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Your rights and responsibilities as a claimant

Educate yourself about your rights and responsibilities as a claimant while receiving unemployment benefits.

Your rights as a claimant

  • You have the right to appeal decisions made by the Department of Unemployment Assistance (DUA) relating to your claim. In many instances, your former employer also has the right to appeal.
  • If either you or your former employer appeal within the period of time allowed by law, you will have the right to a hearing
  • You have the right to see any materials relating to your claim. Your unemployment records are considered confidential, and are not available to anyone (with the exception of your former employer) unless you provide authorization to DUA.

Request weekly benefits

You must request weekly benefits every week that you are unemployed. No payment will be issued for any week that you fail to certify your eligibility.

It is your responsibility to:
  • Report your employment status
  • Report your wages and additional income (including pensions)
  • Inform DUA if you were sick, injured, attending school, or were unable to work during any week that you request benefits for
  • Report any gross wages (wages before taxes) earned if you work part time while receiving unemployment benefits

Additional Resources

Perform weekly work searches

In order to maintain eligibility for unemployment benefits, you are required to conduct an active search for work each week that you request benefits.

It is your responsibility to:
  • Make at least 3 work searches per week, using 3 different methods (i.e. phone, web, in person). Each work search must be conducted on a separate day.
  • Keep a detailed written log of your work search activities using the form under Additional resources
  • If you are required to attend a Career Center activity, remember to bring printed completed copies of all Work Search Activity Logs
  • Provide your work search information to DUA upon request. Keep all work search documents for 1 year after you stop requesting benefits.
Examples of work search include:
  • Registering for work and reemployment services with a local One-Stop Career Center
  • Completing a job application in person or online with employers who may reasonably be expected to have openings for suitable work
  • Mailing a job application and/or resume, as instructed in a public job notice
  • Making in-person visits with employers who may reasonably be expected to have openings
  • Sending job applications to employers who may reasonably be expected to have openings for suitable work
  • Interviewing with potential employers in person or by telephone.
  • Registering for work with private employment agencies or placement services
  • Using the employment resources available at One-Stop Career Centers that may lead directly to obtaining employment, such as:
    • Obtaining and using local labor market information
    • Participating in skills assessments for occupation matching
    • Participating in instructional workshops
    • Obtaining and following up on job referrals from the Career Center
  • Attending job search seminars, career networking meetings, job fairs, or employment-related workshops that offer instruction in improving individuals' skills for obtaining employment
  • Using online job matching systems, including the Massachusetts One-Stop Employment System (MOSES)
  • Reporting to the Union Hall, if this is your primary work search method
  • Using other job search activities such as reviewing job listings on the internet, newspapers or professional journals, contacting professional associations, networking with colleagues or friends

Additional Resources

Report changes in your employment status

You must report any changes in your unemployment status while you are receiving benefits.

It is your responsibility to:
  • Stop requesting benefits once you return to full-time work. You do not need to call DUA but you must stop requesting weekly benefits. You cannot receive benefits after you have started work, regardless of when you get paid.
  • Report all your earnings when requesting weekly benefits if you get a part-time job. Earnings greater than 1/3 of your weekly benefit amount will be deducted from your weekly benefit payment.
  • Inform DUA if you are sick, injured, attending school, travel outside of the area or are otherwise unable to work during any week for which you request benefits. You are not eligible for benefits for any period of time you are outside of the United States, its territories, or Canada.

Report to a Career Center upon request

You will be required to report to a Career Center if you are selected to participate in either of the following programs:

  • Career Center Seminar
  • Reemployment Services and Eligibility Assessment (RESEA) Program

If you are selected, you'll receive a notice by your previously selected correspondence method. Once selected, your participation is mandatory. Failure to comply with requirements by the deadlines specified in the notice may cause a delay or loss of your unemployment benefits.

To schedule your attendance at a Career Center Seminar, call the Automated Career Center Seminar Scheduling System at 1 (800) 653-5586 or contact the Career Center nearest you.

Additional Resources

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Solar Information & Programs

Learn about how solar energy works in Massachusetts

Many people have the misconception that solar (PV) systems do not work in Massachusetts, due to New England's diverse weather conditions. However, the experts agree that Massachusetts is an excellent location for solar systems. This section describes the different types of solar energy and how they are used in Massachusetts. In addition, find out what solar programs and incentives are currently available for your home, business, or institution.

