Please read these procedures before you request an account
The Department has in place procedures for filing several DIA forms electronically, using a log-in and password provided to attorneys, employees (who represent themselves), insurers, self-insurers, employers and third party administrators who have a worker's compensation case.
Forms that can be submitted electronically are:
101 - Employers First Report of Injury/Fatality
103 - Insurer's Notification of Payment
104 - Insurer's Notification of Denial
106NM - Insurer's Notification of Modification
106NT - Insurer's Notification of Termination
107GT - Insurer's Notification of Termination
107 RC/NM - Insurer's Notification of Resumption/Modification of Compensation
108 - Insurer's Complaint For Modification, Discontinuance Or Recoupment Of Compensation
110 - Employee Claim
114 - Notice of Change/Appearance of Counsel
115TPC - Third Party Claim
115TPL - Third Party Lien
116 - Request for a Lump Sum Conference
Log-ins and Passwords will be provided to these parties upon request.
To request a Log-In and Password please click on revised - Request for Login and Password form.
How to Log In and Enter DIA Forms Online
Once you have a log-in and password, follow these steps to file on-line.
Step 1. Type the following URL into your web browser to reach DIA's Internet site - http://www.mass.gov/dia/
On the DIA website click on the On-line Filing Login (on the right side of the main DIA landing page in the shaded section entitled "Online Services"). Login with your username and password. Click on - Plus Sign for Menu "On Line Forms Submitted By Public", then click on the circle next to the form you wish to file electronically. Click on Continue.
Instructions below are for filing a Form 101, the Employer's First Report of Injury (FRI). These instructions, and the online instructions at the site where you log in, can help you in filing other forms.
Step 2. To begin entering a FRI you must find the company in our database. To do that, you may enter information in any of the boxes on the screen - Company Name, Federal EIN, Mass. EIN, Street, City, or Zip code. We recommend entering the Company Name and City.
IMPORTANT: Do not enter leading zeros, dashes, or letters in the EIN field. Use numbers only, with no spaces between them.
Click the Search button and be patient while a list of companies that most closely match what you typed in is compiled and displayed on your screen. (Depending on the information you enter, this search may take as long as a minute.) Select the company from the list by clicking on its name.
Step 3. Now you need to select the company address where notifications should be sent. Most companies have only one such address. Select the correct one by clicking on the street address shown in blue.
Step 4. This screen is similar to the previous screen, except you are selecting the company address where the incident took place. Select it by clicking on the street address shown in blue.
Step 5. Now you are on the Employee screen where you will enter information about the employee who was injured. Notice an asterisk * in front of some fields; the asterisk denotes mandatory fields that must be filled in before you may proceed. Enter all the information about the employee and then click the Next button.
Step 6. On this next screen, enter information about the insurer. Select the insurer's name from the drop down list, type in the policy number, and select whether or not the company is self-insured.
Step 7. Here you will enter information about the injury. Click the Next button to continue.
Step 8. Now the screen will display all the information you have entered for your review. Once you are satisfied reviewing the data, click on the Submit button to finish entering the claim. If your submission goes through, you will receive a Transmittal number on the screen. Write this number down on the paper form you are using to enter the claim, or select the Print button to get a hard copy of the claim exactly as you entered it.
Some Notes and Suggestions
When typing in dates, use four digits for the year - 2003, not 03.
When filing a First Report of Injury, if you do not find your company, your company notification address, or your company incident address in steps 2, 3, or 4, each screen provides a way for you to enter this information manually by clicking on the buttons labeled New Company, New Address, and New Incident Address.
If you find address information that is incorrect, click on the blue words "notify the DIA" and an e-mail screen will appear, addressed to us. Use the e-mail to let us know what information should be changed about your address.
Notice a small icon that resembles a calendar next to all date fields. By clicking on that icon, you can select the date by finding it on the calendar. If you enter a date by typing it and then hit the Tab key to move to the next field, your cursor will move onto the calendar icon automatically and you will need to hit the Tab key a second time.
Be as accurate as you can when you type in the name of your company to ensure your search is successful!