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Some Aspects of Maine Workers' Compensation Law, The Workers'
Compensation Board, And Attorney Advocates

Condensed Draft ...
(1.) Some Aspects of Maine Workers' Compensation Law

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The general mission of the Maine Workers' Compensation Board i...
(1.) Some Aspects of Maine Workers' Compensation Law

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Background (Continued): Workers' Compensation Law in Maine
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Inj...
(1.) Some Aspects of Maine Workers' Compensation Law

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Background (Continued): Workers' Compensation Law in Maine
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If ...
(1.) Some Aspects of Maine Workers' Compensation Law

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An employee should report an injury as soon as ...
(1.) Some Aspects of Maine Workers' Compensation Law
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If an injured employee needs treatment while an employer disput...
(1.) Some Aspects of Maine Workers' Compensation Law
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Compensation Rate (Continued)
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If injured between 1/1/93 a...
(1.) Some Aspects of Maine Workers' Compensation Law
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New / Alternative Work Decision Points: Employees
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An employee m...
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Draft Condensed Summary Maine Workers' Compensation Law by Adam Daley Wilson

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A Draft Condensed Summary of Maine Workers' Compensation Law and Process By Adam Daley Wilson | Please Do Not Distribute Without Permission from Adam Daley Wilson

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Transcript of "Draft Condensed Summary Maine Workers' Compensation Law by Adam Daley Wilson"

