Free Massachusetts Workers Comp Forms

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68 Forms found in Massachusetts — Workers Comp — Page 1 of 2
Title Last Updated
Appeal Of Conference Proceeding May 6, 2016
Conference Memorandum Cover Sheet July 13, 2015
Insurance Inquiry Form July 13, 2015
Insurer Request Certification July 13, 2015
Application For Employment Agency License Or Placement Agency Registration May 6, 2015
Affidavit (General Business) May 6, 2015
Affidavit (Builders-Contractors-Electricians-Plumbers) May 6, 2015
Utilization Review Agent Complaint Form May 5, 2015
Statement Of Eligibility To Serve On Roster Of Impartial Physicians May 5, 2015
Amendment-Suspension-Closure Of Vocational Rehabilitation Plan May 5, 2015
Addendum To Lump Sum Settlement Agreement May 5, 2015
Verification Of Massachusetts Workers Compensation Coverage For Out-Of-State Employers September 12, 2014
Section 19 Agreement September 12, 2014
Certified Vendor Quarterly Report For OEVR September 12, 2014
Agreement To Pay Compensation September 12, 2014
Third Party Claim Notice Of Lien June 26, 2014
Request For Section 46a Conference With Lump Sum Under Section 48 June 26, 2014
Request For Section 37 Or 37A Proceeding June 26, 2014
Request For Lump Sum Conference June 26, 2014
Notification Of Withdrawal Of Claim Or Complaint June 26, 2014
Notification Of Arbitration Award June 26, 2014
Notice Of Change Appearance Of Counsel June 26, 2014
Motion For Expedited Conference June 26, 2014
Mileage Voucher June 26, 2014
Last Best Offer At Conference June 26, 2014
Insurers Notification Of Termination Or Modification Of Weekly Compensation During Payment Without Prejudice Period June 26, 2014
Insurers Notification Of Payment June 25, 2014
Insurers Notification Of Acceptance Resumption Termination Or Modification Of Weekly Compensation June 25, 2014
Individual Written Rehabilitation Program June 25, 2014
Employee Biographical Data June 25, 2014
Complaint Of Improper Claims Handling Against Insurer June 25, 2014
Average Weekly Wage Computation Schedule June 25, 2014
Agreement Under Section 37 Or 37A June 25, 2014
Agreement To Extend 180 Day Payment Without Prejudice Period June 25, 2014
Affidavit Of Employee In Application For Trust Fund Benefits June 25, 2014
Affidavit In Support Of Request For Waiver In Filing Fee Under s11C June 25, 2014
Affidavit In Support Of Employees Request For Speedy Conference Because Of Hardship June 25, 2014
Lien Disclosure Form June 18, 2014
Insurers Hearing Memorandum June 18, 2014
Appeal To Reviewing Board June 18, 2014
Utilization Review Application (To Become An Approved Agent And Affidavit Of Compliance) June 5, 2014
Workers Compensation Insurance Affidavit - General Businesses October 30, 2013
Workers Compensation Insurance Affidavit - Building Plumbing Electrical Contractors October 30, 2013
Request For Speedy Conference Because Of Hardship October 30, 2013
MGL Sec. 65B Appeal Of Cancellation Or Termination Of Policy October 30, 2013
Insurers Notification Of Denial October 30, 2013
Insurers Complaint For Modification Discontinuance Or Recoupment Of Compensation October 30, 2013
Employers First Report Of Injury Or Fatality October 30, 2013
Employees Hearing Memorandum October 30, 2013
Affidavit Of Indigence And Request For Waiver Of Section 11A(2) Fees October 30, 2013