Report SNAP or economic assistance fraud

Do you suspect fraud in the SNAP or economic assistance program? If you do, please report it.

Fraud Hotline

The Details

What you need

Preventing fraud, waste and abuse is a top priority of the Department of Transitional Assistance to ensure that every SNAP and economic assistance dollar goes to individuals and families who truly need it. Anyone who intentionally provides false information to receive benefits for which they would otherwise be ineligible is potentially taking them away from eligible recipients.

If you suspect fraud, you do not need to tell us who you are to make a complaint. In your report, please provide us with as many details as possible about the fraud. We appreciate your help in attempting to reduce fraud.

How to report

Call our toll-free hotline at 1-800-Fraud-99 (1-800-372-8399).

Download the Suspected Fraud Reporting Form  and mail the completed form to: 

         DTA Program Integrity

         Fraud Investigation Unit

         P.O. Box 4411

         Taunton, MA 02780-0435

 

Download the Suspected Fraud Reporting Form  and fax the completed form to the Fraud Investigation Unit at:

(617) 348-5479

 

Contact

Department of Children and Families - Central Office

DCF Management Directory

To contact any of the individuals below, please call the Department of Children and Families Central Office at (617) 748-2000

Linda Spears Commissioner
Lian Hogan Deputy Commissioner, Field Operations
Paola Ferrer Chief of Staff
Ryan Fitzgerald Chief of Operations and Organizational Improvement
David O'Callaghan Chief Financial Officer
Robert Brennan Chief Information Officer
Andrew Rome, General Counsel
Ruben Ferreira Assistant Commissioner, Continuous Quality Improvement
Kathy Lopes Assistant Commissioner for Foster Care, Adoption and Adolescent Services      
Andrea Grossman Director of Public Affairs
Leah Robins Legislative Director
Susan Cummings Ombudsman
Sharon Silvia Director of Adoption
Joy Cochran Foster Care Support
Maureen Fallon-Messeder Adolescent Services
Miriam Vazquez Accounting/Bill Paying

 

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Mass. Projected Household Heating Costs

Forecast of Energy Prices for Heating During Winter of 2017/18

The Energy Markets Division (MassDOER) tracks energy prices and consumption, including those associated with the cost of heating homes, during the winter. DOER analyzed weather forecasts and the projected prices and consumption for this winter for the major heating fuel sources (natural gas, heating oil, propane, electric heating) to provide the following heating season cost projections for 2017-2018.

For ways to save on your heating costs, please see the Opportunities to Save on your Heating Bills section below.

2017/18 Projected Household Heating Costs

Colder Winter Predicted and Higher Fuel Costs will likely Increase Average Household Heating Expenditures  

Based on predictions for a colder winter (October-March) than the last year (see National Oceanic and Atmospheric Administration’s (NOAA) Winter Outlook) and higher fuel costs for crude oil and natural gas, DOER is projecting an increase in fuel bills for all residential heating fuels this winter.

DOER estimates heating expenses for this winter for a residential customer using the average amount of fuel for each particular fuel type will be: $846 for natural gas; $2,278 for oil; $2,248 for propane, and $738 for electric heating (resistance heating). Projected expenditures are based on the average price of fuel; consumers’ expected average fuel usage; and anticipated weather conditions. Historically, space heating (see definition at end of page) is the largest component, fifty-nine percent (59%), of a Massachusetts household’s energy expenditures.   

These costs are calculated based on the average household usage by fuel type and is a useful comparison year to year for any one fuel type. These heating costs should not be used to compare one fuel type to another because it is not normalized for factors that affect fuel usage such as size of household or square footage. For example, it may appear that electric heat is a lower cost alternative to other fuels, however; electric heat is generally used in smaller spaces such as apartments and condos and is actually more expensive both on a square foot basis and based on a comparison of energy delivered (see below for a normalized comparison).

