Massachusetts Workers Comp: Understanding the 180 Day Payment Without Prejudice Period Extension Form

Often times, injured workers who are receiving Massachusetts workers’ compensation benefits are mailed a form titled “Form 105 – Agreement to Extend the 180 Day Payment Without Prejudice Period.”  Workers’ compensation insurers may  send this form to an injured worker who has not yet retained an attorney in hopes of getting the unrepresented injured workers to sign the form without fully understanding the ramifications of doing so.  It is usually sent to the injured worker during the 3rd to 5th month of disability following a work injury.

Signing the Agreement to Extend 180 Day Payment Without Prejudice Period form sent to you by the workers’ compensation insurer can have an extremely negative impact on your claim.
Insurance companies will send you this form under the guise that they are doing you a favor and agreeing to pay you for another 180 days, however by signing this form you are giving up legal rights and you may expose yourself to allowing the insurer to legally terminate benefits and put you in the position where you could go many months with no benefits while you fight the insurance company in court.  In order to fully understand why singing this form can have negative consequences for an injured worker, it would be helpful to explain exactly what the 180 Day Payment Without Prejudice Period is.


If the insurer has commenced benefits timely, namely within 14 days of notice, the insurer is allowed to stop payments to the employee without obtaining approval of the DIA or the consent of the employee. However the insurer is required to give the employee seven(7) day written notice of their intent to stop benefits. The insurer’s written notice of termination must state their reasons and advise the employee of his or her rights to file a claim for further benefits.


Once the 180 day period expires the Workers’ Compensation Act makes it much more difficult for the insurer to stop benefits. Basically, they cannot stop benefits on their own. The reason must be specific and be one of the following: 1) The termination was ordered by a judge at the DIA; 2) was assented to in writing by the employee; 3) the employee returned to work with no wage loss; 4) the insurer has a medical report from the attending physician indicating that the employee is capable of returning to work with a certification that the attending doctor has reviewed a written job description of the employee’s job and the insurer has a letter from the employer indicating that said job is open and ready; 5) where the employee has exhausted the maximum period of benefits; 6) were terminated because the employee failed to provide the insurer with a written request for earning records and; 7) several other technical and specific reasons that are beyond the scope of this brochure. The important thing to remember, however, is that after 180 days of payment, the insurer cannot stop compensation on their own whim, whereas they can basically do that prior to the 180th day.

Because by signing the Agreement you are allowing the workers’ compensation insurer another 6 months to have the right to terminate or modify your benefits for any reason so long as they provide you with seven (7) days advance written notice, it is often times advantageous to your situation to not sign the agreement and let the initial 180 day period lapse, which makes it more difficult for the insurance company to terminate or modify benefits.  Every injured workers’ claim and situation is unique and should be evaluated on its own merits, therefore if you have received an Agreement to Extend 180 Day Payment Without Prejudice Period (Form 105) by your employer’s workers’ compensation insurance company, you should immediately contact one of our Boston workers’ compensation attorneys immediately.

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