Appeal a workers' compensation conference order

Find out what you need to do to appeal a conference order about your workers’ compensation case.
Orders must be appealed within 14 days.

Contact

Department of Industrial Accidents

Phone

This line is open 8 a.m. to 5 p.m., M-F

Toll Free (Mass. Only) (800) 323-3249

This line is open 8 a.m. to 5 p.m., M-F

TDD (Hard of hearing) (800) 224-6196

This line is open 8 a.m. to 5 p.m., M-F

The Details

What you need

You must file an appeal of an administrative judge’s conference order about your workers’ compensation case within 14 days on a Form 121 - Appeal of Conference Order.

Fees

Name Fee Unit
Filing fee for an appeal of a conference order $650 one-time

How to appeal

Download and fill out Form 121 – Appeal of a Conference Order.

  • Attach a copy of the administrative judge’s order to the form
  • If the basis of your appeal is a medical issue, you must pay a $650 fee within 10 days of filing the form. Make checks payable to the Commonwealth of Massachusetts.

Mail Form 121 and attachments to:

               Department of Industrial Accidents – Dept. 121
               1 Congress St., Suite 100
               Boston, MA 02114

If you can’t afford the filing fee, you may submit Form 136 – Affidavit of Indigence and Request for Waiver of § 11A(2) Fees.

  • Attach all supporting documents
  • You have 10 days after filing Form 121 to submit Form 136

Mail Form 136 to:

            Director’s Office
            Department of Industrial Accidents
            1 Congress St., Suite 100
            Boston, MA 02114

Download and fill out Form 121 – Appeal of a Conference Order

  • Attach a copy of the administrative judge’s order to the form
  • If the basis of your appeal is a medical issue, you must pay a $650 fee within 10 days of filing the form. Make checks payable to the Commonwealth of Massachusetts.

Bring Form 121 and attachments to:

               Department of Industrial Accidents – Dept. 121
               1 Congress St., Suite 100
               Boston, MA 02114

If you can’t afford the filing fee, you may submit Form 136 – Affidavit of Indigence and Request for Waiver of § 11A(2) Fees.

  • Attach all supporting documents
  • You have 10 days after filing Form 121 to submit Form 136

Bring Form 136 to:

            Director’s Office
            Department of Industrial Accidents
            1 Congress St., Suite 100
            Boston, MA 02114

Next steps

After the appeal

Once you file an appeal of the conference order, you may receive a notice a to attend an impartial physician's exam set up by the Department of Industrial Accidents. Once the exam has been completed and the doctor's report filed, a full evidentiary hearing will be scheduled before an administrative judge.

If the parties agree that an impartial exam is not needed, your case will be placed in line for hearing date.

Downloads

Contact

Address

1 Congress St, Suite 100, Boston, MA 02114

Phone

This line is open 8 a.m. to 5 p.m., M-F

Toll Free (Mass. Only) (800) 323-3249

This line is open 8 a.m. to 5 p.m., M-F

TDD (Hard of hearing) (800) 224-6196

This line is open 8 a.m. to 5 p.m., M-F

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