Requirements to appeal for a workers’ comp denial

On Behalf of | Feb 21, 2022 | Workers' Compensation |

Denied workers’ compensation? Residents of Springfield and other nearby areas of Massachusetts may want to learn more about what the needs are for an appeal. You may feel they have made the wrong decision, and there are some things that you will need when filing the appeal.

According to state authorities, you can appeal in person or by mail. The Department of Industrial Accidents has the responsibility of handling these claims.

You’ll need to know some things

Your date of injury is important as well as the 1st calendar day of work missed. You will also need the 5th calendar day of work missed. Who is your workers’ compensation insurance carrier?

Type of injury

They will ask for the type of injuries that you had. They will also need to know the body parts where injury occurred.

Type of benefits

They will want to know the type of workers’ compensation benefits that you are seeking. How long will you be out? If you know the answer, you can give them this information.


Where did you first go for treatment? They will need the name of your current treating doctor.

If you file form 110

For Form 110-Employee Claim, you have the requirement to attach at least 1 item of the following:

  • Medical reports
  • Unpaid medical bills
  • Any reports relating to how the accident occurred
  • Names of witnesses
  • Statements of witnesses

You must bring the rest with you when you go to the conciliation meeting.

Make three copies

When you have the form and attachments, you will need to make three copies. Send a copy of the Form 110 – Employee Claim and all supporting documents by Certified Mail.

Rejection: The DIA will send everything back to you with a letter. If information is missing, they will tell you.

Acceptance: A conciliation meeting will be set up. It is an informal meeting.

You can appeal a denial of a workers’ comp claim. However, there are certain requirements that you will need to follow.


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