How to File a Workers’ Comp Claim in Massachusetts

The Short Answer:

To begin a Massachusetts workers’ compensation claim, report your work-related injury or illness to your employer as soon as possible, preferably in writing, and get medical treatment. If the condition causes 5 or more full or partial calendar days of incapacity, your employer must file Form 101 with the Department of Industrial Accidents (DIA) and its workers’ compensation insurer. The days don’t need to be consecutive.

You generally file Form 110: Employee Claim only when the insurer denies your claim, you aren’t receiving the benefits you believe are owed, your employer refuses to report the injury, or at least 30 calendar days have passed without a response from the insurer. If you file Form 110 yourself, you must include supporting documents, send a complete copy to the insurer by certified mail, and keep a copy for your records.

At Jim Glaser Law, our workers’ comp lawyers help injured workers understand Massachusetts filing requirements and respond to disputed claims. This guide explains when Form 110 is needed, what information and documents to gather, how to submit it, and what happens after the DIA receives it.

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Key Takeaways

• Report the injury as soon as possible: Notify your employer promptly and in writing. Include when, where, and how the injury happened, and keep a copy of your report.
• Your employer may need to file Form 101: If you experience 5 or more full or partial calendar days of incapacity, your employer must report the injury to the DIA and its insurer. The days don’t have to be consecutive.
• The insurer must respond: The insurer generally has 14 days after receiving the injury report or written claim for weekly benefits to begin payments or send a written denial.
• Form 110 is used for disputed or unpaid benefits: Don’t file Form 110 simply because an injury occurred. It may be needed if the claim is denied, your employer doesn’t report it, you aren’t receiving the benefits you believe are owed, or 30 calendar days pass without an insurer response.
• A complete filing requires supporting evidence: Include medical reports and other documents supporting the connection between your condition and your work. Send the insurer the same materials you send to the DIA.
• Keep copies and proof of delivery: Retain a complete copy of Form 110, all attachments, and the certified-mail receipt showing that the insurer received its copy.
• Don’t wait to address a problem: Massachusetts generally allows 4 years to file a formal claim, measured from when you first became aware of the connection between your disability and your employment. Delays can still make a claim harder to document.

Step 1: Report Your Workplace Injury Immediately

The first step in filing a workers’ compensation claim is notifying your employer about your injury. This ensures there is a formal accident report on file. 

If your employer refuses to document the injury, denies that you reported it, or disputes whether the condition is work-related, consider speaking with a Massachusetts workers’ compensation lawyer. A lawyer can help you preserve evidence of when and how notice was provided. 

Jimmy’s Pro Tip: Provide a detailed account of how and when the injury occurred, including the exact date, time, and location of the incident, the tasks you were performing at the time, and any contributing factors (e.g., faulty equipment or unsafe conditions). Mention any witnesses and their contact information, and describe the immediate effects of the injury, such as pain or inability to perform certain tasks. Keep a copy of the report for your records to ensure accuracy and protect your rights if the claim is disputed.

Step 2: Seek Medical Attention Right Away

Get emergency treatment immediately if your injury requires it. Even if the injury appears minor, see a medical provider promptly. A timely medical evaluation after a work injury creates a record of your symptoms, diagnosis, treatment, and work restrictions.

Tell each provider that your injury or illness is work-related. Explain how the incident happened or how your job duties caused or worsened the condition. Ask the provider to record when your symptoms began, how the condition is connected to your work, whether you can return to work, and any restrictions you must follow. This documentation may support your claim if the insurer disputes your injury or benefits.

For your first scheduled medical visit, your employer may direct you to a provider within its preferred provider arrangement. After that initial visit, you generally have the right to choose your own healthcare provider. 

Consider seeking legal help if the insurer refuses to authorize treatment, denies work-related medical bills, or disputes the connection between your condition and your job. 

Jimmy’s Pro Tip: Keep copies of your medical reports, work-status notes, restrictions, referrals, bills, and prescription receipts. You should also track the date, destination, and mileage for trips to and from appointments. Store these records together so that they’re available if you need to file Form 110 or provide additional information to the insurer.

