An Act To Amend the Laws Governing Workers' Compensation
Maine Legislature, Session 127, LD 1195
Committee: Labor, Commerce, Research and Economic Development
Sponsors: CUSHING, WARD, MASON, THIBODEAU, VOLK, WHITTEMORE, WOODSOME, GUERIN, LOCKMAN, O'CONNOR
Amends: 39-A MRSA §152, 39-A MRSA §152-A, 39-A MRSA §153, 39-A MRSA §201, 39-A MRSA §205, 39-A MRSA §303, 39-A MRSA §312, 39-A MRSA §318, 39-A MRSA §324, 39-A MRSA §325, 39-A MRSA §359

Legislative Document 
No. 1195 
S.P. 422 
In Senate, April 1, 2015 
An Act To Amend the Laws Governing Workers' Compensation 
Reference to the Committee on Labor, Commerce, Research and Economic Development 
suggested and ordered printed. 
HEATHER J.R. PRIEST 
Secretary of the Senate 
Presented by Senator CUSHING of Penobscot. 
Cosponsored by Representative WARD of Dedham and 
Senators: MASON of Androscoggin, President THIBODEAU of Waldo, VOLK of 
Cumberland, WHITTEMORE of Somerset, WOODSOME of York, Representatives: GUERIN 
of Glenburn, LOCKMAN of Amherst, O'CONNOR of Berwick. 
Be it enacted by the People of the State of Maine as follows: 
Sec. 1.  39-A MRSA §152, sub-§5, as enacted by PL 1991, c. 885, Pt. A, §8 and 
affected by §§9 to 11, is repealed. 
Sec. 2.  39-A MRSA §152, sub-§10, as enacted by PL 1991, c. 885, Pt. A, §8 and 
affected by §§9 to 11, is amended to read: 
10.  Case administration.  The board shall assume an active and forceful role in the 
administration of this Act to ensure that the system operates efficiently and with 
maximum benefit to both employers and employees.  It shall continually monitor 
individual cases to ensure that benefits are provided in accordance with this Act.  The 
board shall develop standards of conduct for attorneys that appear before the board or 
before hearing officers, or who participate in matters governed by this Title.  In 
establishing standards of conduct for attorneys, the board must be guided by the Maine 
Rules of Civil Procedure, Rule 11. 
Sec. 3.  39-A MRSA §152-A is enacted to read: 
§152-A.  Hearing officers 
1.  Appointment.  The Governor shall appoint 8 hearing officers, who are authorized 
to take action and enter orders consistent with this Act in all cases assigned to them by 
the board.  The appointments are subject to review by the joint standing committee of the 
Legislature having jurisdiction over labor matters and to confirmation by the Legislature. 
2.  Term.  A hearing officer serves an initial term of 3 years; a subsequent term is 5 
years. 
Sec. 4.  39-A MRSA §153, sub-§5, ¶E, as enacted by PL 1991, c. 885, Pt. A, §8 
and affected by §§9 to 11, is amended to read: 
E.  Whenever the board determines that a fraud, attempted fraud or violation of this 
Act or rules of the board may have occurred, the board shall report in writing all 
information concerning it to the Attorney General or the Attorney General's delegate 
for appropriate action, including a civil action for recovery of funds and criminal 
prosecution by the Attorney General., except that if the violation has resulted in a de 
minimis alteration in the calculation of an amount, a report to the Attorney General is 
not required. 
Sec. 5.  39-A MRSA §153, sub-§7, as enacted by PL 1991, c. 885, Pt. A, §8 and 
affected by §§9 to 11, is amended to read: 
7.  Investigation.  The board may, when the interests of any of the parties or when 
the administration of this Act demands, appoint a person to make a full investigation of 
the circumstances surrounding any industrial injury or any matter connected to an 
industrial injury, or conduct an audit pursuant to section 359 and report the same without 
delay to the board and the Superintendent of Insurance. 
