State of Massachusetts Forms in Word
Massachusetts Workers’ Compensation Forms in Microsoft Word
|
Massachusetts Form Number |
Form Title |
Price |
Buy Now |
| Form 46A | Request For Section 46A Conference in Conjunction With Lump Sum Under Section 48 | $12.99 | |
| Form 101 | Employer’s First Report of Injury/Fatality | $12.99 | |
| Form 103 | Insurer’s Notification of Payment | $12.99 | |
| Form 104 | Insurer’s Notification of Denial | $12.99 | |
| Form 105 | Agreement to Extend 180 Day Payment-Without-Prejudice Period | $12.99 | |
| Form 106 | Insurer’s Notification of Termination or Modification of Weekly Compensation During Payment-Without-Prejudice Period | $12.99 | |
| Form 107 | Insurer’s Notification of Acceptance, Resumption, Termination or Modification of Weekly Compensation | $12.99 | |
| Form 108 | Insurer’s Complaint for Modification, Discontinuance or Recoupment of Compensation | $12.99 | |
| Form 109 | Notification of Withdrawal of Claim or Complaint | $12.99 | |
| Form 110 | Employee Claim | $12.99 | |
| Form 112 | Appeal to Reviewing Board | $12.99 | |
| Form 112A | Affidavit in Support of Request for Waiver of Filing Fee Under Section 11C | $12.99 | |
| Form 113 | Agreement to Pay Compensation | $12.99 | |
| Form 114 | Notice of Change/Appearance of Counsel | $12.99 | |
| Form 115 | Third Party Claim/Notice of Lien | $12.99 | |
| Form 116 | Request for Lump Sum Conference | $12.99 | |
| Form 116A | Employer Consent to Lump Sum Agreement | $12.99 | |
| Form 116B | Addendum to Lump Sum Agreement: Vocational Rehabilitation Status | $12.99 | |
| Form 116C | Lien Disclosure Form | $12.99 | |
| Form 117 | Agreement for Redeeming Liability by Lump Sum for Injuries On or After Nov. 1, 1986 | $12.99 | |
| Form 117A | Agreement for Redeeming Liability by Lump Sum for Injuries Before Nov. 1, 1986 | $12.99 | |
| Form 121 | Appeal of Conference Order | $12.99 | |
| Form 121A | Agreement That No Impartial Physician Report is Required | $12.99 | |
| Form 122& Request for Sections 37 Proceedings/Agreement | $12.99 | ||
| Form 123 Request for Sections 37A Proceedings/Agreement | $12.99 | ||
| Form 124A | Notification of Arbitration Award | $12.99 | |
| Form 125 | Motion for Expedited Conference | $12.99 | |
| Form 126 | Employee Earning Report | $12.99 | |
| Form 127 | Average Weekly Wage Computation Schedule | $12.99 | |
| Form 130 | Complaint of Improper Claims Handling Against an Insurer | $12.99 | |
| Form 131 | Request For Speedy Conference Because Of Hardship | $12.99 | |
| Form 132 | Affidavit in Support of Employee’s Request for Speedy Conference Because of Hardship | $12.99 | |
| Form 133A | Utilization Review (UR) Agent Complaint | $12.99 | |
| Form 134 | Health Care Provider Complaint | $12.99 | |
| Form 136 | Affidavit of Indigence and Request for Waiver of Sec. 11A(2) Fees | $12.99 | |
| Form 140 | Temporary Conference Memorandum Cover Sheet | $12.99 | |
| Form 141 | Last Best Offer at Conference | $12.99 | |
| Form 151 | Individual Written Rehabilitation Program Form | $12.99 | |
| Form 152 | Amendment/Suspension or Closure of Vocational Rehabilitation Plan | $12.99 | |
| Form 153 | Affidavit of Exemption for Certain Corporate Officers or Directors | $12.99 | |
| Form 154 | Verification of Massachusetts Workers’ Compensation Coverage for Out-Of-State Employers Operating in Massachusetts | $12.99 | |
| Form 160 | Employee’s Biographical Data Sheet | $12.99 | |
| Form 161 | Employee’s Hearing Memorandum | $12.99 | |
| Form 162 | Insurer’s Hearing Memorandum | $12.99 | |
| Form 170 | Affidavit of Employee in Application for Trust Fund Benefits | $12.99 |