Reprinted from http://janus.state.me.us/wcb/question.htm
What should I do if I am injured at
work? You must tell your employer (which can
mean a supervisor or a member of management)
as soon as possible that you have
been injured.
When must I tell my employer that I
have been injured at work? You must tell your
employer within 90 days of your injury,
or when you learn of your injury, that you have
been injured. If you wait more than 90
days after the injury, you will lose the right to claim
workers' compensation benefits.
What should my employer do when I report
an injury? Your employer must complete
a First Report of Injury within 7 days.
Your employer must give you a copy of the First
Report of Injury. If you lose a day's
work because of your injury, your employer must also
file the First Report of Injury with the
Workers' Compensation Board. If your employer
does not complete the First Report of
Injury, you should call a regional office of the
Workers' Compensation Board and ask to
speak to a Troubleshooter.
Can I get medical help for my injury?
Yes. For the first ten days, your employer has the
right to select a health care provider
to treat your injury. After the first ten days of
treatment you may choose a different health
care provider. You do this by telling your
employer that you wish to have a different
person treat your injury.
Can my employer ask me to see another
doctor? Yes. Section 207 of the Workers'
Compensation Act says that if you are
treating with a health care provider of your own
choice, your employer can require you
to see a different doctor for another opinion. This
is not the same thing as an Independent
Medical Exam under Section 312, a process that
is explained later in this guide.
Will my employer pay for any other medical
costs? Yes. Your employer will pay for
medicine and for mileage to and from your
visits to health care providers. They will also
pay for medical aids such as wheelchairs,
crutches and hearing aids.
How long may I receive treatment for
my injury? You can receive treatment until you
recover from your injury. Your employer
must pay for reasonable and proper treatment
that is related to your injury.
If I need treatment while my employer
disputes my claim, will my health insurer pay
my bills? Yes. If the workers'
compensation insurer will not pay your claim for medical
treatment, you can submit the bills to
your health insurer for payment. Your health insurer
must pay the bills if the workers' compensation
insurer is denying your claim and has not
made any payments to you based on your
claim.
What if I have to miss time from work
because of my injury? If you miss more than 7
days of work because of an injury, you
are entitled to receive weekly compensation
benefits. If you lose between 7 and 13
days, you will be paid for those days. If you miss
more than 14 days, you will be paid for
all of the days that you have missed. For example,
if you miss 9 days of work, you would
receive 2 days of benefits. If you missed 16 days of
work, you would receive 16 days of benefits.
Will my employer pay me my full salary
while I am out? No. If you were injured on or
after January 1, 1993, your employer will
pay you 80% of your after-tax average weekly
wage. This is called your compensation
rate. There is a limit on how much you can
receive. Currently, the maximum benefit
you can receive is $441.00 per week.
If you were injured prior to January 1,
1993, your employer will pay you 2/3 of your gross
average weekly wage.
When does my employer have to decide
if it is going to pay me for my lost time?
Your employer must decide whether or not
to pay your lost time claim within 14 days of
the time you tell your employer about
your injury.
What if my employer does not do anything
for the first 14 days? If your employer
does not dispute your claim within 14
days, it must begin paying you weekly
compensation. Your employer must continue
paying you at least until it files a Notice of
Controversy.
How will I know if my employer is going
to pay my claim? If your employer decides to
pay your claim, it will send you a Memorandum
of Payment.
My Memorandum of Payment says that my
claim has been "accepted." What does
that mean? This means that your
employer agrees that you have been injured at work,
and that you are entitled to benefits.
My Memorandum of Payment says that my
"claim is voluntary payment pending
investigation." What does that mean?
This means that your employer is paying your
claim even though it is not sure that
your injury is work-related. This type of payment is
often called "payment without prejudice."
What if I can work but I can not find
a job? You may be entitled to receive 100% of
your compensation rate if your injury
stops you from returning to work. You can show that
your injury prevents you from returning
to work by doing a "work search", in other words,
by keeping a list of the jobs that you
have applied for but have not gotten.
What if I can go back to work, but I
cannot earn as much as I used to earn? If you
can return to work, but your injury stops
you from earning as much as you used to earn,
you may receive partial benefits. Partial
benefits are equal to 80% of the difference
between what your average weekly wage
was before your injury and your earnings after
you return to work.
Do I have to do anything when I return
to work after an injury? Yes. If you are
receiving compensation for your injury,
you must notify the Workers' Compensation
Board and the employer you were working
for when you were injured that you have
returned to work. You must do this within
seven days of returning to work.
How long can I receive benefits for
lost time? Regardless of your date of injury, if
your incapacity is total, you may receive
benefits for as long as you are unable to work.
Total incapacity means that you are unable
to work at all because of your injury.
If your incapacity is partial, and you
were injured on or after January 1, 1993, you can,
with a couple of exceptions, receive benefits
for a maximum of 260 weeks. Partial
incapacity benefits are due if you are
able to work, but still have some restrictions on
what you can do because of your injury.
