Workers’ Compensation

If you practice Workers’ Compensation you have to see this software! These forms fill out almost completely saving you hours of tedious typing which can mean lower staff costs or your actually getting home in time for dinner.

The Workers’ Compensation package is designed to give you all forms necessary to the practice of Workers’ Compensation Law. Included are scores of automated official DIA forms, all of which are fully editable. Included are Reports of Injuries, Notices of Claims, Insurers’ Notifications – virtually every official agency form – all capable of completion within minutes, and some within seconds! The program also contains Vocational Rehabilitation forms.

Type in your client and case information once, and all forms fill out automatically for you. We also give you a special button to make editing easy. You can even create your own version of our forms so you do not have to make the same tweaks every time to accommodate for your own language. This package can grow with your practice that way. Everything is fully automated and all math is done for you.

Updates and unlimited support are included as long as you are a customer!

At just $50.00 per month for the first computer and $20.00 per month for additional computers, with our 30-day money back guarantee there is no reason to not give us a try! Buy now to see for yourself how this software package can make your life easier. (And if it doesn’t let us know so we can refund your money and wish you well!) And if you’re not ready to get going, you can sign up and save so you are alerted to future promotions for this product.

Many customers who look at this product purchase the General Practitioner’s Value Suite because it contains 8 areas of law – including this one – for just an additional $50.00 per month.

 

Our Ever Expanding Document List

Correspondence – General

  • Letter – General

General

  • Application for Stay of Proceedings Pursuant to Rule 1.22 (2)
  • Case Intake Sheet
  • Client’s Authorization for Medical Records
  • Deposition – Notice of Taking & Certificate of Service
  • DIA Board File Request Letter
  • DIA File Request
  • Employee’s Authorization for Medical Records
  • Flat Fee Agreement – Employee
  • Guide for Calculating Loss-of-Function Benefits for Injuries Occurring on or After December 24, 1991
  • Guidelines for Disfigurement Other Than Scars for Injuries Occurring on or After December 24, 1991
  • Hourly Fee Agreement – Employee
  • Insurance Inquiry Form (11-11)
  • Insurer Request Certification (11-11)
  • Lien Release Requests
  • Maximum Compensation Rates (SAWW)
  • Mileage Expense Voucher
  • Motion to the Court and Affidavit
  • Notice to Employees
  • OEVR Rehabilitation Review Officers’ Territories
  • Payment Voucher Input Form
  • Payment Voucher Instructions
  • Petition for Approval of Third Party Settlement
  • Referral Fee Acknowledgment
  • Schedule of Payments for Disfigurement for the Amputation of A Hand, Fingers or Parts Thereof
  • Subpoena Duces Tecum
  • Workers’ Compensation COLA Data Form

Notary

  • Notary Jurat – Affidavit or Other Sworn or Affirmed Declaration
  • Notary Jurat – Attorney-Principal
  • Notary Jurat – Certified Copy
  • Notary Jurat – Individual with Oath or Affirmation
  • Notary Jurat – Individual without Oath or Affirmation
  • Notary Jurat – Representative of Business Entity

