THIRD PARTY CLAIM / NOTICE OF LIEN Forms
| Form Name | THIRD PARTY CLAIM / NOTICE OF LIEN |
| Form # | Form 115 |
| Form Revision | Revised 7/2019 |
| Category | Forms » Legal/Fraud |
| Downloads | |
| Form State | Massachusetts |
| Language | English |
| State Description | This form is used by any party that has provided service or made payments for which it is entitled to reimbursement under the workers' compensation law. If filing a lien (Block 13): You must state th |
| Claimwire Description | n/a |