Claims Kit

Physician Selection  39a: 206  39a: 207

The employer has the right to select an injured worker's initial treating health care provider. Any selected provider must be authorized and licensed to practice in the state of Maine. The pre-injury employer has initial medical control.

The injured worker, however, gains medical control after 10 days from the inception of health care. The employee may select a different health care provider by providing the employer or carrier with the name of their next intended health care provider and a statement of intention to treat with this provider. 

The employer may file a petition objecting to the named health care provider selected by the employee but must set forth specific reasons for the objection. The issue of the health care provider must be set for mediation pursuant to 39a: 313. If the objection is not resolved through mediation, after notice to all parties and a prompt hearing by an administrative law judge, the administrative law judge may order one of the following: 

• The administrative law judge will order that the employer or insurer is required to allow for the change--and thus becomes responsible for payment of related health care charges--if the employer or insurer cannot show sufficient cause as to why the employee should not commence or continue treatment with the prospective elected provider; or
• The administrative law judge will order that the employer is not responsible for payment of related health care charges if the employer or insurer can show sufficient cause as to why the employee should not commence or continue treatment with the prospective elected provider. The employee will become responsible for payment of treatment received from the health care provider from the date the judge's order is mailed. 

The employee may not change health care providers more than once without approval from the employer, insurer, or board.

Penalties for Late Reporting  39a: 205(3)(5)  39a: 360

An employer who has notice or knowledge of a disability or death and fails to give notice to the carrier must pay the following penalty for the period during which they failed to notify the applicable carrier and state.

When there is not an ongoing dispute, if weekly compensation benefits or accrued weekly benefits are not paid by the employer or insurance carrier within 30 days after becoming due and payable, $50 per day must be added and paid to the worker for each day over 30 days in which the benefits are not paid. Not more than $1,500 in total may be added. 

Failure to file any Board-prescribed forms within established time frames is a violation of 360(1) and is subject to a Board-assessed civil penalty of up to $100 per violation. Violations will result in the filing of complaints with the Abuse Investigation Unit.

Reporting of Claim by Employer  39a: 303

The employer must report any injury to the board within 7 days after they receive notice or have knowledge of the injury or illness. An insured employer that has notice or knowledge of any injury and fails to give timely notice to its insurer will reimburse the insurer for any penalty that is due as a result of the late filing. 

The employer must also report the average weekly wages or earnings of the employee--with any other information required by the Workers' Compensation Board--within 30 days after the employer receives notice or has knowledge of a claim for compensation.

The employer must report when the injured employee resumes the their employment and the amount of the employee's wages or earnings at that time.

The employer must complete a First Report of Occupational Injury or Disease (WCB-1) for any injury that has required the services of a health care provider within 7 days after the employer receives notice or has knowledge of the injury. The employer must provide a copy of the form to the injured employee and retain a copy for the employer's records but is not obligated to submit the form to the Board unless the injury later causes the employee to lose a day's work. 

Posting Requirements  39a: 406

A notice in a form as the board approves, stating that the employer has conformed to this Act, together with other information as the board determines, must be posted by the employer and kept posted by the employer in each of the employer's mills, factories, or other places of business. The notice must be conspicuous and posted in a place accessible to the employer's employees.

Workers' Compensation Board Notice to Employees - Form WCB 90

January 2021

Do I have to complete a First Report of Injury (FROI) if an employee is exposed to COVID-19 in the workplace?

If an employer is told or is otherwise aware of a workplace injury/illness that has required the services of a health care provider, the employer must complete a FROI and notify its insurer. The Board encourages employers to notify insurers of all potential claims involving COVID-19 and/or related to the pandemic. This will allow insurers and the Board to better assess the system impact of COVID-19.

Do I have to complete a First Report of Injury (FROI) if an employee has an adverse reaction to a COVID-19 vaccine?

If an employer is told or is otherwise aware of an injury/illness that has required the services of a health care provider, the employer must complete a FROI and notify its insurer. The Board encourages employers to notify insurers of all potential claims involving COVID-19 and/or related to the pandemic. This will allow insurers and the Board to better assess the system impact of

COVID-19.

What if I do not require my employees to be vaccinated?

Adverse reactions to vaccinations, including for COVID-19, may be considered workrelated even if the employer does not specifically require its employees to be vaccinated. If you have questions about whether a claim should be paid, you should contact your insurer.

