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