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Massachusetts Insurer's Notification Of Payment (Form 103)
SKU: FFMA270 |   E-mail this product to a friend
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Product Description

This form is filed by insurance carriers when weekly benefits are paid within 14 calendar days of insurer's receipt of a First Report of Injury/Death form (Form 101), or an initial written claim for weekly benefits on a Form 110 (Employee Claim Form). This form should be mailed to the Department Of Industrial Accidents at the address on the top of the form with a copy going to the Employee and to the Employer.
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