INSURER’S NOTIFICATION OF TERMINATION OR MODIFICATION OF WEEKLY COMPENSATION DURING PAYMENT WITHOUT PREJUDICE PERIOD Forms
| Form Name | INSURER’S NOTIFICATION OF TERMINATION OR MODIFICATION OF WEEKLY COMPENSATION DURING PAYMENT WITHOUT PREJUDICE PERIOD |
| Form # | Form 106 |
| Form Revision | Revised 7/2019 |
| Category | Forms » Insurance |
| Downloads | |
| Form State | Massachusetts |
| Language | English |
| State Description | This form is filed by insurance carriers only if they paid weekly benefits within 14 calendar days of receipt of the First Report of Injury/Death (Form 101), or a claim for weekly benefits on an Emplo |
| Claimwire Description | n/a |