This form must be filed at the lump sum conference. It is not sent in with the Form 116 (Request for Lump Sum Conference). It must be signed by the claimant, the claimant's counsel, and the counsel for the insurer.

When the claimant has been found suitable for vocational rehabilitation this form must also be signed by the Office of Education and Vocational Rehabilitation.

Print Form 116B  pdf format of form-116B.pdf

Recommended Content

People also viewed...

You recently viewed...

Personalization is OFF. Your personal browsing history at Mass.gov is not visible because your personalization is turned off. To view your history, turn your personalization on.

Learn more on our .

*Recommendations are based on site visitor traffic patterns and are not endorsements of that content.