Sec. 6.  39-A MRSA §153, sub-§9, as amended by PL 2005, c. 603, §3, is further 
amended to read: 
9.  Audit and enforcement.  The executive director shall establish an audit, 
enforcement and monitoring program by July 1, 1998, to ensure that all obligations under 
this Act are met, including the requirements of section 359.  The functions of the audit 
and enforcement program include, but are not limited to, auditing timeliness of payments 
and claims handling practices of insurers, self-insurers, the Maine Insurance Guaranty 
Association and 3rd-party administrators; determining whether insurers, self-insurers, the 
Maine Insurance Guaranty Association and 3rd-party administrators are unreasonably 
contesting claims; and ensuring that all reporting requirements to the board and the 
Superintendent of Insurance are met.  When auditing the Maine Insurance Guaranty 
Association, the program shall consider when the Maine Insurance Guaranty Association 
obtained the records of an insolvent insurer.  The program must be coordinated with the 
abuse investigation unit established by section 153, subsection 5 as appropriate.  The 
program must monitor activity and conduct audits pursuant to a schedule developed by 
the deputy director of benefits administration.  Audit working papers are confidential and 
may not be disclosed to any person outside of the board except the audited entity and the 
Superintendent of Insurance.  For purposes of this subsection "audit working papers" 
means all documentary and other information acquired, prepared or maintained by the 
board during the conduct of an audit or investigation, including all intra-agency and 
interagency communications relating to an audit or investigation and draft reports or any 
portion of a draft report.  The final audit report, including the underlying reconciled 
information, is not confidential.  At the end of each calendar quarter, the executive 
director shall prepare a compliance report summarizing the results of the audits and 
reviews conducted pursuant to this subsection.  The executive director shall submit the 
quarterly compliance reports to the board, the Bureau of Insurance and the Director of the 
Bureau of Labor Standards within the Department of Labor.  An annual summary must be 
provided to the Governor and to the joint standing committees of the Legislature having 
jurisdiction over labor and banking and insurance matters by February 15th of each year.  
The quarterly compliance reports and the annual summaries must be made available to 
the public following distribution. 
Sec. 7.  39-A MRSA §201, sub-§7 is enacted to read: 
7.  Medical appointments.  An employee who has sustained a personal injury arising 
out of and in the course of employment, and who has returned to work on a full-time 
basis, is entitled to compensation for time spent attending medical appointments related 
to the injury during hours that the employee is customarily at work, but the employer is 
not required to separately report such time. 
Sec. 8.  39-A MRSA §205, sub-§3, as amended by PL 2009, c. 129, §5 and 
affected by §13, is further amended to read: 
3.  Penalty for delay.  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.  For a first failure 
to pay, not more than $500 may be added pursuant to this subsection to the amount paid 
to the worker, and for a 2nd failure to pay, not more than $1,000 may be added pursuant 
to this subsection to the amount paid to the worker.  Not more than $1,500 in total may be 
added pursuant to this subsection.  For purposes of ratemaking, daily charges paid under 
this subsection do not constitute elements of loss.  For purposes of this subsection, 
"employer or insurance carrier" includes the Maine Insurance Guaranty Association 
under Title 24-A, chapter 57, subchapter 3. 
Sec. 9.  39-A MRSA §205, sub-§4, as amended by PL 2009, c. 129, §6 and 
affected by §13, is further amended to read: 
4.  Payment of bills for medical or health care services.  When there is no ongoing 
dispute, if bills for medical or health care services are not paid within 30 days after the 
carrier has received notice of nonpayment by certified mail from the provider of the 
medical or health care services or, if the bill was paid by the employee, from the 
employee who paid for the medical or health care services, $50 or the amount of the bill 
due, whichever is less, must be added and paid to the provider of the medical or health 
care services or, if the bill was paid by the employee, to the employee who paid for the 
medical or health care services for each day over 30 days in which the bills for medical or 
health care services are not paid. Not more than $1,500 in total may be added pursuant to 
this subsection.  For purposes of this subsection, "carrier" includes the Maine Insurance 
Guaranty Association under Title 24-A, chapter 57, subchapter 3. 
Sec. 10.  39-A MRSA §303, as amended by PL 2013, c. 63, §8, is further amended 
to read: 
§303.  Reports to board 
When any employee has reported to an employer under this Act any injury arising out 
of and in the course of the employee's employment that has caused the employee to lose a 
day's work, or when the employer has knowledge of any such injury, the employer shall 
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 such 
injury and fails to give timely notice to its insurer shall reimburse the insurer for any 
penalty that is due as a result of the late filing of the report of injury.  The employer shall 
also report the average weekly wages or earnings of the employee, as defined in section 
102, subsection 4, together with any other information required by the board, within 30 
days after the employer receives notice or has knowledge of a claim for compensation 
under section 212, 213 or 215, unless a wage statement has previously been filed with the 
board.  The wage statement must report the earnings or wages of the employee on a 
weekly basis, unless the employee is paid on other than a weekly basis, in which case the 
employer may report the earnings or wages in the same manner as earnings or wages are 
paid.  A copy of the wage information must be mailed to the employee.  The employer 
shall 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 shall 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 shall 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.  The employer is also required to 
submit the form to the board if the board has finally adopted a major substantive rule 
pursuant to Title 5, chapter 375, subchapter 2-A to require the form to be filed 
electronically. 
