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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 Letter for FY 2024

DIA Assessment Opt Out Self Insured List 7/1/2023

Standard premium algorithm

Form 50 template

Form 51 template

Policy detail template - Updated February 1, 2018

Zero filer template

Contact for DIA assessment forms

Online

Email Director of Insurance Aalana Feaster at Aalana.Feaster@detma.org

Phone

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

Address

100 Cambridge St., 5th Floor, Boston, MA 02114

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