Maine Workers Compensation Claims: Eligibility, Filing and Appeals

Workers Compensation law in Maine is administered by the Maine Workers Compensation Board. Almost all Maine employers are legally required to provide workers compensation coverage, with a few exemptions for seasonal or casual agricultural employees, and for private domestic servants. Employers may choose to be self insured, or they may provide insurance through a licensed insurer. There are currently over 240 authorized workers' compensation insurance companies in the state of Maine, and approximately 41% of Maine employers are self insured.

Covered Work Related Injuries

Accidental injuries that occur during the course of work are covered by workers compensation. Examples include slip and fall injuries, head injuries, or broken bones. Though Maine's compensation system is generally a no fault system, work related injuries caused by drug or alcohol use are not covered. Many occupational diseases are also covered, as long as the disease or illness is caused due to working conditions and is not a pre-existing condition. Work related disfigurements and hearing loss may also be covered.

Maine Workers Compensation Claims Process

Employees should report a work related injury or illness to their employer as soon as possible. Within seven days after being notified, employers must submit an Employer’s First Report of Occupational Injury or Disease Form (Form WCB-1) to the Maine Workers' Compensation Board and to the insurance carrier. The employee should see a physician or health professional, who must also submit a Physician's First Report Form to the employer or the employer's insurance carrier. All claims are handled by Maine's Claims Management Unit. The claim will be assigned an individual claims manager, who will process the claim.

Workmans Comp Claim Denials

Claims may be denied if the illness or injury is found to be insufficiently related to a workplace event or activity. In order to receive benefits, a worker must have sufficient proof, through medical reports and witness statements if necessary. Claims may also be denied if drugs or alcohol were involved in the incident which led to the injury or illness. Claims that are not reported within the specified time limits, usually within 90 days of the occurrence, may also be denied. Incomplete documentation and incorrectly filed paperwork can also lead to a claim denial.

Appealing a Maine Workers Compensation Denial

Before any formal legal action is taken, a Claims Resolution Specialist will attempt to resolve the issue. The claims resolution specialist will speak to all parties, and may obtain additional medical reports in order to reach a resolution. If this does not work, a meeting will be scheduled with a Workers' Compensation Board mediator. Lawyers or advocates are often used by employees to assist in the mediation. The mediator will discuss the case with the employee and their representative, the employer, and the insurance carrier, and attempt to negotiate a resolution. If mediation fails, the third step is to request a formal hearing with the Board, where evidence will be submitted and witnesses will testify. Board decisions can be further appealed in state court.

Collecting Maine Workers Compensation Benefits

Full medical benefits are paid to injured or ill workers under workers compensation coverage. Both physical and vocation rehabilitation may also be covered. The amount of disability benefits depends on the type of injury or illness as well as the employees’ average weekly wage. Workers generally receive 80% of after tax earnings for temporary total disability, permanent total disability, and permanent partial disability. There is no minimum weekly benefit amount. As of 2009, the maximum weekly compensation rate is $616.74.

Hiring a Maine Workers Compensation Lawyer

Workers compensation lawyers should be consulted in the event of a claims dispute in order to ensure full payment of benefits. Lawyers may find and interview corroborating witnesses, collect medical records and other documentation, and prepare a general argument on an employee’s behalf. Lawyers often represent workers in mediations, and are strongly recommended for Compensation Board hearings and court appeals.

Maine Workers Compensation Office Locations

Maine Workers' Compensation Board
27 State House Station
Augusta, ME 04333-0027
(207) 287-3751 / 1-888-801-9087

Augusta Regional Office
24 Stone Street, Suite 2
Augusta, Maine 04330
(207) 287-2308 / 1-800-400-6854

Bangor Regional Office
106 Hogan Road, Suite 1
Bangor, Maine 04401
(207) 941-4550 / 1-800-400-6856

Caribou Regional Office
One Vaughn Place
43 Hatch Dr.
Caribou, Maine 04736
(207) 498-6428 / 1-800-400-6855

Lewiston Regional Office
36 Mollison Way
Lewiston, Maine 04240
(207) 753-7700 / 1-800-400-6857

Portland Regional Office
62 Elm Street
Portland, Maine 04101
(207) 822-0840 / 1-800-400-6858