There are three exceptions to the 260 week limit
on benefits. First, if your injury has
caused more than 15% permanent impairment, you
can receive benefits for as long as your
injury lasts. Second, if you were injured between
January 1, 1993 and January 1, 1998, and
your injury has caused permanent impairment
of 11.8% or greater, you can receive benefits
for as long as your injury lasts. Third, you
can ask the Workers' Compensation Board
to order the employer to continue paying
benefits after the 260 week cap has been
reached. To do this, you must prove that you
will suffer an extreme financial hardship
because you cannot return to work.
If you were injured between October 17,
1991 and December 31, 1992, you may receive
partial incapacity benefits for a maximum
of 520 weeks.
If you were injured between November 20,
1987 and October 16, 1991, you may receive
partial incapacity benefits for a maximum
of 400 weeks after you have reached maximum
medical improvement. (Maximum medical
improvement means the date after which
further recover is no longer reasonably
anticipated.)
If you were injured prior to November 20,
1987, there is no limit on the amount of partial
incapacity benefits you can receive.
Can my employer stop paying benefits
without my agreement? Yes. If your claim is
"accepted," your employer can stop paying
benefits if you return to work for your
employer, or if you receive an increase
in pay from your employer. Your employer may
also file a Petition for Review to stop
or reduce your weekly benefits.
If your claim is being paid without prejudice,
your employer can stop paying benefits if you
return to work for your employer, or receive
an increase in pay from your employer. In
addition, the employer can stop your benefits
by filing a 21-day certificate of
discontinuance.
What is a 21-day certificate of discontinuance?
If your employer is paying you without
prejudice, it can notify you that it intends
to discontinue weekly benefits no earlier than 21
days from the date that it mailed the
notice to you. Your employer must state the reasons
it is going to stop your benefits.
What can I do if I receive a 21-day
certificate of discontinuance? You can file a
Petition for Review and request a provisional
order. When you file these forms, you will
be asking a Hearing Officer to decide,
within about 21 days, whether or not the employer
should be able to stop your benefits before
a hearing is held. You can contact a regional
office of the Workers' Compensation Board
and speak to a Troubleshooter who will help
you fill out these forms.
What if my injury bothers me in the
future? You can ask that your employer or your
employer's insurer pay for more medical
care and lost time. You can make a claim only if
the statute of limitations on your claim
has not run out.
What is the statute of limitations?
The statute of limitations is the time limit within
which you must file a claim for benefits.
Once the statute of limitations expires, you
cannot make a claim for further benefits.
The statute of limitations is different for different
dates of injury. If your employer makes
a payment for workers' compensation benefits
within two years of your injury or the
last time they made a payment, your statute of
limitations will not expire for at least
two years. If they have not, you need to file a petition
within two years of the date your employer
filed a first report of injury with the Workers'
Compensation Board. There are certain
cases where a longer period between payments
can go by without your statute of limitations
expiring. If you have questions about your
statute of limitations, you should call
a regional office of the Workers' Compensation
Board and ask to speak to a Troubleshooter.
What if my employer refuses to pay my
claim? If your employer refuses to pay your
claim they will file a Notice of Controversy.
A Notice of Controversy is often called a
"NOC". The Notice of Controversy should
indicate why the employer is not agreeing to
pay your claim.
What happens if my employer files a
Notice of Controversy? If your employer files a
Notice of Controversy, your case will
be sent to a Troubleshooter. The Troubleshooter will
try to contact both you and your employer
and try to resolve the disagreement. If you
receive a Notice of Controversy, and you
do not hear from a Troubleshooter within 2
weeks, you should call a regional office
of the Workers' Compensation Board and ask to
speak to a Troubleshooter.
What if the Troubleshooter cannot resolve
the dispute? If the Troubleshooter
cannot resolve the dispute, then your
case will be sent to a Mediator. The Mediator will
meet with you, your employer and the employer's
insurance company. The meeting will
be held in an informal setting. The parties,
with the mediator's help, will attempt to come
to an agreement. The Mediator will not
take sides at the mediation. Any agreements you
reach must be reached voluntarily.
If my case is sent to mediation, will someone
be available to help me? Yes. There
are Worker Advocates at each regional
office who help injured workers with their claims.
You can receive assistance from a Worker
Advocate if you were injured on or after
January 1, 1993, have participated in
troubleshooting, do not have an attorney, and
request the services of a Worker Advocate.
The addresses and phone numbers of the
Worker Advocate offices are listed at
the back of this guide.
What will the Worker Advocate do? The
Worker Advocate will help you prepare for
mediation, and will attend mediation with
you. They will also help you negotiate with your
employer to resolve your dispute.
Can I get a lawyer to help me? Yes.
If you were injured on or after January 1, 1993, you
will be responsible for paying your attorney
for his or her services.
If you were injured prior to June 30, 1985,
your employer will pay your attorney's fees if yo
make a claim in good faith, or if your
employer begins the process.
What if the Mediator cannot resolve the
dispute? If the Mediator cannot resolve the
dispute, then either you or your employer
can file petitions that request a formal hearing.
