What is workers comp Form 110 Massachusetts?

Temporary Total Incapacity Benefits in MA

Workers Compensation Form 110 Massachusetts

Form 110 in Massachusetts is an Employee Claim used to file for workers’ compensation benefits if you suffered a work-related injury or illness. It essentially initiates a formal request for a judicial proceeding before an Administrative Judge to obtain benefits like medical treatment, wage replacement, and disability payments.

In Massachusetts, workers’ compensation is typically administered by the Department of Industrial Accidents (DIA). Employers are required to provide workers’ compensation insurance to their employees, which covers medical expenses and lost wages for workers who are injured or become ill due to their job.

Different states have their own specific forms and procedures related to workers’ compensation. Form numbers, requirements, and processes can vary based on state laws and regulations. If you’re specifically looking for information about Form 110 or any other workers’ compensation form in Massachusetts, I recommend contacting a worker’s comp lawyer in Massachusetts or the Massachusetts Department of Industrial Accidents directly. You should also visit their official website to get the most current and accurate information regarding that particular form or any recent updates to the workers’ compensation system.

Here’s a breakdown of the key things about Form 110:

When to use it:

  • You were injured or became ill due to your work.
  • Your employer doesn’t provide or denies you full workers’ comp benefits (medical bills, lost wages, etc.).
  • Your employer hasn’t filed a First Report of Injury/Illness within 7 days of your 5th day of disability.

What it entails:

  • Filling out details about your injury/illness, including date, nature, body part affected, witnesses, etc.
  • Indicating the type of benefits you’re seeking (medical, wage replacement, etc.).
  • Providing information about your employer, yourself, and the insurance carrier.
  • Signing and dating the form.

How to file:

  • Download the form from the Department of Industrial Accidents (DIA) website or consult a workers compensation attorney to assist you: https://www.mass.gov/how-to/file-a-workers-compensation-claim.
  • Complete it digitally through the DIA’s online system (preferred method).
  • Alternatively, print and fill it out manually, then make three copies:
    • Original: Mail to the DIA address on the form.
    • Copy: Send to your employer’s workers’ compensation carrier.
    • Copy: Keep for your records.

Additional points:

  • Representation by an attorney is not required but recommended for complex cases.
  • Include necessary supporting documentation (medical bills, wage records, etc.) for faster processing.

I hope this clarifies everything about Form 110! Remember, filing a workers’ comp claim can be a complex process, so don’t hesitate to seek help from legal or professional resources if needed.

Are you have questions or concerns regarding workers comp Form 110 in MA. Call workers comp lawyer Todd Beauregard For a Free Consultation! 978-275-1919.

(978) 275-1919