Most Maine businesses with employees are required to pay for workers’ compensation insurance (WC or workers’ comp insurance). The insurance provides compensation to employees who suffer work-related injuries. Here are some basic facts that you need to know about workers’ comp insurance in Maine as a business owner and employer.
If your Maine business has just one employee, you’re generally required to carry workers’ compensation insurance. Two key exceptions apply to household employees (engaged in domestic service) and certain types of agricultural employment, but there are also a few other, narrow exceptions. In addition, business owners, such as members of LLCs, partners in partnerships, and sole proprietors, are not required to be covered by workers’ compensation insurance.
The Maine Workers’ Compensation Board (WCB) is the primary state agency that handles workers’ comp claims. Most of the law for WC insurance is contained in Maine’s Workers’ Compensation Act (Title 39-A of the Maine Revised Laws). In addition to the Act, there are also administrative rules that cover workers’ compensation in Maine.
In Maine, workers’ compensation insurance is available through a limited market of private insurance companies. If your business is unable to obtain coverage through a private insurer, you can get coverage through the Maine Employers Mutual Insurance Company (MEMIC). There is also an option to self-insure, but this may not be advisable for smaller businesses, in part because it requires that a lot of money be set aside to cover potential claims.
The injured employee should tell you as soon as possible that he or she is injured. The employee has 30 days from the date of the injury to notify you. If the employee doesn’t notify you within that period, he or she may lose rights to workers’ compensation benefits.
Assuming you aren’t disputing that the employee was injured, you then have seven days to file a Form WCB-1, Employer’s First Report of Occupational Injury or Disease, with the WCB. In addition, for the first ten days after the injury, you have the right to select the health care providers who will treat the employee’s injury. After that time, the employee can choose other providers if they wish. And, within 14 days, you must start paying WC benefits to the employee.
Beyond these initial steps, there are subsequent steps to the WC claims process, not covered here.
If you think your employee’s workers’ comp claim isn’t valid, you can file Form WCB-9, Notice of Controversy (NOC), rather than a Report of Injury. File the form online. By filing an NOC, you are denying WC benefits to the employee, and initiating a claim dispute process. You have fourteen days from the date you’re notified of the injury to decide whether you want to dispute the claim.
Within two weeks of your filing an NOC, the WCB will have a so-called troubleshooter contact your employer to get more information. If the troubleshooter can’t resolve the dispute, the matter will go to mediation, which is an informal dispute resolution process. If mediation does not lead to a resolution, the matter will move to a formal hearing.
If you still are not happy after the WCB’s formal hearing, you can appeal to a state appellate court.
If you don’t carry workers’ compensation insurance, you may be subject to a penalty of $10,000 or 108% of the premium you would otherwise owe if MEMIC were your insurer, whichever is larger. Other penalties can also apply. Some of the penalties are contained in Section 324 of Maine’s Workers’ Compensation Act.
There are many other workers’ compensation requirements for Maine employers, such as putting up posters about workers’ compensation coverage where employees can see them. The Nolo website has a section devoted to workers’ compensation. In addition, the Maine Workers’ Compensation Commission website also contains many useful resources.