Boston Worker’s Compensation and Injury Blog

What to do When You Receive Form 105

Employees who get hurt on the job and are eligible for workers’ comp benefits expect their employer and its insurer to “play by book.” Unfortunately, that is not always the case. Insurance companies often deny claims from the start without justification and try to minimize or terminate benefits for injured workers who are already getting them.
If you are currently getting workers’ compensation, you might have gotten Form 105 from your employer’s insurance company and are wondering whether you should sign it or not. The short answer is that you should never sign anything from your employer’s insurer without consulting a workers’ comp attorney because doing so can impact your benefits negatively.

What is Form 105?

If you are getting workers’ compensation benefits because of an injury (or illness) you suffered at your workplace, you may suddenly get a Form 105 in the mail. You might be looking at that form right now and wondering exactly what it is.

Form 105 is an “agreement to extend the 180-day payment without prejudice period” which sounds just as confusing as it is to most people who get it.

To begin to comprehend what Form 105 is and the intentions behind it, you first have to understand that insurance companies, like most companies, are out to make a profit. Paying out large sums of money for benefits costs these companies much more than they want to lose. Because of this, insurers are constantly looking for ways to avoid paying benefits.

Insurance companies often send people on workers’ comp Form 105 during the 3rd to 5th month of their disability. Workers without an attorney are targeted in the hopes that they will sign this form without seeking legal advice. Bear in mind that insurance companies do not have your best interest in mind but their own. Signing Form 105 can have severe consequences and can lead to you losing your workers’ comp benefits altogether.

Before you even think about signing Form 105 or providing the insurance company with any information they can use against you, contact a workers’ compensation attorney for advice.

What is the 180-day payment without prejudice period?

At first glance, Form 105 appears to be innocent enough and might even seem like the insurer is trying to help you extend the period of your benefits. Of course, that is far from the truth. To comprehend why signing this form will result in negative consequences it is imperative to understand what the 180-day payment without prejudice period is.

The Initial 180 Days after Disability

Most of the time, insurers will begin workers’ comp payments to injured workers on time. This being the case and if they determine that they have a valid reason, they can choose to stop payments during the initial 180 days after disability begins. Insurance companies often do this because they can get away with it without getting approval from the Department of Industrial Accidents (DIA).

Despite not having to have the go-ahead from the DIA, insurers do have to inform the injured worker of their intent to terminate benefits. This must be done with a written notice and at least 7 days prior to when benefits will end.

If you receive such a notice from your employer’s insurance company, act fast. Talk to a workers’ compensation lawyer who can examine all the facts of your case and get the process of reinstating your benefits going as soon as possible.

After 180 Days

Once injured workers get past the initial 180-day period after disability begins, it becomes much more difficult for insurance companies to terminate benefits. Insurers have to follow more specific guidelines and one of the following things must happen:

  • Judge’s Orders
    A Judge at the Department of Industrial Accidents must order the benefits to end after fully reviewing all the facts of the case.
  • The Employee Agrees
    If for whatever reason, the injured employee agrees that the workers’ comp benefits should end, the insurer can terminate them. This agreement must be made in writing.
  • The Employee Goes Back to Work
    If the employee is able to go back to work and does so earning the same wages as before he or she was injured, benefits can be terminated.
  • Medical Report
    If the injured worker provides the insurer with a report in writing which states that the employee can return to work, benefits can end. A certification indicating that the physician has examined the job description in question is also necessary. Yet another requirement here is for the employer to provide a letter to the insurer stating that the job is still available to the employee.
  • Maximum Period of Benefits
    Workers’ comp benefits will be stopped once the injured worker has gone through the maximum period of benefits.
  • Earning Records
    In order to justify the amount of benefits an injured worker is entitled to or to make adjustments, the insurer may request a written request of earning records. Failure to provide this documentation can be a reason for workers’ compensation benefits to be terminated.

If your benefits are terminated for these or any other reason, you will need an experienced workers’ comp lawyer on your side.

What if I already Signed Form 105?

If you have already signed Form 105 but have not turned it in to the insurer, you should stop right there. If you mailed the signed form, what can be done depends on the circumstances of the case.

With a signed Form 105 from you, the insurer has the right to extend benefits without having to accept any liability and also to terminate them as long as they notify you at least 7 days in advance.

At this point, it is highly advisable to get the best legal assistance possible so that you can keep enjoying the workers’ comp benefits you deserve.

Call for a Free Consultation

Workers’ comp benefits pay for medical care and make up for a percentage of lost wages, making them highly important for injured workers. If you have just received Form 105 and need help deciding what to do about it, do not hesitate to call us at the Law Office of Robert E Frawley.
Dial (617) 523-2929 now for a free consultation!

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