PDF
Word
This version of the form is not currently in use and is provided for reference only. Download this version of
Form 121A
for the current year.
Form 121A Agreement That No Impartial Physician Report Is Required - Massachusetts
What Is Form 121A?
This is a legal form that was released by the Massachusetts Department of Industrial Accidents - a government authority operating within Massachusetts. As of today, no separate filing guidelines for the form are provided by the issuing department.
FAQ
Q: What is Form 121A?
A: Form 121A is an agreement in Massachusetts that states no impartial physician report is needed.
Q: What does Form 121A signify?
A: Form 121A signifies that both parties in a workers' compensation case agree that an impartial physician report is not necessary.
Q: When is Form 121A used?
A: Form 121A is used when there is an agreement between the injured worker and the insurance company that an impartial physician report is not required.
Q: What is the purpose of Form 121A?
A: The purpose of Form 121A is to streamline the workers' compensation process by eliminating the need for an impartial physician report.
Q: Who needs to sign Form 121A?
A: Both the injured worker and the insurance company need to sign Form 121A.
Form Details:
- Released on July 1, 2013;
- The latest edition provided by the Massachusetts Department of Industrial Accidents;
- Easy to use and ready to print;
- Quick to customize;
- Compatible with most PDF-viewing applications;
- Fill out the form in our online filing application.
Download a fillable version of Form 121A by clicking the link below or browse more documents and templates provided by the Massachusetts Department of Industrial Accidents.
