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The Commonwealth Of Massachusetts Labor Law Poster

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  • The Commonwealth Of Massachusetts Labor Law Poster

    As required by Massachusetts General Law, Chapter 152, Sections 21, 22 & 30, this will give you notice that I (we) have provided for payment to our injured employees under the above mentioned chapter by insuring with:

    NAME OF INSURANCE COMPANY

    ADDRESS OF INSURANCE COMPANY

    POLICY NUMBER EFFECTIVE DATES

    NAME OF INSURANCE AGENT

    ADDRESS PHONE #

    EMPLOYER ADDRESS

    EMPLOYER’S WORKERS COMPENSATION OFFICER (IF ANY)

    DATE
    MEDICAL TREATMENT
    The above named insurer is required in cases of personal injuries arising out of and in the course of employment to furnish adequate and reasonable hospital and medical services in accordance with the provisions of the Workers Compensation Act. A copy of the First Report of Injury must be given to the injured employee. The employee may select his or her own physician. The reasonable cost of the services provided by the treating physician will be paid by the insurer, if the treatment is necessary and reasonably connected to the work related injury. In cases requiring hospital attention, employees are hereby notified that the insurer has arranged for such attention at the:

    NAME OF HOSPITAL

    ADDRESS
    TO BE POSTED BY EMPLOYER
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