Information and Instructions
Massachusetts General Laws chapter 152 section 25
requires all employers to provide workers' compensation for their
employees. As quoted from the "law", an employee is defined as
every person in the service of another under any contract of hire, express or
implied, oral or written.
An employer is defined as an individual,
partnership, association, corporation or other legal entity, or any two or more
of the foregoing engaged in a joint enterprise, and including the legal representatives
of a deceased employer, or the receiver or trustee of an individual
,partnership, association or other legal entity, employing employees. However
the owner of a dwelling house having not more than three apartments and who
resides therein, or the occupant of the dwelling house of another who employs
persons to do maintenance, construction or repair work on such dwelling house
or on the grounds or building appurtenant thereto shall not because of such
employment be deemed to be an employer.
MGL chapter 152 section
25 also states that every state or local licensing agency
shall withhold the issuance or renewal of a license or permit to operate a
business or to construct buildings in the commonwealth for any applicant who
has not produced acceptable evidence of compliance with the insurance coverage
required.
Additionally, neither the commonwealth nor any of its
political subdivisions shall enter into any contract for the performance of
public work until acceptable evidence of compliance with the insurance
requirements of this chapter have been presented to the contracting authority.
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Applicants
Please fill in the workers' compensation affidavit
completely, by checking the box that applies to your situation and supplying
company names, address and phone numbers as all affidavits may be submitted to
the Department of Industrial Accidents for confirmation of insurance coverage. Also
be sure to sign and date the affidavit. The affidavit should be returned to
the city or town that the application for the permit or license is being
requested, not the Department of Industrial Accidents. Should you have any
questions regarding the "law" or if you are required to obtain a
workers' compensation policy, please call the Department at the number listed
below.
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City or Towns
Please be sure that the affidavit is complete and
printed legibly. The Department has provided a space at the bottom of the
affidavit for you to fill out in the event the Office of Investigations has to
contact you regarding the applicant. Please be sure to fill in the
permit/license number which will be used as a reference number. The affidavits
may be returned to the Department by mail or FAX unless other arrangements have
been made.
The Office of Investigations would like to thank you
in advance for you cooperation and should you have any questions, please do not
hesitate to give us a call.
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The Department's address, telephone and fax number:
The Commonwealth Of Massachusetts
Department of Industrial Accidents
Office
of Investigations
600 Washington Street
Boston, Ma. 02111
fax #: (617) 727-7749
phone #: (617) 727-4900 ext. 406, 409 or 375