Maine Workers' Compensation Claims: Eligibility, Filing, and Appeals

Learn about your right to benefits and to appeal under the workers' compensation system in Maine.

By , Attorney

Updated January 7, 2019

Nearly all employers in Maine must carry workers' compensation insurance for their employees. Maine's workers' compensation system is a no-fault system that compensates 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 in Maine?

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, on lunch break, or commuting to and from work are generally not compensated through workers' comp. (For more information, see our article on what types of injuries are covered by workers' comp.)

Maine workers' comp system covers both traumatic injuries (those that result from a one-time accident) and occupational diseases (injuries or illnesses that occur over a period of time, such as injuries caused by repetitive movements at work).

What Should I Do If I'm Injured at Work?

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 Workers' Comp Benefits Can I Receive in Maine?

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 $829.30 (as of July 1, 2018).

In Maine, 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 Workers' Comp 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.

Dispute Resolution for Maine Worker's Comp Claims

If your employer's insurance company denies your claim, it will file a Notice of Controversy with the Maine Workers' Compensation Board. The notice will state the specific reason for the denial of your claim. Your case will then be sent to a Board representative called a "troubleshooter."

Within a couple of weeks, the troubleshooter will contact you and the insurance company to discuss the claim. The troubleshooter will try to help you and the insurance company resolve the dispute informally, usually over the phone. If you can't reach a resolution, your case will be sent to mediation.

Mediation is another attempt to help you and the insurance company resolve the dispute informally. A mediation is a meeting held in an informal setting, in which a neutral third party (the "mediator") will try to help you and the insurance company reach a voluntary settlement agreement. (Lump sum settlements are allowed in Maine.) The mediator does not, however, make a decision in your case. If you can't resolve the dispute, you will need to attend a formal hearing.

Formal Workers' Comp Hearing

To request a formal hearing, you will need to file a petition with the Maine Workers' Compensation Board. The Board has different petition forms depending on what issue is in dispute. For example, if you believe you are entitled to wage loss benefits, you would file a Petition for Award of Compensation (Form WCB-140). Other petition forms are available if the dispute is about medical treatment or the extent of your permanent disability.

You must file your petition within two years of your accident or the date your employer filed a first report of injury, whichever is later. However, if the insurance company paid some benefits to you within two years of your injury, you have six years from the last payment to file a petition. Either way, it's usually best to file your petition as soon as possible.

The hearing will be held before a workers' compensation judge, who will listen to the arguments of the parties, consider testimony from witnesses, and review relevant documents. Both you and the insurance company will have an opportunity to present your cases. After the hearing, the judge will mail a written decision to the parties.

Further Workers' Comp Appeals

If the judge doesn't rule in your favor, you can appeal to the Appellate Division of the Maine Workers' Compensation Board within 20 days. To appeal, you must file a Notice of Intent to Appeal (Form WCB-240) with the Appellate Division and send a copy to your employer and its insurance company. You'll also need to request a written transcript of the hearing, along with any documents presented as evidence, from the Workers' Compensation Board. You must send a copy of these documents to the Appellate Division, along with your employer and its insurance company.

Once the Appellate Division receives your request, you will be asked to submit a written brief explaining why you believe the judge's decision was incorrect. A panel of three workers' compensation judges will generally decide your case based on the documents it receives (but either party can request to appear in person to make oral arguments).

If you disagree with the panel's decision in your case, you can appeal through the state court system. You must file your appeal with the Maine Supreme Court within 20 days. (For more information on these appeals, see the Appellate Division's page on appeals.)

Getting Legal Help

The Maine Workers' Compensation Board has a Worker Advocate Program, which provides free legal representation to injured workers without attorneys. A worker advocate can help you file a petition, prepare for mediation, and represent you at a formal hearing. To take advantage of the program, you must participate in the state's troubleshooting process first.

You might also want to consider hiring an experienced workers' compensation lawyer, especially if your injuries are serious and will have a significant impact on your ability to work in the future. A lawyer will be able to represent you at all stages of the appeals process, including before the Appellate Division and through the state court system.

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