There are different petitions which you
can use to request different benefits. For example,
if you want your employer to pay lost
time benefits, then you would file a Petition for
Award. If you want your employer to pay
medical bills, then you will file a Petition to Fix.
These forms are available at the different
regional offices.
After an unsuccessful mediation, you, your
employer, or a Hearing Officer may request
an independent medical exam. Independent
medical exams are explained later in this
guide.
Will the Worker Advocate be able to
help me after the mediation? Yes. If your claim
goes to formal hearing, the Worker Advocate
will help you prepare for the hearing, and
will attend the hearing with you.
What is a formal hearing? The formal
hearing is your opportunity to present your case
to a Hearing Officer. The Hearing Officer
will listen to your evidence, and the evidence
that your employer wants to present. After
the Hearing Officer has heard all of the
evidence, the Hearing Officer will write
a decision. The decision is binding on you and
your employer.
What if I disagree with the Hearing
Officer? You may appeal the decision of the
Hearing Officer to the Supreme Judicial
Court of Maine. (The Supreme Judical Court is
also known as the " Law Court".) The Supreme
Judicial Court does not have to hear your
appeal. They can choose which cases they
want to hear.
What is an independent medical exam?
When a request for an independent medical
exam is granted, the Workers' Compensation
Board will ask a doctor to examine you,
and whatever records you and your employer
want him/her to. The independent medical
examiner will write a report that explains
whether or not your injury is related to work. The
independent medical examiner's decision
will be binding on you and your employer if you
agreed on an examiner. If the Workers'
Compensation Board appointed the examiner, the
examiner's decision will be binding unless
there is clear and convincing evidence that the
examiner's findings are wrong.
What is the difference between an independent
medical exam under Section 312
and a medical exam under Section 207?
An examination under Section 207 is an
examination by a doctor that your employer
has chosen. The doctor's medical opinion is
not binding on the parties. An independent
medical exam is an exam under Section 312
by a doctor that the Workers' Compensation
Board has chosen. Unlike a Section 207
exam, the findings of an independent medical
examiner are binding unless there is clear
and convincing evidence that the examiner's
findings are wrong.
Does my employer have to give me my
job back? If you are able to return to work, and
your job is open, your employer must offer
you your previous job. If your old job has been
filled, or if your injury prevents you
from doing that job, your employer must give you a job
that you can do even with your injury.
Your employer must also make reasonable
accommodations for your injury. That means
that your employer must make changes to
a job that will allow you to return to
work, as long as the changes would not impose an
undue hardship on your employer.
What if I cannot return to my old job,
and there is no other work at my employer's
business? If you cannot return
to your old job because of your work related injury, you
may be entitled to receive vocational
rehabilitation. Vocational rehabilitation may include
job retraining and job placement.
What if my employer will not pay for
vocational rehabilitation? If your employer will
not voluntarily pay for vocational rehabilitation,
you can ask the Workers' Compensation
Board to recommend a vocational rehabilitation
plan. If your employer refuses to pay for
the plan, the Workers' Compensation Board
will pay for you to go through with the
rehabilitation plan. You will not be responsible
for any of the cost of a plan that the
Workers' Compensation Board pays for.
Can my employer discriminate against
me if I file a workers' compensation claim?
No. Your employer cannot discriminate
against you for filing a workers' compensation
claim. Your employer cannot discriminate
against you for testifying in a workers'
compensation claim. If you think your
employer has discriminated against you because
you filed a claim or testified, you can
file a Petition to Remedy Discrimination.
Are there penalties in the Workers'
Compensation Act? Yes. Employers and
employees can be penalized for not filing
required reports and forms, and for not filing
required reports and forms, and for willful
violations of the Workers' Compensation Act,
fraud or intentional misrepresentation.
Employers can be penalized for making late
payment of benefits.
Where can I get more information?
You can get more information at any one of the
regional offices listed at the front of
this guide.
What are the addresses and phone numbers
of the worker Advocate offices? The
addresses and phone numbers of the Worker
Advocate offices are listed below. If you
have not spoken to a Troubleshooter, please
use the addresses and phone numbers
listed at the beginning of this guide.
If you have already spoken to a Troubleshooter, and
need to contact a Worker Advocate, please
use the addresses and phone numbers listed
below.
AUGUSTA
24 Stone Street
Augusta, ME 04330-5220
(207) 287-2266
1-888-645-2266 (Maine Only)
BANGOR
106 Hogan Road
Bangor, ME 04401-5640
(207) 941-4556
1-888-594-4556 (Maine Only)
CARIBOU
One Vaughn Place
10 Washburn Ave, Suite 110
Caribou, Maine 04736-2347
(207) 498-6428 or 800-400-6855 (Maine
only)
LEWISTON
140 Canal Street
Lewiston, Maine 04240-7761
(207) 783-5490 or 800-400-6857 (Maine
only)
PORTLAND
62 Elm Street
Portland, Maine 04101-0840
(207) 822-0840 or 800-400-6858 (Maine
only)