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Massachusetts Agreement To Pay Compensation (Form 113)
SKU: FFMA150 |   E-mail this product to a friend
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Reminder: After you have selected your free form(s) and added it to your cart, you are to complete the checkout process. You will not be charged for the form(s). Upon completion of the checkout process, you will be sent an email with a link to download your free form(s). For more information click here.
 
 
Product Description

This form is used to report specific compensation amounts by type, where compensation is not being made pursuant to MGL c. 152, § 7.

In all cases a payment for § 36 injuries must be reported to the department using this form.

NOTE: The employee will not be denied from claiming additional benefits under the workers' compensation law by signing this agreement.
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