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What is Form 105?

An accident at work can be traumatic and painful. If you or a loved one have been injured on the job, it is important to protect yourself and talk to an experienced workers compensation attorney in Massachusetts. However, the workers’ compensation process is complicated. One error can result in denial of claims, denial of treatment, or termination of employment.

If you have contracted an illness at work, or sustained a workplace injury, our workers’ compensation attorneys at the Bellotti Law Group, P.C. can help. We have over 38 years of expertise in dealing with workers’ compensation cases. Each of our workers’ compensation attorneys are well prepared to help clients and their families receive the compensation they deserve after a work-related injury. Contact us today at 617-225-2100 for a free consultation. 

In Massachusetts, the workers’ compensation law allows insurers to voluntarily pay benefits for 180 days. These 180 days are known as the “pay without prejudice period” (PWOP). During this period, insurance companies can stop benefits at any time as long as they give the injured worker a 7 days notice. In order to continue receiving benefits, you must file a claim. When an insurer pays your benefits beyond the 180 day PWOP, they are accepting liability, and the company is required to continue your benefits. Insurance companies that pay your benefits beyond the PWOP cannot stop your benefits without the permission of a judge. 

Form 105 is an agreement to extend the “pay without prejudice period”. Insurance companies do not want to accept liability, so they will use Form 105 as a tool to discontinue your benefits. When you sign Form 105, you give up your legal rights, which can cause your benefits to be discontinued at any moment. Insurance companies will often claim that you should sign the form in order to continue your benefits, however, the form allows insurance companies to discontinue your benefits as long as they give you a weeks’ notice. 

The form must be filed 7 days prior to the end of the PWOP. Insurance companies will often send Form 105 as soon as they are notified of your injury, and often before you can speak to an attorney. Contact an attorney before you sign any forms. 

There are very few reasons to sign Form 105, as this is mainly for the benefit of the insurance companies. You need the assistance of an experienced attorney. You will need the help of a qualified workers’ compensation attorney to help you navigate a workers’ compensation claim. Contact an experienced lawyer at Bellotti Law Group, P.C. for a free consultation. Call 617-225-2100.
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