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Form 110-A Employee's Claim for Post-lump Sum Medical Mediation - Massachusetts
What Is Form 110-A?
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 110-A?
A: Form 110-A is the Employee's Claim for Post-lump Sum Medical Mediation.
Q: What is the purpose of Form 110-A?
A: The purpose of Form 110-A is to request medical mediation for employees who have received a lump sum settlement.
Q: Who can use Form 110-A?
A: Form 110-A can be used by employees in Massachusetts who have received a lump sum settlement and need medical mediation.
Q: Is there a deadline to submit Form 110-A?
A: Yes, Form 110-A must be submitted within 180 days from the date of the lump sum settlement.
Form Details:
- Released on July 1, 2019;
- 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 110-A by clicking the link below or browse more documents and templates provided by the Massachusetts Department of Industrial Accidents.
