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Forms Library

Claim 

The forms linked here are in Portable Document Format (PDF), that requires them to be downloaded and printed using Adobe Acrobat software. If you do not have Adobe Acrobat Reader, you can immediately obtain this free software at: www.adobe.com/products/acrobat/readstep2.html

Massachusetts 

Claim Kits

A.I.M. Mutual

AEIC

AIS

MEIC

A.I.M. Works Med-Fax Report (Medical only claims – do not file this form with the Department of Industrial Accidents)

Documents Required to File a Lost Time Claim

Form 101 (Lost Time) Employer’s First Report of Injury or Fatality

Industry Reference Code (Form 101)

Form 127 (Lost Time) Average Weekly Wage Computation Schedule

Supplemental Employee Forms– Lost Time only

Form A.I.M. Mutual 20 Request for Medical Services

Stay at Work/Return to Work™ Booklet

Stay at Work/Return to Work™ Forms

New Hampshire 

Claim Kit - NH

Medical Only Claims

Employers First Report of Occupational Injury or Disease – NH Form 8WC

Notice of Accidental Injury or Occupational Disease – NH Form 8aWCA

Documents Required to File a Lost Time Claim

Employers First Report of Occupational Injury or Disease 8WC

13 WCA Employer’s Supplemental Report of Injury

76 WCA Wage Schedule

Supplemental Employee Forms -Lost Time Only

Additional Information - MA and NH

A.I.M.Works Worksite Poster - All Companies MA
 
A.I.M. Works Worksite Poster - NH

BDOHI Affiliated Primary Occupational Health Centers Massachusetts

New Hampshire Primary Occupational Health Centers including BDOHI Affiliates

New Hampshire Employers Guide to BDOHI

Express Scripts Pharmacy Network

A.I.M. Express Scripts Temporary Prescription Services I.D.

AIS, LLC- Express Scripts Temporary Prescription Services I.D.

Connecticut 

Claim Kit- CT

Employer's First Report of Occupational Injury or Illness 

Form 1A- Filing Status and Exemption

Employee Medical and Work Status 

HIPAA Release

Corvel PPO Lookup

Express Scripts Pharmacy Network

Loss Control 

OSHA Form 301

OSHA Poster - English

OSHA Poster - Spanish

OSHA Record Keeping Forms

Premium Audit 

Policyholder Self Audit Report

Customer Service / Underwriting Mandatory Posting Notices 

A.I.M. Mutual - Notice to Employees

A.I.M. Mutual - NH Notice of Compliance

AEIC

MEIC

Request a Certificate 

Voluntary Policyholders

VDAC / Assigned Risk