Appeal a workers' compensation first report violation notice

Follow these steps to appeal a first report violation notice from the Department of Industrial Accidents (DIA).

Francisco Pena, Claims Manager

The Details of Appeal a workers' compensation first report violation notice

What you need for Appeal a workers' compensation first report violation notice

The DIA fines employers who don’t file a Form 101 - First Report of Injury/Fatality within the time frame specified by the workers’ compensation law. Please note, all First Reports of Injury to the DIA must be filed online. If you think the report violation is in error, you should gather all supporting documents, including:

  • Physical or electronic date stamps on documents
  • Witness statements
  • The date you were notified of the injury

How to appeal Appeal a workers' compensation first report violation notice

You must either pay or appeal a first report violation notice within 30 calendar days.

  • All appeals must be made in writing with a copy of the violation notice
  • Briefly state the reasons you believe the fine was issued in error
  • Include all relevant information and send everything to:

          First Report Appeals
          Department of Industrial Accidents
          Lafayette City Center
          2 Avenue de Lafayette
          Boston, MA 02111-1750

Next steps for Appeal a workers' compensation first report violation notice

Review and decision

The DIA will conduct an administrative review of your appeal.

  • If the review supports your appeal, we will withdraw the violation
  • If the review upholds the fine, payment is due within 14 calendar days of the review

If you aren’t satisfied with the decision, you have the right to request a formal hearing within 14 calendar days.

You will be notified of the date, time and place of the hearing.

More info for Appeal a workers' compensation first report violation notice

  • If you do not pay or appeal your original violation, additional violations on your account will be incurred
  • You can’t appeal a Demand Notice
  • Only one administrative review allowed per violation

Contact for Appeal a workers' compensation first report violation notice

Address
The Lafayette City Center, 2 Avenue de Lafayette, Boston, MA 02111-1750
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