Department of Industrial Accidents (DIA)

State of Massachusetts

Official Website: https://www.mass.gov/orgs/department-of-industrial-accidents

Forms & Documents

Browse all Department of Industrial Accidents (DIA) government forms

21 - 40 of 61 forms

Form Title Topics
Form 110 - Employee Claim
Form 112A - Affidavit in Support of Request for Waiver of Filing Fee Under § 11C
Form 112 - Appeal to Reviewing Board
Form 113: Agreement to Pay Compensation
Form 114 - Notice of Change/Appearance of Counsel
Form 116A: Employer Consent to Lump Sum Agreement
Form 116B: Addendum to Lump Sum Agreement: Vocational Rehabilitation Status
Form 116B: Addendum to Lump Sum Agreement: Vocational Rehabilitation Status
Form 116C: Lien Disclosure Form
Form 117 - Lump Sum Settlement Agreement for Injuries On or After 11/1/1986
Form 121A: Agreement that No Impartial Physician Report is Required
Form 122: Request for Sections 37/37A Proceedings
Form 123: Request for Sections 37/37A Agreement
Form 124A: Notification of Arbitration Award
Form 125: Motion for Expedited Conference
Form 126: Employee Earning Report
Form 127 - Average Weekly Wage Computation Schedule
Form 130: Complaint of Improper Claims Handling Against an Insurer
Form 131: Request For Speedy Conference Because Of Hardship
Form 131: Request For Speedy Conference Because Of Hardship

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