DOER’s comparison of this year’s consumer heating expenditures versus the previous years’ shows an increase in all consumer heating expenditures this winter: See Table 1 below:

Table 1: 2017-18 Estimated Average Residential Winter Heating Bills

Heating Fuel Estimated Expenditures Change From Last Year
Natural Gas $846 13%
Heating Oil $2,278 17%
Propane $2,248 10%
Electric $738 17%

Figure 1 provides a summary by fuel type of this winter’s projected average residential heating bills and the past five heating seasons. See Table 4 for the corresponding numbers.

Figure 1: Estimated Average Residential Winter Heating Bills by Fuel

Data source: U.S. DOE/EIA; Mass. Utility Filings, DOER State Heating Oil and Program Pricing (SHOPP) surveys.

As noted above, Figure 1 is calculated based on costs associated with the average household usage by fuel type and is a useful comparison year to year for any one fuel type. This chart should not be used to compare one fuel type to another because it is not normalized for factors that affect fuel usage such as size of household or square footage.

Table 2 shows a comparison (normalized) among fuels for the same household that uses the same equivalent amount of fuel, without differences due to square footage or variations in fuel usage. In this example, the costs of fuels relative to each other are evident.   

Table 2: Cost of Heating Fuels Assuming an Household Using an Equivalent Amount of Fuel

  Heating Season  
  2016-2017 2017-2018
Heating Fuel    
Natural Gas $1,280 $1,569
Heating Oil $1,949 $2,278
Propane $3,331 $3,744
Electric $6,102 $7,188

Comparison of Heating Fuel Costs on a Unit Basis

Fuel costs can also be compared on a unit basis are shown in Table 3 and Figure 2. The unit of measure across fuels uses energy intensity expressed as millions of British thermal units (MMBtu), (One Btu is the heat required to raise the temperature of one pound of water by one degree Fahrenheit.)-U.S. EIA). Based on this measure of energy intensity, Table 3 and Figure 2 depict electricity as the highest cost fuel on a unit basis as well.

Table 3: 2017-18 Average Prices of Heating Fuels per Millions of British Thermal Units (MMBTU)

Heating Fuel

$/MMBTU

Change From Last Year

Natural Gas

$13.98

7.2%

Heating Oil

$20.48

10.2%

Propane

$33.37

6.0%

Electric

$64.07

11.1%

Figure 2: Measuring Energy Intensity of Heating Fuels by Prices per Millions of British Thermal Units (MMBTU)

Data source: U.S. DOE/EIA; utility filings; and DOER customer migration data

Figure 2 depicts traditional heating fuels such as oil and propane.  However, there are new technologies such as renewable thermal technologies that are providing reduced heating costs (see below).

Factors Affecting Projected Heating Costs

Anticipated Higher Crude Prices and Colder Weather Driving up Demand Lead to Higher Residential Bills

Natural Gas: Based on the utilities’ natural gas filings at the Department of Public Utilities (DPU). DOER estimates that the projected natural gas price this winter will increase to an average $14.00/MMBtu ($1.40/therm) compared with $13.00/MMBtu ($1.30/therm) last winter. Consumption of natural gas is expected to increase due to forecasted colder winter temperatures than last year and the continued increase in demand for natural gas for electric generation across the U.S.  In 2016, the Northeast added pipeline capacity for the first time since 2010 when the Algonquin Incremental Market (AIM) Project came online to deliver gas from the Marcellus region in Pennsylvania to New England.  In addition, the Salem Lateral (in Salem, MA) was also completed.  These projects will help move natural gas to demand centers into New England, however; additional capacity is needed and consumers could still experience localized price volatility during periods of very cold temperatures.

Heating Oil: Higher heating oil prices reflect higher crude oil prices. The U.S. EIA estimates that the cost of Brent crude oil spot prices will average $54/ barrel this winter, an increase of about $2/barrel (6 cents/gallon) from last winter. The increase in crude prices is attributed to the gradual tightening of global oil supplies. Another reason for higher heating oil prices is that stocks of distillate fuel, while still within the five-year average, are lower than last year by about 16.8 million at 35.5 million barrels.  The lower stocks are a result of high demand for U.S. distillate exports coupled with refinery outages caused by Hurricane Harvey.  Refineries in the Gulf are expected to make up these shortfalls as the season goes along. 