  1. 1. Some Aspects of Maine Workers' Compensation Law, The Workers' Compensation Board, And Attorney Advocates Condensed Draft Outline by Adam Daley Wilson. Please do not distribute this draft without permission.
  2. 2. (1.) Some Aspects of Maine Workers' Compensation Law ● ● The general mission of the Maine Workers' Compensation Board is to serve the employees and the employers of Maine fairly and efficiently by ensuring compliance with Maine's workers' compensation laws, ensuring the prompt delivery of benefits that are legally due, promoting the prevention of disputes, utilizing dispute resolution to reduce litigation, and facilitating labor-management cooperation. The 125th Maine Legislature enacted LD 1913, effective in part on August 30, 2012, with the remainder effective in part on January 1, 2013. This new law has been described as the first major workers' compensation reform in 20 years in Maine. The changes will be summarized in a later slide. ● Maine's Worker's Compensation Law is statutory as well as set forth in rules and regulations. ● Background Facts About Maine's Workers' Compensation Laws and its Workers' Compensation Board: – See Glossary of Frequently Used Terms of Art (a later slide) – Workers' Compensation is a type of insurance provided by an employer to its employees. It provides benefits to employees who suffer injuries on the job. These benefits include: – Weekly payments for lost time from work because of an injury, Payment of medical bills, prescriptions, and related costs, Payment for the loss of a specific body part, Payment of the cost of vocational rehabilitation (job retraining, job placement), and Payment of death benefits to the dependents of a worker whose death was work related. – (continued)
  3. 3. (1.) Some Aspects of Maine Workers' Compensation Law ● Background (Continued): Workers' Compensation Law in Maine – Injured employees must take certain steps if they are injured at work: ● ● ● – Employee must tell an employer (a supervisor or someone from management) of injury within 30 days of injury; If employer has selected a health care provider, employee must go there for the first ten days of treatment; If employee wants to change health care providers after the first ten days, employee must notify employer, and also tell employer the name of the new health care provider; Employers must do the following when an employee notifies them of an injury: ● Employer must fill out a First Report of Injury, giving the employee a copy; and ● Employer must pay the employee's time for lost time within 14 days; ● ● Or, the Employer must send a Notice of Controversy to the employee and to the Workers' Compensation Board if the employer does not want to pay the employee's medical bills and/or lost time benefits. (continued)
  4. 4. (1.) Some Aspects of Maine Workers' Compensation Law ● Background (Continued): Workers' Compensation Law in Maine – If there is a dispute about whether an employer must pay an employee injury claim: ● A WCB Troubleshooter will contact the employee, to try to resolve the dispute; ● If the Troubleshooter cannot resolve the dispute, a mediation will be held; ● If mediation does not resolve the dispute, the employee may request a formal hearing; ● Qualified injured workers are entitled to the services of a Worker Advocate Worker Advocates help injured workers prepare for mediation and formal hearings. The following pages flesh out this broad overview of Maine Workers' Compensation Law. – ●
  5. 5. (1.) Some Aspects of Maine Workers' Compensation Law ● ● ● ● ● ● ● An employee should report an injury as soon as possible; an employee loses the right to claim benefits if does not report injury within 30 days of injury (or first knowledge of injury); An employer must complete the First Report of Injury within 7 days of notice. The employer must give a copy to the employee. If employee loses a day's work because the injury, the employer must also file this First Report of Injury with the WCB. If employee does not receive a First Report of Injury, or if the employer does not fill one out, the employee should call the regional WCB office and ask to speak to a Troubleshooter. Getting medical help for the injury: For the first 10 days, the employer has the right to select the health care provider where treatment occurs. After that, the employee may chose the provider. The employee must notify the employer of the new provider. An employer can ask an employee to see another doctor: § 207 of the Workers' Compensation Act (WCA) provides that if an employee is seeking treatment with a provider of his/her own choice after the first ten days, then the employer has the right to require the employee to see a different doctor for another opinion. (This is not the same thing as an Independent Medical Exam under § 312, discussed later.) What costs are paid for by the employer? Medical Provider costs, medicine, mileage to/from treatment, and medical aids where necessary (crutches, wheelchairs, hearing aids, etc.) An employee receives treatment for an injury until he/she recovers from the injury. During this time, the employer must pay for reasonable and proper treatment that is related to the employee's injury. (continued)
  6. 6. (1.) Some Aspects of Maine Workers' Compensation Law ● ● If an injured employee needs treatment while an employer disputes the claim, the applicable health insurer must pay the employee's bills: In other words, if the workers' compensation insurer (the employer) will not pay the employee's claim for medical treatment, the employee may submit bills to his/her health insurer for payment, and that health insurer must pay those bills –— provided that the workers' compensation insurer is denying the claim and has not made any payments to the employee based on the claim. A first introduction to missed time / lost time issues: If an employee must miss more than 7 work days due to injury, the employee is entitled to weekly compensation benefits. The compensation structure divides as follows: If an employee loses between 7 and 13 days, the employee will be paid for only those days in the 7 to 13 day window. If an employee misses more than 14 days, however, he/she will be paid for all of the days that they have missed. – – ● Example: Employee misses 9 days of work: Receives 2 days of benefits. Example: Employee misses 16 days of work: Receives 16 days of benefits. A first introduction to compensation rates: An employer is not required to pay the employee his/her full salary while he/she misses work due to the injury. For all employees injured on or after 1/1/13, the employer will pay 2/3 (66%) of the employee's average weekly wage. – ● ● This is called the employees Compensation Rate. Additionally, there is a limit as to how much an employee may receive. As of 1/1/13, the maximum benefit for any employee is $717.09 per week. (This amount will be adjusted annually on July 1.) (continued)
  7. 7. (1.) Some Aspects of Maine Workers' Compensation Law ● Compensation Rate (Continued) ● ● ● If injured between 1/1/93 and 1/1/13, the employer pays 80% of the after-tax average weekly wage. If injured prior to 1/1/93, the employer pays 2/3 of the gross average weekly wage. Decision Points: Employer ● ● ● ● ● An employer must decide whether or not to pay a lost time claim within 14 days of the time the employee tells the employer about the injury; If the employer does not dispute the claim within 14 days, it must begin paying the employee weekly compensation, and the employer must continue paying the employee “at least” until it files a Notice of Controversy, should it elect to do so; An employee knows whether an employer is going to pay a claim because, when an employer so decides, it must send the employee a Memorandum of Payment. A Memorandum of Payment that says “accepted” means that the employer agrees with the employee that the employee has been injured at work (and not, for example, somewhere else), and that the employee is entitled to WC benefits. Separately, if a Memorandum of Payment says “claim is voluntary payment pending investigation,” this means an employer has elected to pay the claim even though it is not yet agreeing that the injury is work-related. This type of payment is also called “payment without prejudice.” (continued)
  8. 8. (1.) Some Aspects of Maine Workers' Compensation Law ● New / Alternative Work Decision Points: Employees ● An employee may be entitled to receive up to 100% of his/her compensation rate if the injury prevents them from returning to work. – An employee can show that the injury prevents them from returning to work by doing a “work search” –— keeping a list or records of the jobs he/she applied for, but did not receive an offer. – An employee who can obtain work and go back to work, but whose injury prevents them from earning as much as he/she used to earn, may still be able to receive partial benefits. Such partial benefits are equal to 2/3 of the difference between the employee's average weekly wage before the injury, on the one hand, and the new average weekly wages after the injury, on the other. If injured prior to 1/1/13, partial benefits were 80% in the above equation. An employee who returns to work after an injury must –— if receiving compensation for the injury –— notify the WCB and the employee's former employer –— the employer the employee was working for when he/she was injured---that the employee has returned to work. The employee must do this within 7 days of returning to work. – ● ● [Working Draft To Be Continued. Please Do Not Distribute.]
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