This is one of the official Workers' Compensation forms for the state of Massachusetts.
Lowell Massachusetts Employee Hearing Memo for Workers' Compensation
State:
Massachusetts
City:
Lowell
Control #:
MA-161-WC
Format:
PDF
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How to fill out Massachusetts Employee Hearing Memo For Workers' Compensation?
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FAQ
If your claim for workers' compensation is denied, you can file an appeal with the Department of Industrial Accidents (DIA). According to Mass.gov, you will need to file a Form 110- Employee Claim that includes the following information: The date of your injury. The first calendar day of work missed.
Phone Call Public Information Office at (857) 321-7470. TTY Call Public Information Office, TTY at (800) 224-6196. Toll Free In Massachusetts Only Call Public Information Office, Toll Free In Massachusetts Only at (800) 323-3249.
What is the statute of limitations? Under the workers compensation law, (MGL c. 152, § 41) for injuries on or after January 1, 1986, a claim must be filed with the insurer within 4 years of the date you become aware of a connection between your injury/illness and your employment.
For how long? Compensation begins on the 6th day of disability. You will not be paid for the first 5 days unless you can't work for 21 calendar days or more.
The days don't need to be consecutive. You have 7 calendar days (except for Sundays and legal holidays) after the injured worker's 5th day of full or partial disability to report the injury to the DIA. You need to file the Form 101- Employer's First Report of Injury/Fatality electronically.
You can also call our Office of Insurance for assistance at (617) 626-5480 or (617) 626-5481, or look up your employer's insurer online. If your employer doesn't have workers' compensation insurance, you will need to file a claim against the Workers' Compensation Trust Fund, which is part of the DIA.
The first step in the dispute resolution process is a meeting between the employee and immediate supervisor to determine if they can resolve the issue.
Settlement may take two forms in Massachusetts. A case can be settled with liability in which case the insurance company is required to pay for medical care for an industrial injury for the rest of the employee's life provided the treatment is reasonable, necessary, and related to the industrial accident.
If you were injured at work, you may be eligible for workers' compensation benefits. If you qualify, you can receive payments to partially replace your paycheck and for medical care related to your injury. You may also be eligible for vocational rehabilitation if you need help getting back to work.