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This page, DIA assessment forms, is offered by
Department of Industrial Accidents

DIA assessment forms

All the forms needed be filed by insurers with the Department of Industrial Accidents.

Forms

DIA Assessment Rate Letter FY 2025 with Opt Out Self Insured List 7/1/2025

Standard premium algorithm

Form 50 template - This is an example of the form. To complete this form, you will need to log into your DIA online account as it has the most up-to-date bill dates.

Form 51 template - This is an example of the form. To complete this form, you will need to log into your DIA online account as it has the most up-to-date bill dates.

Policy detail template - Updated February 1, 2018

Zero filer template

Contact

Online

Email Director of Insurance Aalana Feaster at Aalana.Feaster2@mass.gov

Phone

Call Director of Insurance Aalana Feaster at (617) 626-5468

Address

Lafayette City Center, 2 Avenue de Lafayett, Boston, MA 02111

Directions

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