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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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