Claims Kit
Massachusetts
Forms
State Compliance Information
Reporting of Claim by Employer Chapter 152: Section 6
Massachusetts Form 101 - Employer's First Report of Injury or Fatality must be filed within 7 calendar days, not including Sundays and legal holidays, of receipt of notice of any injury alleged to have arisen out of and in the course of employment, which totally or partially incapacitates an employee for a period of 5 or more calendar days from earning wages.
All FROIs are submitted to DIA electronically.
Physician Selection 152 Section 30, 152 Section 45
Except for the employee’s first scheduled appointment, which an employer may require to be with a health provider within their preferred provider arrangement, the worker has the right to choose their own healthcare professional for treatment and to change this professional once. When referred by the treating health care professional to another provider in a particular specialty, the employee may also change once to a different provider in that specialty. In cases of emergency or where the insurer or administrative judge agrees, the employee may seek treatment from additional providers
An employer may request from time to time that an employee submit to an examination during the continuance of his disability
Posting Requirements 152 Sections 21, 22
Employers doing business in Massachusetts are required to post a notice in their workplace, with the name of their workers' compensation insurance carrier. The employer must also indicate the policy number, the effective dates of the policy as well as a contact information on the poster.
The notice must be completed in its entirety, indicating the insurance carrier, the address, policy number and a contact person to whom injuries or incidents should be reported. This is all public information, and must be readily available to any person who needs it. Failure to provide the information to the employee is a violation of the law, and the employer is subject to a fine. There is also an optional space on this notice to list a designated health care provider for initial treatment following an injury.
Poster - Notice to Employees
Penalties for Late Reporting Chapter 152: Section 6
Any person who violates the provision of this section three or more times in any year will incur a fine of one hundred dollars ($100) for each violation. Each failure to pay a fine within thirty days of receipt of a bill from the department will be considered a separate violation.
Documents Provided by CopperPoint
Portal User Guides
Pharmacy First Fill
Pharmacy First Fill - Spanish
Change of Address
Witness Statement - English
Witness Statement - Spanish
Accident Report - English
Accident Report - Spanish
Gramm-Leach-Bliley Act (GLBA) Privacy Notice - English
Return To Work
Return To Work Transitional Employment Offer Template - EnglishReturn To Work Transitional Employment Offer Template - Spanish
Return To Work Policy Guide
Injured Worker Guide
The worker's compensation system can be complicated, and each state has its own laws regarding workers' compensation.
The information contained in your state's guide provides a general guide for workers injured or made ill on the job.
This state-issued publication will assist you in navigating the workers' compensation system and serve as a resource for basic legal rights as well as steps to take to initiate workers' compensation benefits, deadlines and who to contact for additional assistance.
If you have questions about the workers' compensation process, this guide will provide the contact information for the regulatory agency for your state. In addition, many states have an ombudsman to oversee and assist all interested parties in the workers' compensation system.
Publications
Need help?
Phone: 800.231.1363
For Claim Reporting, please complete your First Notice of Loss and email to reportaclaim@copperpoint.com