• Insurers are required to begin payment for lost wages or send a notice of denial to the employee within 14 days of receiving the Employer First Report of Injury -- With Instructions (Form 101) from the employer.
  • Insurers may pay workers' compensation benefits to employees for up to 180 days without making a final decision on the case. This is referred to as the "Pay Without Prejudice" period.
  • Insurers may increase the 180-day "Payment Without Prejudice" period, with the employees consent, for up to one year, by filing an Agreement To Extend 180 Day Payment-Without-Prejudice Period (Form 105) Agreement To Extend 180 Day Payment Without Prejudice Period - Form 105 with the Office of Conciliation.
  • A Conciliator can approve the Agreement if it is determined that such as Agreement is not detrimental to the employee's case.

    Please mail the signed, original Form 105, with a copy of both the Form 101 and 103, to:


Sandra Perez
Department of Industrial Accidents
1 Congress Street, Suite 100
Boston, MA 02114-2017

FAX: (617) 727-4366
Please contact Sandra Perez at 617-727-4900 x 4368 with any questions.