Massachusetts Workers’ Compensation Reference Chart for Adjusters, Produced by AI

23 Aug, 2025 Frank Ferreri

                               

Coverage Requirements

All employers must carry workers' compensation insurance for employees, including part-time and seasonal workers. Sole proprietors, partners, and LLC members may opt out. Corporate officers with ≥25% ownership may file Form 153 to exempt themselves.

Claim Reporting & Filing

TriggerAction RequiredDeadline
≥5 days of disabilityEmployer files Form 101Within 7 days of 5th day of disability
Insurer receives Form 101 or ClaimFile Form 103 (Payment) or Form 104 (Denial)Within 14 days

Penalties range from $200 to $10,000 for delays.Benefit Types & Calculations

Benefit TypeSectionRateDuration
Temporary Total Disability (TTD)§3460% of AWWUp to 156 weeks
Temporary Partial Disability (TPD)§3560% of wage loss (max 75% of §34)Up to 260 weeks (or 520 weeks with extension)
Permanent & Total Disability (PTD)§34A66.67% of AWWLifetime
Scarring / Loss of Function§36Based on severity and SAWWLump sum
Medical Treatment§30All necessary careNo time limit

Medical & Vocational Services

  • Medical bills follow DIA fee schedule.
  • Utilization Review (UR) required even for denied claims.
  • Workers may choose their doctor but can only switch once per specialty without insurer approval.
  • Vocational rehab under §30G includes training and job placement.

Dispute Resolution Process

  1. Conciliation: Informal meeting.
  2. Conference: Judge issues temporary order.
  3. Hearing: Formal proceeding with evidence.
  4. Appeals: Reviewing Board and Court of Appeals.

Adjuster Responsibilities

  • Timely filing of Forms 103/104.
  • Accurate AWW calculation.
  • Monitor benefit eligibility and duration.
  • Coordinate UR and medical bill review.
  • Communicate with DIA, employer, and injured worker.
  • Avoid penalties for late actions.

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