Propane: Propane is impacted by higher crude oil and natural gas prices, as these are the fuels used to make propane. As a result of higher crude oil prices, propane prices are expected to rise about 6% this winter. While supply issues that have occurred in past years such as the prolonged cold weather throughout the U.S. during the winter, or late season crop drying in the Midwest resulting in high usage of propane stocks are not expected to reoccur, rising exports to international markets could impact available supply and drive up prices.

Electricity: Based on filings by the Electric Distribution Companies with the DPU, basic service, also known as energy supply prices, for Massachusetts utilities will increase for this winter. This is largely due to higher natural gas prices since natural gas is the primary fuel used for electric generation in the region. DOER estimates the total retail residential rates (supply plus distribution rates) will increase about 11% from 19.67 cents/kWh last winter to 21.86 cents/kWh this winter. This increase coupled with higher consumption due to colder temperatures will increase total expenditures for electric heat by 17%. Municipal electric heat customers should check with their individual utility for prices.

Renewable thermal technologies, including cold climate heat pumps, solar water heating, biofuels, and biomass pellet heating, are attractive new technologies now entering the market that can offer homeowners significant energy costs savings. DOER is supporting these emerging technologies, as outlined on DOER’s website under Renewable Energy.

For consumers interested in following energy markets and prices throughout the heating season, the U.S. DOE’s Energy Information Administration (EIA) tracks energy prices and the issues influencing them. This information is published in, “This Week in Petroleum” (TWIP) on DOE’s website, www.eia.doe.gov. To assist in tracking factors impacting all heating fuels, EIA also publishes the “Annual Winter Fuels Outlook” as part of its monthly Short-Term Energy Outlook.

2017-18 Winter Weather Expected to be Colder than Last Winter

While fuel costs are the primary factor in establishing winter heating prices, winter weather is the other driver having a significant impact on heating bills, as energy expenditures are a function of fuel usage. Colder weather leads to higher usage and warmer weather leads to lower usage. DOER expects that heating fuel usage, calculated based on projected Heating Degree Days (HDD-see definition below) will be higher than last winter, increasing consumers’ heating expenditures. Nationally, The National Weather Service (NWS) forecasters expect winter temperatures to be 13% colder overall this winter than last winter but 2% warmer than a “normal” winter, as measured by the 10-year average of Heating Degree Days. For Massachusetts, this winter is expected to be 2% warmer than normal but 6% colder than last winter. Colder weather will lead to higher consumption for consumers for this winter.

Based on these predictions and higher fuel costs for natural gas and crude oil, DOER is projecting an increase in fuel bills for all residential heating fuels this winter heating season. 

Opportunities to Save on your Heating Bills

Massachusetts offers a wide variety of financial incentives for all consumers to save on their energy bills, including no-cost programs and enhanced incentives for income eligible customersThe statewide Mass Save® program offers no-cost home energy assessments, rebates on efficient heating equipment as well as 0% financing for major energy efficiency measures.  Residents can reach the Mass Save program at 1-866-527-SAVE (7283)

Additionally, the Massachusetts Clean Energy Center offers rebates for air source heat pumps, ground source heat pumps, modern wood heating, and solar hot water through its Clean Heating and Cooling Rebate Programs.

DOER has also recently promulgated changes to its Alternative Portfolio Standard (APS) that allow consumers to receive compensation for heat that is generated by renewable heating and cooling technologies such as heat pumps, solar thermal, woody biomass, liquid biofuels, and biogas. Eligible facilities receive certificates for the heat they produce, which can then be sold to retail electricity suppliers that must purchase a certain amount of certificates each year.

Customers of municipal light plant companies (MLPs) can also often access similar benefits through the HELPS or other energy efficiency programs.

For a complete list of available incentives visit The Commonwealth Energy Tool for Savings (energyCENTS) that provides a single entry point to all of the energy saving opportunities, including MassSave and Low-Income Energy Assistance (LIHEAP) program. Consumers of the electric distribution companies can also shop for their generation service via the Commonwealth’s EnergySwitch site.

Further Background Data on Heating Prices

Comprehensive Household Heating Data for Average Residential Customers

Table 4 provides the comprehensive average residential pricing and consumption data for the past five years and estimates for this heating season.

