Orders must be appealed within 14 days.
Find out what you need to do to appeal a conference order about your workers’ compensation case.
- This page, Appeal a workers' compensation conference order, is offered by
- Department of Industrial Accidents
Appeal a workers' compensation conference order
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.
Email to: Deborah.Keefe@mass.gov, Maryanne.Fitzpatrick@mass.gov AND Ingrid.Askew@mass.gov.
- 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. Please mail the check to:
Department of Industrial Accidents
Dept. 121
Lafayette City Center
2 Avenue de Lafayette
Boston, MA 02111-1750
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
Email to Deborah.Keefe@mass.gov AND Maryanne.Fitzpatrick@mass.gov.
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
Open PDF file, 148.24 KB,
Form 121 - Appeal of a Conference Order
(English, PDF 148.24 KB)
Open PDF file, 178.13 KB,
Form 136 - Affidavit of Indigence and Request for Waiver of § 11A(2) Fees
(English, PDF 178.13 KB)
Contact
Address
Boston - Main Office - (617) 727-4900 - 8:30 - 5:00
Lafayette City Center, 2 Avenue de Lafayette, Boston, MA 02111-1750
Fall River - (508) 676-3406 - 8:30 - 5:00
1 Father DeValles Blvd., 3rd Fl., Fall River, MA 02723
Lawrence - (978) 683-6420 - 8:30 - 5:00
354 Merrimack St., Entrance C, Suite 230, Lawrence, MA 01843
Springfield - (413) 784-1133 - Open 8:30 - 5:00
1441 Main Street, Suite 205, Springfield, MA 01103
Worcester - (508) 753-2072 - 8:30 - 5:00
Mercantile Center, 100 Front St., Suite 310, Worcester, MA 01608