Free Massachusetts 127 Template in PDF

The Massachusetts 127 form is essential for calculating an injured employee's average weekly wage. It is often accompanied by other important documents to ensure a comprehensive understanding of the case. Below is a list of related forms and documents that may be required in conjunction with the Massachusetts 127 form.

• Form 104 - Employee's Claim for Compensation: This form is used by employees to formally claim workers' compensation benefits after an injury. It outlines the details of the injury and the benefits sought.
• Form 110 - Insurer's Notification of Denial: Insurers use this form to notify an employee that their claim for benefits has been denied. It includes reasons for the denial and any relevant information.
• Form 130 - Employee's Appeal: If a claim is denied, this form allows the employee to appeal the decision. It requires a detailed explanation of why the employee believes the denial was incorrect.
• Form 140 - Insurer's Report of Injury: This report is submitted by the insurer to document the injury and the circumstances surrounding it. It includes information about the employee and the employer.
• Motor Vehicle Bill of Sale: To ensure the proper transfer of vehicle ownership, utilize our official Motor Vehicle Bill of Sale template resources for accurate documentation.
• Form 150 - Medical Report: A medical report from a healthcare provider detailing the employee's injury, treatment, and prognosis is often required. It supports the employee's claim for compensation.
• Form 160 - Wage Verification Form: Employers may need to complete this form to verify the wages of the injured employee. It provides a detailed account of earnings and hours worked.
• Form 170 - Return to Work Form: This form is used when an employee is ready to return to work after an injury. It confirms that the employee has received medical clearance to resume their duties.
• Form 180 - Settlement Agreement: If both parties reach an agreement, this form outlines the terms of the settlement regarding the workers' compensation claim.
• Form 190 - Final Report: This document is submitted at the conclusion of a claim to summarize the case and the benefits awarded to the employee. It serves as a record of the entire process.

These forms and documents work together to facilitate the workers' compensation process in Massachusetts. Ensure you have all necessary paperwork ready to avoid delays in your claim. Timely submission can significantly impact the outcome of your case.

The Massachusetts 127 form is designed to compute the average weekly wage of an injured worker. It shares similarities with several other documents used in employment and workers' compensation contexts. Below is a list of seven such documents, highlighting their similarities.

• Wage Verification Form: Like the Massachusetts 127, this form collects information about an employee's earnings over a specified period to establish a baseline for compensation calculations.
• Workers' Compensation Claim Form: Both documents initiate the process for claiming benefits due to work-related injuries, requiring details about the employee and the incident.
• Employee Injury Report: This report documents the circumstances surrounding an injury at work. Similar to the 127 form, it includes employee information and details about the incident.
• Bill of Sale Form: Similar to the documents mentioned, the UsaLawDocs.com offers a vital resource for completing legitimate sales transactions, ensuring clarity and legal protection for both buyers and sellers.
• Payroll Records: Payroll records provide a historical account of an employee's earnings, just as the Massachusetts 127 does by requiring wage details from the preceding year.
• Tax Form W-2: The W-2 summarizes an employee's annual wages and taxes withheld. The Massachusetts 127 similarly requires a breakdown of wages to determine compensation eligibility.
• Disability Benefits Application: This application seeks to establish eligibility for disability benefits. Like the 127 form, it gathers information about the employee's work history and earnings.
• Employer's First Report of Injury: This document notifies the insurance company of a workplace injury. It shares the Massachusetts 127's focus on injury details and employee information for claims processing.

1. What is the Massachusetts 127 Form?

   The Massachusetts 127 Form, also known as the Average Weekly Wage Computation Schedule, is a document used by the Commonwealth of Massachusetts to calculate an employee's average weekly wage for workers' compensation purposes. This form is essential for determining the benefits an injured worker may be entitled to after an accident or disability.

2. Who needs to fill out the Massachusetts 127 Form?

   The form must be completed by employers when an employee has sustained an injury or disability related to their job. It gathers crucial information about the employee’s wages, employment duration, and dependents, which is necessary for calculating compensation benefits.

3. What information is required on the form?

   The Massachusetts 127 Form requires various details, including:

   • Employer's name and address
   • Insurer's case file number
   • Employee's name and address
   • Number of dependent children and other dependents
   • Date of injury and disability
   • Wage information for the 52 weeks preceding the injury

   Additionally, it asks about any benefits or tips the employee may have received.

4. How is the average weekly wage calculated?

   To calculate the average weekly wage, the employer must report the gross wages earned by the injured worker during the 52 weeks before the accident. If the employee has worked for less than 52 weeks, the employer should use the wages of a fellow employee in the same job classification who has been employed for a year or more.

5. What if the employee has not worked for a full year?

   If the injured employee has worked for less than 52 weeks, the employer should report the actual wages earned during the time worked. For the remaining weeks, wages from a fellow employee in the same class of employment who has worked for a full year can be used to fill in the gaps.

6. Are there any additional benefits to report?

   Yes, if the employee received tips or other benefits, these should be described on the form. It is important to state the value of these benefits per week, as they can affect the overall compensation calculation.

7. What happens after the form is completed?

   Once the Massachusetts 127 Form is completed, it should be submitted to the appropriate workers' compensation insurer. This helps ensure that the injured employee receives the correct benefits based on their average weekly wage.

8. Is there a deadline for submitting the form?

   While specific deadlines can vary, it is generally advisable to submit the form as soon as possible after the injury occurs. Timely submission helps facilitate the processing of the claim and ensures that the injured worker receives benefits without unnecessary delays.

9. Where can I find more information about the Massachusetts 127 Form?

   For more information, individuals can visit the Massachusetts Department of Industrial Accidents website at www.mass.gov/dia or contact their information line at 800-323-3249, extension 7470 for assistance.