INSURER’S NOTIFICATION OF DENIAL Forms
| Form Name | INSURER’S NOTIFICATION OF DENIAL |
| Form # | Form 104 |
| Form Revision | Revised 7/2019 |
| Category | Forms » Insurance |
| Downloads | |
| Form State | Massachusetts |
| Language | English |
| State Description | This form is filed by insurance carriers within 14 calendar days of the insurer's receipt of a First Report of Injury/Death form (Form 101), or an initial written claim for weekly benefits on an Emplo |
| Claimwire Description | n/a |