reglab/statecodes huggingface dataset:
Code of Maine Rules › 90 - INDEPENDENT AGENCIES › 351 - WORKERS' COMPENSATION BOARD › Chapter 6 - REHABILITATION › Subchapter II - APPLICATION AND PLAN › Section 351-6-3 - Evaluation for Suitability

Current through 2024-29, July 17, 2024
1. A party seeking
				  rehabilitation services must file an Application for Evaluation for Employment
				  Rehabilitation Services (WCB-320) pursuant to
				  39-A M.R.S.A.
				  §217(1) with the
				  Executive Director or the Executive Director's designee.
A. The application must be complete, include
				  copies of relevant medical records, and indicate whether the employee is
				  receiving benefits or has received benefits;
B. The applicant must provide a copy of the
				  application and an attachment index to the parties; and
C. Proposed rehabilitation plans will not be
				  accepted with the application.
Code of Maine Rules › 90 - INDEPENDENT AGENCIES › 351 - WORKERS' COMPENSATION BOARD › Chapter 6 - REHABILITATION › Subchapter II - APPLICATION AND PLAN › Section 351-6-4 - Proposed Employment Rehabilitation Plan

Current through 2024-29, July 17, 2024
1. Upon receipt of a proposed plan, the
				  Executive Director or the Executive Director's designee shall forward the plan
				  to all interested parties.
2. No
				  later than 10 business days after receipt of the plan:
A. The Executive Director or the Executive
				  Director's designee, or an interested party may request clarification of the
				  plan.
i. Requests for clarification must
				  include specific, written questions to the provider, with copies provided to
				  the Executive Director or the Executive Director's designee, and interested
				  parties; and
ii. The provider shall
				  respond to the request in writing and amend the report as needed, or request a
				  conference, with copies provided to the Executive Director or the Executive
				  Director's designee, and interested parties, no later than 10 business days
				  after receipt of the request for clarification.
Code of Maine Rules › 90 - INDEPENDENT AGENCIES › 351 - WORKERS' COMPENSATION BOARD › Chapter 6 - REHABILITATION › Subchapter II - APPLICATION AND PLAN › Section 351-6-5 - Extension and Modification Requests; Parties

Current through 2024-29, July 17, 2024
1. If a provider requests an extension or
				  modification of a previously approved plan, the provisions of §4
				  subsections
				  1 through 4 apply.
Code of Maine Rules › 90 - INDEPENDENT AGENCIES › 351 - WORKERS' COMPENSATION BOARD › Chapter 6 - REHABILITATION › Subchapter II - APPLICATION AND PLAN › Section 351-6-6 - Plan Termination

Current through 2024-29, July 17, 2024
An employment rehabilitation plan may end in the following
					 ways:
1. The provider notifies the
				  parties and the Executive Director or the Executive Director's designee,
				  through a closure report, that services outlined in the plan have been
				  completed.
2. The duration allowed
				  under §217(5) has expired.
3.
				  A provider's request for an extension of time is denied by the Executive
				  Director or the Executive Director's designee, or, if there is an objection to
				  the request, by the Hearing Officer or ALJ.
4. The provider terminates the plan because
				  the applicant is unwilling or unable to continue, or is otherwise
				  uncooperative.
5. The parties enter
				  into an agreement to end the plan.
6. A Hearing Officer or ALJ orders the plan
				  to end.
7. The applicant's workers'
				  compensation claim lump sum settles. The Employment Rehabilitation Fund is not
				  responsible for costs incurred after a case is lump sum settled. If the
				  provider was not notified of the date of the lump sum settlement, then any
				  costs incurred after the settlement date shall be paid by the
				  employer/insurer.
Code of Maine Rules › 90 - INDEPENDENT AGENCIES › 351 - WORKERS' COMPENSATION BOARD › Chapter 6 - REHABILITATION › Subchapter II - APPLICATION AND PLAN › Section 351-6-7 - Recovery of Costs

Current through 2024-29, July 17, 2024
1. If an injured
				  employee returns to suitable employment after completing a rehabilitation plan
				  to which the employer/insurer did not agree to pay, the Executive Director or
				  the Executive Director's designee shall order the employer/insurer to pay an
				  amount equal to 180% of the costs paid, except the cost of the evaluation, from
				  the Employment Rehabilitation Fund.
2. The employer/insurer shall, no later than
				  14 days after receipt of the Board's order, either pay the amount ordered by
				  the Board or file a petition in the Central Office of the Workers' Compensation
				  Board objecting to the order.
3. If
				  a timely petition is received, the Board shall refer the matter to
				  mediation.
4. If the matter is not
				  resolved during mediation, the matter will be forwarded to a Hearing Officer or
				  ALJ for hearing.
A. The provisions of Chapter
				  12, §§3 6, 9, and 12-19 apply to hearings conducted under this
				  section.
B. The employer/insurer
				  may raise all issues and defenses that were, or could have been raised, in any
				  prior proceeding conducted under this chapter or §217.
C. The Hearing Officer or ALJ's decision is
				  subject to appeal as set forth in
				  39-A M.R.S.A.
				  §321-B.
Code of Maine Rules › 90 - INDEPENDENT AGENCIES › 351 - WORKERS' COMPENSATION BOARD › Chapter 7 - UTILIZATION REVIEW, TREATMENT GUIDELINES, PERMANENT IMPAIRMENT › Section 351-7-1 - Certification

