Agreement Under 37 37a for Workers' Compensation - Massachusetts 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering the Employee's Name in the designated field. Ensure you include the last name, first name, and middle initial.
3. Fill in the Home Address of the employee, including street number, city, state, and zip code.
4. Next, provide the Employer's Name and their corresponding address in the following fields.
5. Input the Insurance Carrier's Name and their address to ensure proper documentation.
6. Complete sections regarding verification by providing a contact person's name, address, and telephone number.
7. Indicate important dates such as 'Paid Through' and 'First Date of Disability' using the mm/dd/yyyy format.
8. Specify the total amount to be reimbursed under Section 37 or 37A and check all applicable agreement types.
9. If applicable, fill out details regarding any quarterly reimbursements and whether the employee is still receiving weekly compensation benefits.
10. Finally, ensure that all signatures are completed by authorized representatives before submitting your form.

Start using our platform today to streamline your document editing process for free!