Table 4: Household Heating Fuel Consumption and Expenditures

Definitions

Heating Degree Days: Heating degree day (HDD) is a measurement designed to reflect the demand for energy needed to heat a building. It is derived from measurements of outside air temperature of 65 degrees. The heating requirements for a given structure at a specific location are considered to be directly proportional to the number of HDD at that location. The difference between the average daily temperature and the base temperature of 65 degrees is the heating degrees for that day.

Space Heating: The use of energy to generate heat for warmth in housing units using space-heating equipment. The equipment could be the main space-heating equipment or secondary space-heating equipment. It does not include the use of energy to operate appliances (such as lights, televisions, and refrigerators) that give off heat as a byproduct (U.S.EIA)

MassHealth Payment and Coverage Guideline Tools

See below for the MassHealth DME and Oxygen Payment and Coverage Guidelines Tool and the MassHealth Orthotics and Prosthetics Payment and Coverage Guidelines Tools.

MassHealth DME and Oxygen Payment and Coverage Guidelines Tool

This online tool provides abbreviated descriptions for all durable medical equipment (DME) and oxygen service codes covered by MassHealth, identifies applicable modifiers, place-of-service codes, prior-authorization requirements, service limits, and pricing and markup information.

If you want to receive e-mail alerts when MassHealth posts changes to the DME and Oxygen Payment and Coverage Guidelines Tool, Sign up here. Note: When you click on the sign up link, a blank e-mail should appear.  If your settings prevent this, you may also copy and paste join-masshealth_dme_oxy_guidlines@listserv.state.ma.us into your e-mail address line. Just send the blank e-mail as it's addressed. No text in the body or subject line is needed.

Additional Resources

MassHealth Orthotics and Prosthetics Payment and Coverage Guidelines Tool

This online tool provides abbreviated descriptions for all orthotics (ORT) and prosthetics (PRT) service codes covered by MassHealth, identifies applicable modifiers, place-of-service codes, prior-authorization requirements, service limits, and pricing and markup information.

If you want to receive e-mail alerts when MassHealth posts changes to the Orthotics and Prosthetics Payment and Coverage Guidelines Tools, Sign up here. Note: When you click on the sign up link, a blank e-mail should appear.  If your settings prevent this, you may also copy and paste join-masshealth_ort_prt_paymnt_coverage_guidelines_tool@listserv.state.ma.us into your e-mail address line. Just send the blank e-mail as it's addressed. No text in the body or subject line is needed.

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Numerical form list

See all the numerical forms used by the Department of Industrial Accidents (DIA). We also have forms that don't have numbers, please refer to our alphabetical form list for all forms.

Forms by Number

Form 19 - Section 19 Agreement

Form 19A - Section 19A Medical Mediation Agreement

Form 46A - Request for § 46A Conference in Conjunction with Lump Sum Under § 48

Form 101 - Employer's First Report of Injury/Illness must now be filed via a DIA online account.

Form 103 - Insurer's Notification of Payment (updated 7/2013)

Form 104 - Insurer's Notification of Denial (updated 7/2013)

Form 105 - Agreement to Extend 180 Day Payment-Without-Prejudice (updated 2/2017)

Form 106 - Insurer's Notification of Termination or Modification of Weekly Compensation During Payment-Without-Prejudice Period (updated 7/2013)

Form 107 - Insurer's Notification of Acceptance, Resumption, Termination or Modification of Weekly Compensation (updated 7/2013)

Form 108 - Insurer's Complaint for Modification, Discontinuance or Recoupment of Compensation (updated 7/2013)

Form 108-A - Insurer's Request for Post-lump Sum Medical Mediation

Form 109 - Notification of Withdrawal of Claim or Complaint (updated 7/2013)

Form 110 - Employee Claim (updated 7/2013)

Form 110-A - Employee's Claim for Post-Lump Sum Medical Mediation

Form 112 - Appeal to Reviewing Board (updated 7/2013)

Form 112A - Affidavit in Support of Request for Waiver of Filing Fee Under § 11C (updated 7/2013)

Form 113 - Agreement to Pay Compensation (updated 8/2014)

Form 114 - Notice of Change/Appearance of Counsel (updated 7/2013)

Form 115 - Third Party Claim/Notice of Lien (updated 7/2013)

