Maine Workers' Compensation Claims: Eligibility, Filing, and Appeals
Learn about your rights under the workers' compensation system in Maine.
Nearly all employers in Maine must carry workers’ compensation insurance for their employees. As in every other state, the workers’ compensation system in Maine is a no-fault system designed to compensate injured workers for medical bills, lost wages, and permanent impairments resulting from their injuries. To take advantage of these benefits, injured workers must take certain steps required by Maine law.
Who Is Eligible for Workers’ Comp Benefits?
Workers’ compensation covers all injuries or illnesses that happen in the course of employment. In general, injuries that happen while you are performing your work duties or running work errands are covered by workers’ comp. On the other hand, injuries that occur while you’re off-duty are generally not compensated through workers’ comp. For example, if you were injured during your lunch break or during your commute to and from work, you will typically not be covered by workers’ comp. For more information, see our article on what types of injuries are covered by workers’ comp.
Workers’ comp covers both traumatic injuries and occupational diseases. Traumatic injuries are those that result from a one-time accident at work, such as a broken bone from a slip and fall. Occupational diseases are injuries or illnesses that occur over a period of time, such as injuries caused by repetitive movements at work (such as carpal tunnel syndrome) or illnesses developed from exposure to toxic substances at the workplace (such as cancer from exposure to asbestos).
What Should I Do If I’m Injured at Work?
If you’re injured at work, you should notify your employer and get medical treatment right away. You must notify your employer within 30 days of your accident or of discovering your work-related occupational disease. Otherwise, you risk losing your right to collect workers’ compensation benefits. In most cases, though, it’s best to give notice immediately after your injury occurs.
Once you give notice of your injuries, your employer must fill out a form called a “First Report of Injury” within seven days. Your employer must file the report with the Maine Workers’ Compensation Board and provide a copy to you and its insurance company. The insurance company has 14 days to either accept or deny your claim.
How Do I Get Medical Treatment?
In an emergency, you can choose which doctor or hospital to seek treatment from. At your initial appointment, be sure to explain how your injuries happened and that they are work-related. For all non-emergency care, your employer has the right to select your treating physician for the first ten days of your treatment. After the first ten days, you can notify your employer that you are switching to a doctor of your own choosing.
What Benefits Can I Receive?
All reasonable and proper medical treatment will be covered through workers’ comp, including the cost of doctors’ visits, hospital bills, prescriptions, and prosthetic devices. You’ll also be reimbursed for the mileage you incur in traveling to and from medical appointments. In addition to medical benefits, you will also be eligible to receive benefits for lost wages.
You will be eligible to receive compensation for your lost wages during the time you are totally disabled and unable to work. Total incapacity benefits are two-thirds of your average weekly wages, subject to a weekly maximum of $789.35 (as of July 1, 2016).
You can continue to receive total incapacity disability benefits for as long as you are totally disabled. You are presumed to be totally disabled for 800 weeks if you suffered the loss of two hands, feet, arms, legs, or eyes; paralysis of two arms or legs; or total mental incapacity.
If you’re able to work in some capacity, but still have limitations due to your injury, you may be eligible for partial incapacity benefits. Partial incapacity benefits are two-thirds of the difference between your average weekly wages before and after the injury, subject to the same maximum mentioned above. These benefits are generally available for up to 520 weeks. However, your benefits may be extended if all of the following are true:
- You received a whole body impairment rating of more than 18% from your doctor.
- Your wages during the last 26 weeks are 65% or less of your pre-injury wages.
- You earned wages in at least 12 out of the last 24 months.
What If My Claim Is Denied?
If your workers’ comp claim has been denied, or the insurance company is disputing any portion of your claim, you have the right challenge the decision. If the insurance company didn’t make any benefit payments, you must file a petition with the Maine Workers’ Compensation Board within two years of your accident or the date your employer filed the first report of injury (whichever is later). If the insurance company did pay some benefits within two years of your injury, you have six years from the last payment to file a petition. For more information on the appeals process, see our article on appealing a denial of your Maine workers’ comp claim.