Effective May 26, 2020, the DIA will require certain forms be completed on-line via their website and filed electronically. The DIA will no longer accept or process paper forms that are received via postal mail, facsimile or email attachment (*with exceptions noted below).
The following forms are required to be completed online via the website and filed electronically:
Form 101
- Employer’s First Report of Injury
Form 103
- Insurer’s Notification of Payment
Form 104
- Insurer’s Notification of Denial
Form 106
- Insurer’s Notification of Modification / Termination
Form 107
- Insurer’s Notification of Modification / Termination /
Form 107 -
Resumption of Weekly Compensation During
Form 107 -
Pay Without Prejudice Period
Form 108
- Insurer’s Request for Discontinuance/Modification
(*Supporting docs must be faxed/emailed - see form instructions below)
Form 110
- Employee’s Claim
(*Supporting docs must be faxed/emailed - see form instructions below)
Form 114
- Attorney’s Appearance of Counsel
Form 115
- Third Party Claim/Lien
Form 116
- Request for Lump Sum Conference
With respect to Form 108 & Form 110 attachments, you are required to accompany any claim for compensation or discontinuance with the proper supporting documentation. To perfect this, you must file the respective form electronically, and then either fax the additional documents to 617-727-4551 or email them to
DIA-docattach@mass.gov
.
Each electronic filing is given a transmittal ID number you must reference when sending the attachments. Filing instructions are provided on the electronic forms.