Form 116 - Request for Lump Sum Conference (updated 7/2013)

Form 116A - Employer Consent to Lump Sum Agreement (updated 7/2013)

Form 116B - Addendum to Lump Sum Agreement: Vocational Rehabilitation Status (updated 1/2015)

Form 116C - Lien Disclosure Form (updated 7/2013)

Form 117 - Lump Sum Settlement Agreement for Injuries On or After 11/1/1986 (Updated 6/2017)

Form 117A - Lump Sum Settlement Agreement for Injuries Before 11/1/1986

Form 121 - Appeal of Conference Order (updated 8/2015)

Form 121A - Agreement That No Impartial Physician Report Is Required

Form 122 and Form 123 - Request for §§ 37/37A Proceedings/Agreement Forms

Form 124A - Notification of Arbitration Award (updated 7/2013)

Form 125 - Motion for Expedited Conference (updated 7/2013)

Form 126 - Employee Earning Report (updated 7/2013)

Form 127 - Average Weekly Wage Computation Schedule

Form 130 - Complaint of Improper Claims Handling Against an Insurer (updated 7/2013)

Form 131 - Request for Speedy Conference Because of Hardship (updated 7/2013)

Form 132 - Affidavit in Support of Employee's Request for Speedy Conference Because of Hardship (updated 7/2013)

Form 133A - Utilization Review (UR) Agent Complaint (updated 3/2015)

Form 134 - Health Care Provider Complaint

Form 136 - Affidavit of Indigence and request for Waive of § 11A(2) Fees (updated 7/2013)

Form 140 - Conference Memorandum (updated 11/2017)

Form 141 - Last Best Offer at Conference (updated 7/2013)

Form 151 - Individual Written Rehabilitation Program (updated 2/2014)

Form 152 - Amendment, Suspension or Closure of Vocational Rehabilitation Plan (updated 7/2013)

Form 153 - Affidavit of exemption for Certain Corporate Officers or Directors

Form 154 - Verification of Massachusetts Workers' Compensation Coverage for Out-of-State Employers Operating in Massachusetts

Form 160 - Employee's Biographical Data Sheet (updated 7/2013)

Form 161 - Employee's Hearing Memorandum (updated 8/2013)

Form 162 - Insurer's Hearing Memorandum (updated 7/2013)

Form 170 - Affidavit of Employee in Application for Trust Fund Benefits (updated 7/2013)

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Explore opportunities with DCF

Learn more about working for DCF, review current openings, and complete an application.

Mass Careers

The Details

What you need

Preferred applicants will possess a demonstrated commitment to the core practice values:

  • Child-driven
  • Family-centered
  • Strength-based
  • Community-focused
  • Committed to diversity/cultural competence, and
  • Committed to continuous learning.

A commitment to diversity and cultural competence is central to the agency's organizational change.

Minorities, women, and persons with a disability are encouraged to apply.

If you need a reasonable accommodation, please contact our Civil Rights Manager, Diane Chang, at (617) 748-2104.

Where equal opportunity/affirmative action is a practice.

How to apply

Go to Mass Careers to explore DCF employment opportunities and complete an application.

Contact

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Alphabetical form list

All the Department of Industrial Accidents' (DIA) forms that we use.

Forms

Addendum to Lump Sum Agreement: Vocational Rehabilitation Status (Form 116B) (Updated 1/2015)

Affidavit for Builders, Contractors, Plumbers, and Electricians (Updated 2/23/2015)

Affidavit of Employee in Application for Trust Fund Benefits (Updated 7/2010)

Affidavit of Exemption for Certain Corporate Officers (Form 153) (Updated 7/2010)

Affidavits for General Businesses (Updated 2/23/2015)

Affidavit of Indigence and Request for Waiver of §11A(2) Fees (Form 136) (Updated 7/2013)

Affidavit in Support of Employee's Request for a Speedy Conference Because of Hardship (Form 132) (Updated 7/2013)

Affidavit in Support of Request for Waiver of Filing Fee Under §11C

Agreement to Extend 180 day Payment-Without-Prejudice (Form 105) (updated 2/2017)

Agreement That No Impartial Physician Report is Required (Form 121A)

Agreement to Pay Compensation (Form 113)

