File a workers' compensation claim

Find out how to file a claim if your employer’s workers’ compensation insurer denies your claim, your employer refuses to file a claim, or it’s been 30 or more calendar days since your injury.
You should get a notice within 1 – 2 weeks after submitting your claim form.

Public Information Office

Phone

Phones open M-F 8 am - 5 pm

Phones open M-F 8 am - 5 pm

Toll Free In Massachusetts Only (800) 323-3249

Phones open M-F 8 am - 5 pm.

The Details

What you need

To file a workers' compensation claim with the Department of Industrial Accidents (DIA) you will need to know:

  • Your date of injury, illness, or death if a dependent is filing for benefits
  • The 1st calendar day of work you missed
  • The 5th calendar day of work you missed
  • The workers’ compensation insurance carrier
  • The body parts and types of injuries
  • What type of benefits you are looking for
  • How long you may be out, if known
  • Where you first went for treatment
  • Your current treating doctor

You are required to attach copies of at least 1 item below to the Form 110 – Employee Claim and bring the rest with you to the conciliation – the first step in the process.

  • Unpaid medical bills
  • Medical reports
  • Any reports that supports how the accident happened
  • Witness statements
  • Witness names

You can check if you employer has workers' compensation online.

How to file

To file a claim, download and complete Form 110 – Employee Claim. You will need 3 copies of this form and all other materials:

  • 1 copy for the DIA
  • 1 copy for the workers’ compensation carrier
  • 1 copy for your records, or in case you hire an attorney at a later date

Send your original signed copy of Form 110 – Employee Claim with copies of your supporting documents to:

               Department of Industrial Accidents
               Dept. 110
               1 Congress St., Suite 100
               Boston, MA 02114

Submit your original signed copy of Form 110 – Employee Claim with copies of your supporting documents in person at the DIA office:

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

Next steps

  1. Get notification

    Once you have completed the form and have your attachments, you will need to make 3 copies:

    • Send a copy of the Form 110 – Employee Claim and all supporting documents to your employer’s workers’ compensation carrier by Certified Mail
       
      • You must attach copies of medical reports, bills, etc. to the form you send to the insurer even if you know they already have them. If these documents aren’t attached, the insurer’s attorney will ask the DIA to withdraw the claim because it wasn’t filed correctly.

    The DIA will review your claim and respond in 2 ways:

    • The DIA can reject the form for several reasons and send everything back to you. A rejection letter is attached to the form stating what information is missing or incorrect.
    • If the information is correct, we’ll send a notice to you, the insurance company, and your employer with a date, time and place to appear to meet a conciliator to discuss your claim. This informal meeting is called a conciliation.
       
      • Your employer gets a notice as a courtesy. They don’t need to appear unless the insurance company wants them to, or if they had no workers' compensation insurance on the date of your injury.

     

  2. Information

    Most claims get rejected by the DIA because they have the incorrect insurance carrier, have not checked off the types of benefits they are looking for, or do not enter a 1st and 5th day of disability.

    If you don’t know the name of your employer’s insurance company, you can look on any of the insurer forms they send you, especially the Form 104 – Notification of Denial. You can also call our Office of Insurance for assistance at (617) 626-5480 or (617) 626-5481, or look up your employer's insurer online.

    If your employer doesn’t have workers' compensation insurance, you will need to file a claim against the Workers' Compensation Trust Fund, which is part of the DIA.

Contact

Address

Boston DIA
1 Congress St., Suite 100, Boston, MA 02114

Phone

Phones open M-F 8 am - 5 pm

Phones open M-F 8 am - 5 pm

Toll Free In Massachusetts Only (800) 323-3249

Phones open M-F 8 am - 5 pm.

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