Official Forms

  • Form 046A (3-11) – Request for Section 46A Conference
  • Form 101 (7-10) – Employer’s First Report of Injury or Fatality
  • Form 103 (7-10) – Insurer’s Notification of Payment
  • Form 104 (7-10) – Insurer’s Notification of Denial
  • Form 105 (7-10) – Agreement to Extend 180 Day Payment Without Prejudice Period
  • Form 106 (7-10) – Insurer’s Notification of Termination or Modification of Weekly Compensation During Payment Without Prejudice Period
  • Form 107 (7-10) – Insurer’s Notification of Acceptance, Resumption or Termination or Modification of Weekly Compensation
  • Form 108 (7-10) – Insurer’s Complaint for Modification, Discontinuance or Recoupment of Compensation
  • Form 109 (7-10) – Notification of Withdrawal of Claim or Complaint
  • Form 110 (7-10) – Employee’s Claim
  • Form 112 (7-10) – Appeal to Reviewing Board
  • Form 112A (7-10) – Affidavit in Support of Request for Waiver of Filing Fee Under Sec. 11C
  • Form 113 (7-10) – Agreement to Pay Compensation
  • Form 114 (7-10) – Notice of Change – Appearance of Counsel
  • Form 115 (7-10) – Third Party Claim – Notice of Lien
  • Form 116 (7-10) – Request for Lump Sum Conference
  • Form 116A (7-10) – Consent of Employer to Lump Sum Settlement
  • Form 116B (7-10) – Addendum to Lump Sum Settlement Agreement
  • Form 116C (7-10) – Lien Disclosure Form
  • Form 117 (7-10) – Agreement for Redeeming Liability By Lump Sum On or After 11-1-86
  • Form 117A (7-10) – Agreement for Redeeming Liability By Lump Sum Before 11-1-86
  • Form 121 (7-10) – Appeal of Conference Proceeding
  • Form 121A (7-10) – Agreement That No Impartial Physician Report is Required
  • Form 122 (7-10) – Request for Section 37 or 37A Hearing
  • Form 123 (7-10) – Agreement Under Section 37 or 37A
  • Form 124A (7-10) – Notification of Arbitration Award
  • Form 125 (7-10) – (Employee’s) Motion for Expedited Conference
  • Form 125 (7-10) – (Insurer’s) Motion for Expedited Conference
  • Form 126 (7-10) – Employee’s Earning Report
  • Form 127 (8-05) – Average Weekly Wage Computations Schedule
  • Form 130 (7-10) – Complaint of Improper Claims Handling Against an Insurer
  • Form 131 (1-12) – Request for Speedy Conference Because of Hardship
  • Form 132 (7-10) – Affidavit in Support of Employee’s Request for Speedy Conference Because of Hardship
  • Form 133A (9-10) – Utilization Review Agent and Quality Assessment Program Complaint Form
  • Form 134 (7-10) – Health Care Provider Complaint Form
  • Form 136 (7-10) – Affidavit of Indigence and Request for Waiver of Section 11A(2) Fees
  • Form 140 (7-10) – Temporary Conference Memorandum Cover Form
  • Form 141 (7-10) – Last Best Offer at Conference
  • Form 151 (12-11) – Individual Written Rehabilitation Program Form
  • Form 152 (12-11) – Amendment-Suspension or Closure of Vocational Rehabilitation Plan
  • Form 153 (7-10) – Affidavit of Exemption for Certain Corporate Officers
  • Form 154 – Verification of MA Workers’ Compensation Coverage for Out-Of-State Employers Operating in MA
  • Form 160 (7-10) – Employee Biographical Data
  • Form 161 (7-10) – Employee’s Hearing Memorandum
  • Form 162 (7-10) – Insurer’s Hearing Memorandum
  • Form 170 – Affidavit of Employee in Application for Trust Fund Benefits
  • Insurance Affidavit (7-10) – Contractors
  • Insurance Affidavit (7-10) – General Business

Vocational Rehabilitation

  • Affidavit of Compliance (Corporation)
  • Affidavit of Compliance (Unincorporated Entity)
  • Affidavit of Qualifications
  • Case Review Form (Provider Check-off Form)
  • Certified Vendor Quarterly Report for O.E.V.R.
  • Form 151 (7-10) – Individual Written Rehabilitation Program
  • Form 152 (7-10) – Amendment-Suspension or Closure of Vocational Rehabilitation Plan
  • Form TF-1 – Section 30H-VR Encumbrance Form
  • Form TF-2 – Section 30H-VR Payment Request
  • Form TF-3 – Section 30H-VR Payment Authorization
  • OEVR Referral Form
  • Rehabilitation Provider Certification Form

More Information

Editions