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Step 3: Ensure Your Employer’s Workers’ Compensation Insurer Is Notified

If your injury prevents you from earning your full wages for 5 or more full or partial calendar days, your employer must file Form 101: Employer’s First Report of Injury or Fatality. The 5 days don’t need to be consecutive. Your employer generally has 7 calendar days, excluding Sundays and legal holidays, after the 5th day of incapacity to report the injury to the Massachusetts Department of Industrial Accidents (DIA) and its workers’ compensation insurer. You should also receive a copy of Form 101.

If you have fewer than 5 full or partial days of incapacity, your employer may report the injury as a medical-only claim directly to the insurer. A medical-only claim doesn’t need to be reported to the DIA.

After receiving the injury report, the insurer generally has 14 days to begin weekly benefit payments or send a written denial. Form 103: Insurer’s Notification of Payment notifies you that payments are beginning. Form 104: Insurer’s Notification of Denial explains why the insurer is denying the claim.

If you receive Form 104 or the insurer doesn’t respond within the required period, Jim Glaser Law can review what happened and help determine your next step. 

Learn more about these and other Massachusetts workers’ comp deadlines with our article, How Long Does an Employee Have To Report an Injury in Massachusetts?

Jimmy’s Pro Tip: Request a copy of Form 101, the insurer’s contact information, your claim number, and the adjuster’s name and contact information. Keep any Form 103 or Form 104 you receive with your other claim records.

Do You Need to File a Form 110?

Not every injured worker needs to file Form 110. Reporting your injury to your employer begins the normal workers’ compensation insurance process. Form 110: Employee Claim is used when you need the Massachusetts Department of Industrial Accidents (DIA) to resolve a dispute over benefits.

If you’re unsure whether you need Form 110, Attorney Jim Glaser and his team can review your payment history, medical disputes, and any Forms 103, 104, or 106 you received before you begin the DIA dispute process.

Step 4: File Form 110–Employee Claim

Once you determine that Form 110 is needed, download the current Form 110: Employee Claim from the Massachusetts Department of Industrial Accidents (DIA). Using the current form and completing every applicable field can help prevent your filing from being returned.

Gather the information required for Form 110. Along with your personal information, you should have:

• The date of your injury or illness
• The 1st calendar day you missed work
• The 5th calendar day you missed work
• Your employer’s legal name and address
• The correct workers’ compensation insurer
• The insurer’s claim number, if assigned
• Your DIA board number, if assigned
• The injured body parts
• The type of injury or illness
• The benefits you are claiming
• Where you first received medical treatment
• Your current treating provider
• How long you may be unable to work, if known
• The names and contact information of witnesses

Don’t guess about the insurer or other claim information. Ask your employer, check the workers’ compensation notice posted at your workplace, or contact the DIA if you can’t confirm the correct information.

Attach documents supporting your claim. Your records should help show how your condition is connected to your work and why you’re requesting benefits. Depending on your claim, supporting documents may include:

• Medical reports connecting your injury or illness to your work
• Work-status notes and medical restrictions
• Unpaid medical bills
• Accident or incident reports
• Witness statements or witness information
• The insurer’s Form 104 denial
• Relevant letters, emails, or other communication with the employer or insurer

Attach written radiology reports rather than raw X-ray or MRI images. The DIA requires at least 1 supporting item with Form 110, but you should include all available documents that support your claim. Bring any remaining evidence to the conciliation.

The DIA may return or reject a Form 110 that is missing required information or documentation. You must also send the insurer the same supporting documents you send to the DIA. If the insurer doesn’t receive the attachments, its attorney may ask the DIA to withdraw the claim because it wasn’t filed correctly.

If you are filing Form 110 without an attorney, follow these steps:

1. Download the current official Form 110.
2. Complete every applicable field.
3. Select the specific benefits you are claiming.
4. Sign and date the form.
5. Attach your supporting documents.
6. Prepare 3 complete sets of the form and attachments.
7. Mail or hand-deliver the signed original and supporting documents to the DIA.
8. Send a complete set to the workers’ compensation insurer by certified mail.
9. Keep the 3rd set and your certified-mail receipt.

