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Office of Claims Administration (OCA)Mass

Office of Claims Administration (OCA)Mass 2026

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The document is a Workers' Compensation Insurance Affidavit from the Commonwealth of Massachusetts Department of Industrial Accidents, designed for builders, contractors, electricians, and plumbers. It requires applicants to provide information about their business, employee status, and insurance coverage. The affidavit must be completed accurately to comply with Massachusetts General Laws chapter 152, which mandates workers' compensation insurance for employers. Failure to secure coverage can result in penalties. The document also outlines the responsibilities of city or town officials in verifying the affidavit.

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Click ‘Get Form’ to open the Office of Claims Administration (OCA)Mass document in the editor.
Begin by filling out the Applicant Information section. Print your name, address, city/state/zip, and phone number clearly.
Indicate your employment status by checking the appropriate box. If you are a general contractor, ensure to list your sub-contractors on the attached sheet.
Select the type of project you are undertaking from the provided options. This is a required field.
If applicable, provide your workers’ compensation insurance details including the insurance company name, policy number, and expiration date.
Attach a copy of your workers’ compensation policy declaration page as instructed.
Finally, certify that all information is accurate by signing and dating the affidavit before submission.

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