Sec. 11.  39-A MRSA §312, sub-§§3, 5 and 9, as enacted by PL 1991, c. 885, 
Pt. A, §8 and affected by §§9 to 11, are amended to read: 
3.  Appointment.  If the parties to a dispute can not agree on an independent medical 
examiner of their own choosing, the board shall assign an independent medical examiner 
within 30 days of a request by any party from the list of qualified examiners to render 
medical findings in any dispute relating to the medical condition of a claimant, including 
but not limited to disputes that involve the employee's medical condition, improvement or 
treatment, degree of impairment or ability to return to work. 
5.  Medical findings; fees.  The independent medical examiner shall submit within a 
reasonable time after the independent medical examiner's examination a written report to 
the board, the employer and the employee stating the examiner's medical findings on the 
issues raised by that case and providing a description of findings sufficient to explain the 
basis of those findings.  In any case in which the report is not filed within 60 days 
following the independent medical examiner's examination, the hearing officer shall 
inquire of the independent medical examiner the status of the independent medical 
examiner's review.  It is presumed that the employer and employee received the report 3 
working days after mailing.  The fee for the examination and report must be paid by the 
employer. 
9.  Annual review.  The board shall create a review process to oversee on an annual 
basis the quality of performance and the timeliness of the submission of medical findings 
by the independent medical examiners and shall publish its findings no later than July 1st 
of each year. 
Sec. 12.  39-A MRSA §318, first ¶, as enacted by PL 1991, c. 885, Pt. A, §8 and 
affected by §§9 to 11, is amended to read: 
The hearing officer shall hear those witnesses as may be presented or, by agreement, 
the claims of both parties as to the facts may be presented by affidavits.  If the facts are 
not in dispute, the parties may file with the hearing officer an agreed statement of facts 
for a ruling on the applicable law.  From the evidence or statements furnished, the hearing 
officer shall in a summary manner decide the merits of the controversy.  The hearing 
officer's decision must be rendered within 60 days of the close of evidence of the hearing, 
unless the executive director authorizes the hearing officer to take additional time to 
render the decision.  The hearing officer's decision must be filed in the office of the board 
and a copy, attested by the clerk of the board, mailed promptly to all parties interested or 
to the attorney of record of each party.  The hearing officer's decision, in the absence of 
fraud, on all questions of fact is final; but if the hearing officer expressly finds that any 
party has or has not sustained the party's burden of proof, that finding is considered a 
conclusion of law and is reviewable in accordance with section 322. 
Sec. 13.  39-A MRSA §324, sub-§2, as amended by PL 2009, c. 129, §10 and 
affected by §13, is further amended to read: 
2.  Failure to pay within time limits.  An employer or insurance carrier who fails to 
pay compensation, as provided in this section, is penalized as follows.  For purposes of 
this subsection, "employer or insurance carrier" includes the Maine Insurance Guaranty 
Association under Title 24-A, chapter 57, subchapter 3. 
A.  Except as otherwise provided by section 205, if an employer or insurance carrier 
fails to pay compensation as provided in this section, the board may assess against the 
employer or insurance carrier a fine of up to $200 for each day of noncompliance.  If 
the board finds that the employer or insurance carrier was prevented from complying 
with this section because of circumstances beyond its control, a fine may not be 
assessed. 
(1)  The fine for each day of noncompliance must be divided as follows:  Of each 
day's fine amount, the first $50 is paid to the employee to whom compensation is 
due and the remainder must be paid to the board and be credited to the Workers' 
Compensation Board Administrative Fund. 
(2)  If a fine is assessed against any employer or insurance carrier under this 
subsection on petition by an employee, the employer or insurance carrier shall 
pay reasonable costs and attorney's fees related to the fine, as determined by the 
board, to the employee. 
(3)  Fines assessed under this subsection may be enforced by the Superior Court 
in the same manner as provided in section 323. 
B.  Payment of a fine assessed under this subsection is not considered an element of 
loss for the purpose of establishing rates for workers' compensation insurance. 