The current mailing address is:

Boston DIA
Lafayette City Center
2 Avenue de Lafayette
Boston, MA 02111-1750

A self-represented worker may mail Form 110 or deliver it to the DIA’s Boston office. If you have an attorney, the attorney must file Form 110 through the DIA’s online system.

Jimmy’s Pro Tip: Before submitting Form 110, double-check the insurer’s name, the benefits you selected, the date of injury, and the 1st and 5th days of incapacity. Make sure the form is signed and that the DIA and insurer receive the same documents. Keep copies of everything you send and proof of when it was delivered.

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What Happens After You File Form 110?

After the Department of Industrial Accidents (DIA) receives Form 110, it reviews the form and supporting documents. If information is missing or incorrect, the DIA may return the filing with a letter explaining what needs to be corrected. You should generally receive notice from the DIA within 1 to 2 weeks after submitting your claim.

If the filing is accepted, the DIA will schedule a conciliation. This is an informal meeting involving you or your attorney, the insurer, and a conciliator. Bring any medical records and other supporting documents that you didn’t submit with Form 110. The purpose is to determine whether the parties can resolve the dispute. The conciliator doesn’t approve or deny your claim.

If the parties don’t reach an agreement, the claim may proceed to a conference before an administrative judge. Additional stages may include a hearing and an appeal to the Reviewing Board. Learn more in our guide to appealing a denied workers’ compensation claim in Massachusetts.

Common Mistakes to Avoid When Filing Form 110

Filing errors can cause the Department of Industrial Accidents (DIA) to return Form 110 or delay the dispute resolution process. Avoid these common mistakes:

• Naming the wrong insurance carrier: Confirm which workers’ compensation insurer covered your employer on the date of your injury. Using the wrong carrier may cause the DIA to reject the filing.
• Failing to identify the benefits being claimed: Form 110 requires you to select the specific benefits you are requesting. Don’t assume the DIA will determine this for you.
• Leaving out incapacity dates: Include the 1st and 5th calendar days of incapacity when they apply to your claim. Make sure the dates are accurate and consistent with your work and medical records.
• Filing Form 110 before it is appropriate: Form 110 is used to address disputed or unpaid benefits. It isn’t the form used to give your employer the first notice of an injury.
• Failing to sign and date the form: Review the signature section before submitting Form 110. An unsigned or undated form may be returned.
• Submitting no supporting documentation: Attach records supporting the connection between your condition and your work. Medical reports, work-status notes, bills, incident reports, and witness information may support different parts of your claim.
• Sending different documents to the DIA and insurer: The insurer should receive the same Form 110 and supporting documents that you submit to the DIA.
• Failing to use certified mail: Send the insurer’s complete copy by certified mail so you have proof of when it was sent and delivered.
• Keeping no copy or proof of filing: Retain a complete copy of the form, every attachment, and your certified-mail receipt.
• Using an outdated Form 110: Download a new copy from the DIA website instead of relying on an older saved or printed version.

Why You Should Have a Massachusetts Workers’ Compensation Lawyer

Navigating the workers’ compensation process can be complicated, especially if your employer or their insurer disputes your claim. If you need to hire a lawyer, a workers’ compensation attorney can handle the legal aspects of your case, negotiate with the insurer, and help ensure you receive the maximum benefits available under the law.

At Jim Glaser Law, we offer free case reviews and work on a contingency fee basis, so the cost to hire a lawyer is nothing upfront—you don’t pay unless we win your case.

Get Help Filing Your Workers’ Compensation Claim Today

If you’ve been injured on the job in Boston, Sharon, Cambridge, or elsewhere in Massachusetts, don’t face the state’s workers’ compensation system alone. At Jim Glaser Law, we’re committed to helping injured workers secure the benefits they may deserve. 

If your workers’ compensation claim was denied, your benefits were stopped or reduced, or you need help filing Form 110, Jim Glaser Law can review your situation and explain your next steps. Contact us today for a free consultation.