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External Workers’ Compensation Process for Out of State Employees in Massachusetts

Massachusetts

In the event of an on-the-job injury or illness occurring in the State of Massachusetts, please follow the below steps in order.

  • Step 1:  Report the injury or illness to your supervisor immediately. Seek treatment with a medical provider of your choosing.

  • Step 2:  Document your injury as soon as possible by choosing one of the following options: 
    • If you work for an agency that reports an injury, illness or near miss using the Workday system, logon to Workday. Select Report a Safety Incident within the Workday Safety application. 

    • If your agency has not established an injury, illness or near miss reporting process or you are unaware of the process, please click on this hyperlink. Select Submit a New Risk Management Request, fill-in the fields on the form and select  Out-of-State Safety Incident Report under the Type of Request drop down menu, then submit the form.
    • Step 3: Please complete the State of Massachusetts Form 110  immediately and send a copy to DAS Risk Management. 

    • Step 4:  File a claim with the appropriate insurance carrier. https://www.zurichna.com/claims Your claim will be managed by Zurich, our out of state insurance provider.  You should expect a call from Zurich after the claim is filed. Please work with Zurich and provide them with any needed information during the life of your claim. 
    Please review this link File a workers' compensation claim | Mass.gov to help familiarize yourself with the claims process. 


    For any questions or concerns please reach out to DAS Risk Management


    Mailing address:
         PO Box 12009
         Salem, Oregon 97309
     
    Phone: 503-373-7475
    Fax: 503-373-7337​