A by clicking the link below or browse more documents and templates provided by the Massachusetts Department of Industrial Accidents.
