File a workers' compensation claim against the Workers' Compensation Trust Fund (WCTF)

Find out how to file a claim with the Department of Industrial Accidents (DIA) if your employer does not have workers’ compensation insurance.
You should get a notice within 1 – 2 weeks after submitting your claim.

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) against the Workers’ Compensation Trust Fund (WCTF) you will need to know:

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

You are required to attach copies of at least 1 item below and bring the rest with you for the conciliation – the first step in the process:

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

How to file

To file a claim against the WCTF, you will need to file 3 documents and any supporting documentation as required:

To verify that your employer has no workers’ compensation insurance.

  1. Download and fill out an Insurer Request Certification Form. Mail the form to:

                         Tom Finneran
                         Office of Insurance
                         Department of Industrial Accidents
                         19 Staniford St., 5th Floor
                         Boston, MA 02114

The Office of Insurance will send you a certified letter called a Certification of No Insurance.

Include the original certified letter when you file the Form 110 – Employee Claim.

  1. Download and complete the Form 110 – Employee Claim. List the Workers’ Compensation Trust Fund as the insurer.
  2. Download and fill out the Form 170 – Affidavit of Employee in Application for Trust Fund Benefits.

You will need 3 copies of all the forms and documents

  • 1 copy for the DIA
  • 1 copy for the Workers’ Compensation Trust Fund
  • 1 copy for your records, or in case you hire an attorney later

Send your signed Form 110 – Employee Claim with copies of your supporting documents, Certification of No Insurance, and Form 170 - Affidavit of Employee in Application for Trust Fund Benefits to:

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

Also send a  copy by certified mail to:

                     Workers’ Compensation Trust Fund
                     c/o Department Industrial Accidents
                     1 Congress St., Suite 100
                     Boston, MA 02114

Submit your original copy of Form 110 – Employee Claim with copies of your supporting documents, original Certification of No Insurance, and Form 170 - Affidavit of Employee in Application for Trust Fund Benefits in person at the DIA office:

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

Next steps

Notification and investigations

You will be contacted by a claims representative and an investigator from the DIA to discuss your claim.

You will receive a notice from the DIA regarding a conciliation for your claim. A conciliation is the first step in the dispute process. 

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.

Address

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

Address

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

Feedback

Tell us what you think