If you would like to obtain a copy of a particular employer's classification information to help determine whether premium evasion fraud may be occurring through misclassification or otherwise, please complete the form below, then press the submit button.

After your request is acted upon, you will be sent the employer's classification codes listed on their workers' compensation insurance policy and the percentage of payroll by classification code for the current and prior two policy years, if available. The information will be emailed to you if you provide an email address. Otherwise it will be mailed to the address that you provided. Please allow 2-3 business days for the processing of your request.

*1. Name of business and/or person about whom you are reporting and making the request for classification information.
*2. Address, City, State and telephone number (if known) of the business and or person.
3. (OPTIONAL & NOT A PREREQUISITE)What leads you to make this report and request the classification information?

   Employer has misclassified its employees

   Employer classifying employees as independent contractors

   Other, please explain.
*4. Your Name
*5. Your Address
*6. Your Daytime Telephone Number
*7. Your Email Address
* Denotes required field.
An investigator may contact you to clarify the information that was provided or to obtain additional information.

Classification Request Form Application Disclaimer and Conditions

The online Classification Request Form Application enables individuals to request a specific employer’s workers’ compensation classification codes and the percentage of payroll associated with each classification code. This application is being provided by the Workers’ Compensation Rating and Inspection Bureau of Massachusetts (“WCRIBMA”) at the request of the Massachusetts Department of Industrial Accidents and the Joint Enforcement Task Force on the Underground Economy and Employee Misclassification. Use of the Classification Request Form Application is conditioned upon your acceptance of and compliance with the terms, conditions and notices stated herein.

Each submission of a Classification Request Form will constitute both your acknowledgment that you are requesting a particular employer’s classification information to help determine whether premium evasion fraud may be occurring through misclassification or otherwise and your understanding that the WCRIBMA has a statutory obligation to report fraudulent insurance transactions to the Insurance Fraud Bureau.

The WCRIBMA assumes no responsibility or liability for damages of any kind arising from reliance on the information generated by use of this Classification Request Form Application.