Sec. 14.  39-A MRSA §325, sub-§4, as enacted by PL 1991, c. 885, Pt. A, §8 and 
affected by §§9-11, is amended to read: 
4.  Attorney's fees for lump-sum settlements.  Attorney's fees for lump-sum 
settlements pursuant to section 352 for injuries occurring after January 1, 2015 must be 
determined as follows: 
A.  Before computing the fee, reasonable expenses incurred on the employee's behalf 
must be deducted from the total settlement, including: 
(1)  Medical examination fee and witness fee; 
(2)  Any other medical witness fee, including cost of subpoena; 
(3)  Cost of court reporter service; and 
(4)  Appeal costs; and 
B.  The computation of the fee, based on the amount resulting after deductions 
according to paragraph A, may not exceed: 
(1)  Ten percent of the first $50,000 of the indemnity benefits of the settlement; 
(2)  Nine percent of the first $10,000 over $50,000 of the indemnity benefits of 
the settlement; 
(3)  Eight percent of the next $10,000 over $50,000 of the indemnity benefits of 
the settlement; 
(4)  Seven percent of the next $10,000 over $50,000 of the indemnity benefits of 
the settlement; 
(5)  Six percent of the next $10,000 over $50,000 of the indemnity benefits of the 
settlement; and 
(6)  Five percent of any amount over $90,000 of the indemnity benefits of the 
settlement. 
C.  A fee may not be assessed for the amount of any settlement intended to pay for 
current or future medical costs. 
Sec. 15.  39-A MRSA §359, as amended by PL 2009, c. 129, §11 and affected by 
§13, is further amended to read: 
§359.  Audits; penalty; monitoring 
1.  Audits.  The board shall audit claims, including insurer, self-insurer, Maine 
Insurance Guaranty Association and 3rd-party administrator claim files, on an ongoing 
basis to determine whether insurers, self-insured employers, the Maine Insurance 
Guaranty Association and 3rd-party administrators have met their obligations under this 
Act and to identify the disputes that arose, the reasons for the disputes, the method and 
manner of their resolution, the costs incurred, the reasons for attorney involvement and 
the services rendered by the attorneys.  Any de minimis error in the calculation of average 
weekly wage may not be considered in the calculation of any penalty under this section. 
If as a result of an examination and after providing the opportunity for a hearing the board 
determines that any compensation, interest, penalty or other obligation is due and unpaid 
to an employee, dependent, service provider or any other entity, the board shall issue a 
notice of assessment detailing the amounts due and unpaid in each case and shall order 
the amounts paid to the unpaid party or parties. 
After an audit and examination, if the board determines that an assessment in the 
aggregate could equal or exceed the amount of compensation, interest, penalty or other 
obligations identified in audit, a hearing must be held before a 3-member panel composed 
of the executive director, a hearing officer appointed by the board and the Superintendent 
of Insurance or the superintendent's designee.  The superintendent or the superintendent's 
designee shall serve as the chair of the panel.  The panel shall render its decision by 
majority vote and advise the board of its decision.  The board shall then issue a notice of 
assessment accordingly. 
2.  Penalty.  In addition to any other penalty assessment permitted under this Act, the 
board Superintendent of Insurance may assess civil penalties not to exceed $25,000 upon 
finding, after hearing, that an employer, insurer or 3rd-party administrator for an 
employer has engaged in a pattern of questionable claims-handling techniques or repeated 
unreasonably contested claims.  The board shall certify its findings to the The 
Superintendent of Insurance, who shall take appropriate action so as to bring any such 
practices to a halt.  This certification by the board is exempt from the provisions of the 
Maine Administrative Procedure Act.  The amount of any penalty assessed pursuant to 
this subsection must be directly related to the severity of the pattern of questionable 
claims-handling techniques or repeated unreasonably contested claims.  All penalties 
collected pursuant to this subsection must be deposited in the General Fund.  An 
insurance carrier's payment of any penalty assessed under this section may not be 
considered an element of loss for the purpose of establishing rates for workers' 
compensation insurance. 
3.  Monitoring.  No later than July 1, 1993 the board shall implement a monitoring 
program to evaluate and compare the cost, utilization and performance of the workers' 
compensation system for each calendar year beginning with 1988.  The information 
compiled must include the number of injuries occurring and claims filed as compared to 
employment levels, the type and cost of the benefits provided, attorney involvement and 
litigation levels, and the long-term, postinjury economic status of injured workers, as well 
as any other data that is actuarially valid and can be utilized to accomplish the purposes 
of this Act, including rulemaking and recommending legislation.  The board shall report 
the results of its monitoring program to the joint standing committee having jurisdiction 
over workers' compensation matters on an annual basis by March 1st of each year. 
Sec. 16.  Task force.  The Workers' Compensation Board, established in the Maine 
Revised Statutes, Title 39-A, shall convene a task force to study psychological injury and 
impairment arising out of injuries sustained by employees in the course of employment.  
