Request For Section 37 Or 37A Proceeding {122}

Form 122 - REQUEST FOR SECTION 37 OR 37A PROCEEDING. This form is used in the Commonwealth of Massachusetts' Department of Industrial Accidents to request a proceeding for reimbursement claims under Section 37 or 37A of Massachusetts workers' compensation law. These sections address claims for "subsequent injuries," which involve situations where an employee's pre-existing condition is exacerbated by a workplace injury. The form is filed by insurers seeking reimbursement for compensation payments made after the 104th week of disability or death. The form requires details about the employee, the subsequent injury, and the insurer. It also specifies which sections of the law the reimbursement relates to, including payments for medical services, incapacity, dependents' benefits, and burial expenses. The form mandates documentation, including medical records and employer knowledge of the employee’s pre-existing condition. After submission, the claim is scheduled for conciliation or adjudication. www.FormsWorkflow.com