Amendment, Suspension or Closure of Vocational Rehabilitation Plan (Form 152)

Appeal of a Conference Order (Form 121)

Appeal to Reviewing Board (Form 112)

Application to Become an Approved Utilization Review Agent and Affidavit of Compliance forms (updated 12/2016)

Application to Serve as an Impartial Physician (updated 11/2014)

Average Weekly Wage Computation Schedule (Form 127)

Conference Memorandum (Form 140) (updated 11/2017)

Complaint of Improper Claims Handling Against an Insurer (Form 130)

CR-28 Massachusetts Workers' Compensation COLA Data Form

DOR Lien Release Request Guidance

Employee Biographical Data Form (Form 160)

Employee Claim (Form 110) (updated 7/2013)

Employee Earning Report (Form 126) (Updated 7/2013)

Employee's Hearing Memorandum (Form 161) (updated 7/2013)

Employee's Claim for Post-Lump Sum Medical Mediation (Form 110A)

Employer Consent to Lump Sum Agreement (Form 116A) (updated 7/13)

Employer First Report of Injury (Form 101) Can only be filed electronically

Health Care Provider Complaint Form (Form134)

Individual Written Rehabilitation Program (Form 151)

Insurance Certification Request Form

Insurer's Complaint for Modification, Discontinuance or Recoupment of Compensation (Form 108) (updated 7/2013)

Insurer's Hearing Memorandum (Form 162) (updated 7/2013)

Insurer's Notification of Acceptance, Resumption, Termination or Modification of Weekly Compensation (Form 107) (updated 7/2013)

Insurance Inquiry Form (updated 4/2014)

Insurer's Notification of Denial (Form 104) (updated 7/2013)

Insurer's Notification of Payment (Form 103)

Insurer's Notification of Termination or Modification of Weekly Compensation During Payment-Without-Prejudice Period (Form 106)

Insurer's Request for Post-Lump Sum Medical Mediation (Form 108-A)

Last Best Offer at Conference (Form 141)

Lien Disclosure (Form 116C)

Lump Sum Agreement for Injuries On or After 11/1/1986 (Form 117) (updated 7/2017)

Lump Sum Agreement for Injuries Before 11/1/1986 (Form 117A)

MGL c. 152, §65B Appeal of Cancellation or Termination of Policy

Mileage Reimbursement Form for VR Providers

Motion for Expedited Conference (Form 125)

(updated 7/2013)

Notification of Arbitration Award (Form 124A)

Notice of Change/Appearance of Counsel (Form 114)

Notification of Withdrawal of Claim or Complaint (Form 109)

OEVR Provider Quarterly Report for Closed Cases - No RTW

OEVR Provider Quarterly Report for Closed Cases - RTW

OEVR Provider Quarterly Report for Open Cases

Posters - Notice to Employees

Poster - Notice to Employees (English)

Poster - Notice to Employees (Arabic)

Poster - Notice to Employees (Cape Verdean)

Poster - Notice to Employees (Chinese)

Poster - Notice to Employees (Haitian Creole)

Poster - Notice to Employees (Khmer)

Poster - Notice to Employees (Portuguese)

Poster - Notice to Employees (Spanish)

Poster - Notice to Employees (Vietnamese)

Referral for Mandatory Meeting

Request for Lump Sum Conference (Form 116)

Request to Records Access Office for File Information

Request for §§ 37/37A Proceedings/Agreement Forms (Form 122 and 123)

Request for § 46A Conference in Conjunction with Lump Sum Under § 48 (Form 46A) (updated 3/2011)

Request for Speedy Conference Because of Hardship (Form 131) (updated 7/2013)

Section 15 Calculator Version 8.5 (updated 4/2012)

Section 15 Interactive Petition v.2.62 (updated 5/2012)

Section 19 Agreement (Form 19)

Section 19A Medical Mediation Agreement (Form 19A)

Section 50 Interest Calculator - 3/09

Third Party Claim/Notice of Lien (Form 115)

Utilization Review (UR) Agent Complaint Form (Form 133A) (updated 3/2015)

Verification of Massachusetts Workers' Compensation Coverage for Out-of-State employers operating in Massachusetts (Form 154)

W-9 -  Request for Taxpayer Identification Number and Certification

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