The board shall invite the participation of health care professionals, including 
psychiatrists,  psychologists, licensed clinical professional counselors; attorneys; a 
representative of Maine Employers' Mutual Insurance Company; a commercial workers' 
compensation insurance  carrier; a representative of the Workers' Compensation 
Coordinating Council of Maine; a representative of the Maine AFL-CIO; a representative 
of the Maine State Chamber of Commerce; and the Superintendent of Insurance. 
In conducting its review, the task force shall evaluate the appropriate clinical standards 
for use in the evaluation of psychological impairment, the degree to which claims based 
on psychological impairment have increased or decreased over the past 10 years and the 
extent to which employees who have been diagnosed as suffering a psychological 
impairment arising out of a work-related injury have been able to return to gainful 
employment. 
No later than February 1, 2016, the Worker's Compensation Board shall submit the report 
of the task force, together with any recommendations, to the Joint Standing Committee on 
Labor, Commerce, Research and Economic Development. 
SUMMARY 
This bill makes the following changes to the laws governing workers' compensation 
and the Workers' Compensation Board, or "board." 
1.  It repeals language requiring the board to hire qualified persons to serve as hearing 
officers, and instead requires hearing officers to be appointed by the Governor and 
confirmed by the Senate. 
2.  Current law authorizes the board to establish the terms of hearing officers by rule; 
this bill instead provides that the initial term of a hearing officer is 3 years and subsequent 
terms are 5 years. 
3.  It provides that if a violation of the Maine Workers' Compensation Act of 1992 
results in a de minimus alteration to a calculation of benefits, a report to the Attorney 
General is not required. 
4.  It requires that a person appointed to investigate circumstances surrounding an 
industrial injury or to conduct an audit must submit a report of the investigation or audit 
to the Superintendent of Insurance as well as to the board. 
5.  It eliminates authorization for the board to audit the Maine Insurance Guaranty 
Association. 
6.  It authorizes the disclosure of audit working papers to the Superintendent of 
Insurance. 
7.  It provides that an employee who has received a personal injury arising out of and 
in the course of employment and who has returned to work on a full-time basis is entitled 
to compensation for time spent attending medical appointments related to the injury that 
occur during hours that the employee is customarily at work. 
8.  It specifies that for a first failure to pay benefits, the penalty for delay of $50 per 
day may not be more than $500, and that for a second failure to pay, the penalty for delay 
of $50 per day may not be more than $1,000. 
9.  It eliminates language identifying the Maine Insurance Guaranty Association as an 
employer or insurance carrier for purposes of assessing penalties for delay in payment. 
10.  It specifies that wage statements must report wages of the employee in the same 
manner as wages are paid. 
11.  It requires that if an independent medical examiner is assigned by the board, the 
assignment must be made within 30 days of the request. 
12.  It requires that the independent medical examiner submit a written report of 
findings within a reasonable time following the examination.  If a report is not filed 
within 60 days following the examination, the hearing officer is directed to follow up 
with the independent medical examiner. 
13.  It requires the board to annually publish its findings regarding the quality and 
timeliness of the submission of medical findings by independent medical examiners. 
14.  It requires hearing officers to render decisions within 60 days of the close of 
evidence of a hearing unless the executive director authorizes the hearing officer to take 
additional time to render the decision. 
15.  It specifies that the law governing the determination of attorney's fees for lump-
sum settlements applies to injuries occurring after January 1, 2015; that the computation 
of the amount is based on the indemnity benefits of the settlement; and that a fee may not 
be assessed for the amount of any settlement intended to pay for current or future medical 
costs. 
16.  It specifies that a de minimus error in the calculation of average weekly wage 
may not be considered in the calculation of a penalty. 
17.  It specifies that, if after an audit the board determines that an assessment in the 
aggregate could equal or exceed the amount of compensation, interest, penalty or other 
obligations, a hearing must be held before a panel composed of the executive director of 
the board, the Superintendent of Insurance and a hearing officer appointed by the board. 
18.  It authorizes the Superintendent of Insurance, rather than the board, to assess 
civil penalties if it is found that an employer, insurer or 3rd-party administrator for an 
employer has engaged in a pattern of questionable claims-handling techniques or repeated 
unreasonable contested claims. 
19.  It requires the board to annually report the results of its monitoring program to 
the joint standing committee of the Legislature having jurisdiction over workers' 
compensation matters. 
20.  It directs the board to conduct a study regarding psychological injury and 
impairment arising out of injuries sustained by employees in the course of employment.