The Maine workers’ compensation system covers medical treatment and pays benefits to employees who are injured at work. Workers’ comp is usually the employee’s only recourse for getting compensation. (There are a few exceptions that would allow an employee to sue in court; to learn more, see Workplace Injury: When You Can Sue Outside of Workers’ Compensation.) This article explains the workers’ comp process in Maine and how to file a claim if you were injured at work.
Nearly all private employers in Maine are required to have workers’ compensation coverage for their employees. Employers often fulfill this obligation by securing coverage through a private insurance company. The insurance company reviews claims and decides whether to pay benefits. The Maine Workers’ Compensation Board oversees the workers’ compensation system and resolves disputes between employees and insurance companies.
Workers’ compensation covers injuries that happen in the course and scope of employment. Injuries that happen at work or off-site while the employee is performing work-related tasks, are typically covered. Although workers’ comp is a no-fault system, injuries caused by certain misconduct will typically not be covered. For example, injuries caused by the worker’s own intoxication or by instigating a fight with a coworker are not covered. (For more information, see Workers’ Compensation: Is Your Injury or Illness Work-Related?)
The first step to making a workers’ comp claim is to report your injury to your employer. You have 30 days to provide notice, but it is best to notify your employer right away. The sooner you make your claim, the sooner you can receive medical treatment and benefits.
Once your employer has received notice, it must file a First Report of Injury with the Workers’ Compensation Board. Your employer is required to give you a copy of this form. If you don’t receive it, you can call a troubleshooter at the Workers’ Compensation Board who can help.
Your employer should also notify its insurance company of your claim. The insurance company will evaluate your claim, usually by talking to you, your employer, and your doctors. The insurance company has 14 days to decide whether to accept or deny your claim.
You should also get medical treatment right away. If you need emergency treatment, you should go to the nearest emergency room or urgent care. For non-emergency treatment, you must check with your employer first. If your employer has a designated doctor for work injuries, you must treat with that doctor for the first ten days. After that, you can switch doctors, but you must give your employer notice beforehand.
Workers’ compensation pays for all necessary medical treatment related to your work injury. This includes the cost of doctors’ visits, hospital stays, prescriptions, and medical equipment. You can also receive disability benefits if you need time off work or if your injury causes permanent impairment.
If the insurance company denies your claim, you can challenge its decision with the Maine Workers’ Compensation Board. (For common grounds for a denial, see Denied Workers’ Compensation Claims.) To do so, you must file a petition with the Workers’ Compensation Board. If you haven’t received any benefit payments, you must file within two years of your injury or within two years of the date your employer filed a First Report of Injury. If you have received benefit payments within two years of your injury, you have six years to file your petition.
Many workers can handle the initial workers’ comp claim process on their own. However, if the insurance company denies your claim or disputes the amount of benefits you are entitled to, you should consider hiring a lawyer. This is especially true if you need to attend a workers’ comp hearing, which follow complex procedural rules. For more information, see Should I Hire a Workers’ Comp Attorney or Can I Handle My Own Case?