DI 52120.110 Maine Workers' Compensation (WC)
The Maine Workers’ Compensation Board is responsible for the administration of their workers’ compensation law. WC insurance may be provided through a competitive State fund, a private insurance carrier, or employers may self-insure.
A. Types of WC payments
The Maine statute governing WC is Title 39-A (Part 1, Chapter 5, covers indemnity payments). The WC Act of 1992 made major revisions to the WC law. For injuries occurring on or after 01/01/1993 Maine law requires employers to make periodic payments for specific bodily loss and for injuries resulting in total and partial incapacity. This reform package actually lowered the maximum weekly amounts for anyone injured 01/01/1993 or later, but workers with a date of injury before then did not have their benefits lowered. Weekly WC benefits are now based on 80 percent of the worker’s after-tax earnings, subject to the State maximum amount (for workers injured before 01/01/1993, WC was based on 2/3 of the gross average weekly wage). There is no minimum payment.
1. Compensation for Total Incapacity (§212.1 & .2): Temporary Total (TT) or Permanent Total (PT)
These benefits continue for the duration of the disability. For certain severe injuries (such as paralysis or blindness) total incapacity is presumed for 800 weeks from the date of injury. After 800 weeks, and for less severe injuries, a determination of total incapacity must be made.
2. Compensation for Partial Incapacity (§213): Temporary Partial (TP) or Permanent Partial (PP)
These benefits are based on 80 percent of the difference between worker’s after-tax earnings before and after his injury, subject to a weekly maximum payment amount. Depending upon the extent of the disability, these payments will either be capped at 364 weeks or will continue for the duration of the disability. The limit was increased from 260 weeks to 364 weeks as of 01/01/2000.
3. Scheduled Award payments for a specific loss (§212.3)
These payments commence at the time of the accident, and ARE reduced because of receipt of TT benefits. Some injured workers receive their compensation for a specific loss in a lump sum payment rather than over the prescribed weekly period; this does not change the fact that the payment is WC for offset purposes.
4. Lump sum settlement awards
Maine lump sum settlement agreements that are arranged out of court between the parties and submitted to the WC Board for approval are effective upon execution. Unless either party can prove there was fraud or mistake of fact, the agreement can only be reopened to correct a clerical error.
Many of the lump sum settlements involve a structured settlement. For more information on structured settlements, see DI 52150.065D. Also, pay close attention to the wording in lump sum awards, as a life expectancy rate expressed in the award might have been calculated based on the net lump sum instead of the gross lump sum.
5. Permanent Impairment (PI) benefits for disfigurement
These additional WC payments (a type of scheduled award also known as Section 56a payments) were paid for cases where the DOI was before 01/01/1993. After several changes in the methods of determining the amount of these benefits, they were finally eliminated effective 01/01/1993. These benefits had been paid in addition to any other weekly compensation awarded.
NOTE: The POMS provision showing that scheduled award payments for a specific loss are offsettable was added on 04/30/2001. Prior to that, various offices had not offset for these payments. This was not a "change of position" per GN 04001.100; cases that were worked erroneously treating these WC payments as not offsettable should be handled under the normal rules of administrative finality. For information regarding reopening based on an error on the face of the evidence, see GN 04010.020.
B. Cost-of-living Adjustments (COLA)
1. Date of Injury 01/01/1993 or later
There is no provision in the WC Act for cost of living adjustments.
2. Date of Injury 12/31/1992 or earlier
COLAs are given for these cases, but the rules are complex. See the charts and instructions provided by the WC Board: http://www.maine.gov/wcb/departments/Claims/cola.rtf
C. Attorney fees
Attorney fees are decided on a case-by-case basis. When the worker’s date injury was prior to 1993 the employer usually paid the attorney fee, but workers injured 01/01/1993 or later are generally responsible for the fee. Note that only fees paid by the workers are excludable WC expenses.
D. Retirement insurance benefit (RIB) considerations
WC payments are offset by 50 percent of SSA RIB received.
E. Time limitations for filing claims
There is a 2 year time limit for filing a WC claim. If the worker does not file a petition within 2 years of his date of injury, he may lose his right to claim benefits in the future. However, if the employer made payments ‘without prejudice’ (without admitting liability), then the worker has 6 years from the date of the most recent payment to file.
F. Verifying WC payment amounts
Contact the Maine WC Board at:
1. Memorandum of Payment or MOP (WCB-3)
This form is sent from an insurer to an injured worker and the WC Board to advise that a payment for lost time was made. It must include, at a minimum, the names of the employee, employer and insurance carrier, the date of injury, and the initial weekly WC rate.
2. Discontinuance or Modification of Compensation (WCB-4)
When the employee's benefits are discontinued or modified in accordance with a decree or agreement between the parties this form must be sent to the WC Board.
3. Consent between Employer and Employee (WCB-4A)
The employer or insurer must file this form with the WC Board when compensation is initiated, reduced, modified or discontinued based on an agreement of the parties outside the litigation process.
4. 21-day certificate of discontinuance (WCB-8)
When the employer is paying the worker ‘without prejudice’ (without admitting liability), it can discontinue WC benefits by mailing a 21-day certificate of discontinuance to provide advance notice to him. WC cannot be stopped earlier than 21 days from the date the certificate is mailed, and it must state the reasons for stopping payment. Sections 19-21 of the form (under ‘Discontinuance’) give information about the WC paid. Sections 24-26 (under ‘Modification’) provide information regarding the change in WC payments.
5. Notice of Controversy or NOC (WCB-9)
This form is sent from an employer to the injured worker and the WC Board to let them know the employer is denying the request for WC benefits.
Sections 24-26 (under ‘Modification’) provide information regarding the change in WC payments.
6. Lump Sum Settlement (WCB-10)
The employer, insurer, third-party administrator, employee, and/or attorney files the Lump Sum Settlement form to request approval of a lump sum settlement.
7. Statement of Compensation Paid (WCB-11)
This form is filed by the carrier within 6 months from the date of injury when WC benefits are paid, and on the injury date anniversary subsequent to that. A final report is filed when no further benefits are anticipated.
8. Agreement between Employer and Employee as to Permanent Impairment: of Compensation Paid (WCB-80)
This form is still used on cases with injury dates before 01/01/1993, although its use is not required (effective 01/01/1993 specific loss WC is paid as scheduled awards; see DI 52120.110A. 3. above for information on scheduled awards).
H. Exhibits – State forms