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Massachusetts Employee Earnings Report for Workers' Compensation

State:
Massachusetts
Control #:
MA-126-WC
Format:
PDF
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Description

This is one of the official Workers' Compensation forms for the state of Massachusetts.

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FAQ

Report the Injury or Illness Your employer has seven days to report the injury or illness to their insurance company and to DIA if you lose five or more days' wages on a form called the first report of injury, also known as Form 101.

These benefits can last up to three years. If you have to take a lower paying job or work fewer hours due to your injury or illness, you will partial benefits for up to five years.

The truth is that workers comp benefits don't last forever; in California, injured workers can only receive workers compensation benefits for 104 weeks within a period of five years for most injuries.

Workers Compensation Calculator Most often, benefits are calculated and paid based on the average weekly wage. This is calculated by multiplying the employee's daily wage by the number of days worked in a full year. That number is then divided by 52 weeks to get the average weekly wage.

Under Massachusetts workers' compensation laws, the following are the benefit amounts a disabled worker is entitled to: Total and permanent incapacity: Two-thirds of the worker's average weekly wage.Partial incapacity: 60 percent of the difference between the worker's weekly wage before the injury and after the injury.

Once the 500-week period ends, your employer will seek to suspend or terminate your workers' compensation benefits, but you may still have the right to continue receiving benefits if your injuries persist.

What are the benefits? The maximum weekly benefit is 75% of your weekly total temporary benefits. (Temporary total benefits are 60% of your gross average weekly wage).

If you suffered a work-related injury/illness on or after Jan. 1, 1995 that permanently impacted you or your ability to work, you may be eligible for permanent disability compensation, including any wage loss from your permanent work restrictions.

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Massachusetts Employee Earnings Report for Workers' Compensation