Form 105 is an Agreement to Extend the 180 Day Payment Without Prejudice Period (PWOP). Workers’ Compensation insurers may send this form to you if you are injured and have not gotten an attorney. This typically means that the insurer is trying to get you to sign this form without entirely comprehending the consequences of doing so. By signing this form, you are offering up your legal rights which could end up discontinuing your benefits.
180 Pay Without Prejudice Period
The workers’ compensation law in Massachusetts allows the insurer to voluntarily pay benefits for 180 days. This 6 month period is known as the “pay without prejudice” period (PWOP).
During the PWOP, the insurer can stop benefits at any time by giving you a week’s notice. You then have to file a claim to continue receiving benefits. If the insurer pays your benefits beyond the 6-month PWOP, they are now on the hook to continue your benefits and can’t cancel them unless they have permission from a judge.
No workers’ compensation insurance company wants to go to court or accept liability which brings us to Form 105. This form allows an insurance company to extend benefits without accepting liability, and also allows them to retain the right to cancel benefits with 7 days notice.
We highly recommend speaking to an attorney about your situation before signing any forms. In particular, speak to an attorney before signing Form 105 or any documents sent over from any insurance company.
There are very few scenarios where it makes sense to sign Form 105 but an experienced attorney can help you make the right decision. Without your signature, Form 105 will not be valid, and thus the Pay-Without-Prejudice Period will not be able to extend to a full year.
If the claim is brought to an end without your rights, or privileges being determined, waived, or lost, then the insurer can extend the claimant’s workers’ compensation using Form 105. This form is validated through the signature of the employee and judge or conciliator.