Claims Kit
Maine
Forms
State Compliance Information
Penalties for Late Reporting 39A MRSA 360
Failure to file any Board-prescribed forms within established time frames is a violation of section 360(1) and is subject to a Board-assessed civil penalty of up to $100.00 per violation. Violations will result in the filing of complaints with the Abuse Investigation Unit.
Physician Selection 39A MRSA 206 207
For the first ten days, the employer has the right to select a health care provider to treat the injury. After the first ten days of treatment the employee may choose a different health care provider by telling the employer that they wish to have a different person treat their injury.
The employee may not change health care providers more than once without approval from the employer or the board.
An employee being treated by a health care provider of his own choice and if requested by the employer, submit to an examination by a physician, surgeon or chiropractor authorized to practice as such under the laws of Maine. This exam will be paid by the employer. This is not the same thing as an Independent Medical Exam.
Once an employer selects a health care provider to examine an employee, the employer may not request that the employee be examined by more than one other health care provider, other than an independent medical examiner appointed pursuant to section 312, without prior approval from the employee or an administrative law judge. This provision does not limit an employer's right to request that the employee be examined by a specialist upon referral by the health care provider. Once the employee is examined by the specialist, the employer may not request that the employee be examined by a different specialist in the same specialty, other than an independent medical examiner appointed pursuant to section 312, without prior approval from the employee or the board. The employee has the right to have a physician, surgeon or chiropractor of the employee's own selection present at such an examination, whose costs are paid by the employer.
Posting Requirements 39A MRSA 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 places of business. The notice must be conspicuous and posted in a place accessible to the employer's employees.
Form WCB 90 - Notice to Employees
Reporting of Claim by Employer 39A MRSA 303
The employer must report the injury to the board within 7 days after the employer receives notice or has knowledge of the injury. 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 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 employee's employment and the amount of the employee's wages or earnings at that time.
The employer must complete a first report of injury form 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.
Posters & Brochures
Documents Provided by CopperPoint
Portal User GuidesPharmacy First Fill
Pharmacy First Fill - Spanish
Change of Address
Witness Statement - English
Witness Statement - Spanish
Accident Report - English
Accident Report - Spanish
Gramm-Leach-Bliley Act (GLBA) Privacy Notice - English
Return To Work
Return To Work Transitional Employment Offer Template - EnglishReturn To Work Transitional Employment Offer Template - Spanish
Return To Work Policy Guide
Injured Worker Guide
The worker's compensation system can be complicated, and each state has its own laws regarding workers' compensation.
The information contained in your state's guide provides a general guide for workers injured or made ill on the job.
This state-issued publication will assist you in navigating the workers' compensation system and serve as a resource for basic legal rights as well as steps to take to initiate workers' compensation benefits, deadlines and who to contact for additional assistance.
If you have questions about the workers' compensation process, this guide will provide the contact information for the regulatory agency for your state. In addition, many states have an ombudsman to oversee and assist all interested parties in the workers' compensation system.
Publications
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Phone: 800.231.1363
For Claim Reporting, please complete your First Notice of Loss and email to reportaclaim@copperpoint.com