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- To file a complaint for workers' compensation in Massachusetts, you need to follow these steps12:
- Download and complete Form 110 - Employee Claim.
- Make three copies of your completed Form 110 (including all supporting documents).
- Send your original signed copy of Form 110 with your supporting documents to the Department of Industrial Accidents (DIA).
- Send a copy of Form 110 to your employer's workers' compensation carrier by Certified Mail.
- The date of your injury
- The first calendar day of work missed
- The fifth calendar day of work missed
- Your employer's workers' compensation insurance carrier
- The body parts affected and the types of injuries
- The types of benefits you're looking to obtain
- How long you may be out of work, if known
- Your current treating doctor
Learn more:âś•This summary was generated using AI based on multiple online sources. To view the original source information, use the "Learn more" links.Here are the steps:
- Step 1: Download and complete Form 110 – Employee Claim. ...
- Step 2: Make three copies of your completed Form 110 (including all supporting documents).
www.enjuris.com/massachusetts/workplace-injuries/According to Mass.gov, you will need to file a Form 110- Employee Claim that includes the following information:
- The date of your injury
- The first calendar day of work missed
- The fifth calendar day of work missed
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