What if I do not think the COVID-19 exposure, adverse reaction, etc. should be covered by workers’ compensation?

The filing of a FROI with your insurer indicates that an employer has been informed of or is otherwise aware of a possible workplace injury/illness. Filing a FROI with your insurer does not indicate the employer agrees the injury should be covered by workers’ compensation. The Board encourages employers to notify insurers of all potential claims involving COVID-19 and/or related to the pandemic. This will allow insurers and the Board to better assess the system impact of COVID-19.

Janaury 21, 2021

Will the Board be adjusting form filing deadlines or waiving penalties for late filed forms and payments?

The Board does not have the authority to unilaterally change filing requirements in the statute or its rules. The Board will monitor the impact of COVID-19 on form filing deadlines as we work through this unprecedented and evolving time. We will keep Governor Mills informed of any issues that would require her executive authority. Where the Board has the discretion to waive and/or adjust penalties, issues related to COVID-19 will certainly be taken into consideration.

Do I have to file a First Report of Injury if an employee has an adverse reaction to a COVID-19 vaccine?

If an employer knows or has some knowledge either from the employee or from the circumstances that a COVID-19 vaccination that relates to an employee’s job causes the employee to miss one or more days of work, a First Report of Injury must be filed with the Board.

How should an insurer report a case involving an adverse reaction to a COVID-19 vaccine to the Board through EDI? When submitting a First Report of Injury:

• Nature of Injury Code (DN0035) should only be populated with code 83 (COVID19) to report COVID exposures, COVID quarantine, or a positive COVID test result. All other injuries involving COVID-19, including adverse reactions to a vaccine, should be coded in accordance with the remaining nature of injury codes based on the claimed injury/illness.

• Cause of Injury Code (DN0037) should be populated with code 83 (pandemic) for all injuries/illnesses involving or related to COVID-19 including adverse reactions to a COVID-19 vaccination.

• Please be sure to include descriptive comments for all First Reports of Injury sent to the Board, e.g. “Claimant experienced a negative reaction to a COVID-19 vaccination.”

What if I do not require my employees to be vaccinated?

Adverse reactions to vaccinations for COVID-19 might be considered work-related even if the employer does not specifically require its employees to be vaccinated. If you have questions about the compensability of a claim, you should contact your workers’ compensation insurer.

Janauray 20,2021

When submitting a First Report of Injury:

• Nature of Injury Code (data element #0035) should be populated with code 83 (COVID-19).

• Cause of Injury Code (data element #0037) should be populated with code 83 (pandemic).

COVID-19: New/Revised Procedure Codes 10/6/2020

A number of new and revised procedure codes have been adopted due to the outbreak of Covid-19. Please note that while these codes will not be in the Board’s fee schedule until the annual update is complete for dates of service on or after 1-1-21, providers are allowed to bill for any items or services with a valid procedure code. COVID-19 billing and coding guidance is available through the AMA and CMS websites.

The Board does not have the authority to unilaterally change filing requirements in the statute or its rules. The Board will monitor the impact of COVID-19 on form filing deadlines as we work through this unprecedented and evolving time. We will keep Governor Mills informed of any issues that would require her executive authority.Where the Board has the discretion to waive and/or adjust penalties, issues related to COVID-19 will certainly be taken into consideration.

Reporting COVID-19

If an employee is exposed to the COVID-19 while at work, they should report the exposure as soon as possible.

COVID-19 exposure, as is the case withother injuries/illnesses, if an employee who has properly filed a claim can show that an injury/illness happened while at work and because of work, the employee will be entitled to workers’ compensation benefits.

A new Cause of Injury Code (DN0037) - 83 for “Pandemic” and a new Nature of Injury Code (DN0035) - 83 for “COVID-19” were approved. The codes are anticipated to be used for the reporting for any claim effective December 2019 or later. The IAIABC recommends that EDI reporting and collection systems be modified to recognize these new codes by April 1, 2020. The new Injury Description Tables may be found on the WCIO website, Injury Description Table page at: https://www.wcio.org/Document%20Library/InjuryDescriptionTablePage.aspx.
The Maine Workers’ Compensation Board has made the necessary modifications and is now accepting the new codes recommended by the IAIABC.