Current through 2024-29, July 17, 2024
1. An entity may conduct utilization review
				only if that entity is certified by the Board.
2. An Insurer, Self-Insurer or Group
				Self-Insurer which contracts with another entity to perform utilization review
				activities, maintains full responsibility for compliance with Maine Workers'
				Compensation law and Board Rules.
3. To become certified by the Board, the
				entity shall show proof of one the following by attaching the appropriate
				documentation:
A.
Unconditional
				Certification
: Accreditation by the Utilization Review Accreditation
				Commission (URAC) under URAC's National Workers' Compensation Utilization
				Management Standards by providing a copy of the Certificate of Accreditation
				and any other documents/information as requested by the Board; or
B.
Conditional Certification
:
				Verification that an Application for Accreditation under URAC's National
				Workers' Compensation Utilization Management Standards has been submitted to
				URAC by providing a copy of the URAC confirmation letter indicating the
				application is under review and any other documents/information as requested by
				the Board.
(1) The entity requesting Board
				certification shall advise the Board if the URAC application is withdrawn or
				denied. Withdrawal or denial of the URAC application shall result in immediate
				revocation of Board certification.
(2) Within six months of applying for a
				Conditional Certification, an entity must submit proof of accreditation as
				outlined in A above and achieve Unconditional Certification. If proof of
				accreditation is not provided, immediate revocation of Board certification will
				result. Entities may re-apply for Board certification as outlined in this
				Chapter at any time.
Code of Maine Rules › 90 - INDEPENDENT AGENCIES › 351 - WORKERS' COMPENSATION BOARD › Chapter 7 - UTILIZATION REVIEW, TREATMENT GUIDELINES, PERMANENT IMPAIRMENT › Section 351-7-3 - Utilization Review; Procedures

Current through 2024-29, July 17, 2024
1. When an
				employer/insurer requests Utilization Review, the employer/ insurer must notify
				the injured employee that it intends to initiate Utilization Review.
2. Notice to the employee must, at a minimum,
				contain:
A. An explanation of the reason(s)
				Utilization Review is being requested;
B. Identification of the Utilization Review
				Agent that has been selected; and
C. Notice that the injured employee can send
				a letter to the Utilization Review Agent, within 10 days, explaining why the
				contested treatment is appropriate.
Code of Maine Rules › 90 - INDEPENDENT AGENCIES › 351 - WORKERS' COMPENSATION BOARD › Chapter 7 - UTILIZATION REVIEW, TREATMENT GUIDELINES, PERMANENT IMPAIRMENT › Section 351-7-4 - Board Appeals

Current through 2024-29, July 17, 2024
1. Once a health
				care provider or an employee has received final notification that health care
				services will not be certified by the UR Agent, the health care provider,
				employee or their representative may initiate a Board Appeal by submitting a
				copy of the notification not to certify to the Board. This submission shall be
				referred to the appropriate Claims Resolution Specialist. If the Claims
				Resolution Specialist is unable to informally resolve the dispute, it shall be
				scheduled for mediation.
2. Once a
				provider receives notification that they are liable for the return of any fees,
				the provider may submit a copy of the notification to the Board. This
				submission shall be referred to the appropriate Claims Resolution Specialist.
				If the Claims Resolution Specialist is unable to informally resolve the
				dispute, it shall be scheduled for mediation.
3. If the mediator is unable to informally
				resolve the dispute, the matter shall, upon appropriate petition, be scheduled
				for a formal hearing.
4. Except as
				provided in Section 3.3, a Utilization Review report is admissible as evidence
				of the appropriateness in terms of both the level and quality of health care
				and health care services provided an injured employee, but is not binding on
				these issues.
Code of Maine Rules › 90 - INDEPENDENT AGENCIES › 351 - WORKERS' COMPENSATION BOARD › Chapter 7 - UTILIZATION REVIEW, TREATMENT GUIDELINES, PERMANENT IMPAIRMENT › Section 351-7-5 - Definitions

Current through 2024-29, July 17, 2024
1.
Board Appeal
: If a health
				care provider or injured employee disagrees with the determination rendered in
				the utilization review process, that party may appeal to the Board by
				submitting a copy of the notification not to certify.
2.
Conditional Certification
:
				Certification by the Board of an entity to perform utilization review
				activities that requires proof of application for accreditation with the
				Utilization Review Accreditation Commission (URAC) under URAC's National
				Workers' Compensation Utilization Management Standards.
3.
Insurer
: An insurance
				carrier, self-insurer or group self-insurer.
4.
Treatment Guidelines
:
				Standards of care and clinical pathways approved by the Workers' Compensation
				Board.
5.
Unconditional
				Certification
: Certification by the Board of an entity to perform
				utilization review activities that requires proof of accreditation by the
				Utilization Review Accreditation Commission (URAC) under URAC's National
				Workers' Compensation Utilization Management Standards.
6.
Utilization Review (UR)
: The
				initial prospective, concurrent or retrospective evaluation of the
				appropriateness in terms of both the level and the quality of health care and
				health services provided an injured employee, based on the appropriate Maine
				Workers' Compensation Board Treatment Guidelines.
7.
Utilization Review Accreditation
				Commission (URAC)
: a non-profit organization established to encourage
				efficient and effective utilization management processes and to develop and
				provide a method of evaluation and accreditation of utilization management
				programs.
8.
Utilization
				Review Agent
: Any person or entity, including insurance carriers,
				self-insurers, and group self-insurers, certified by the Board, to perform
				utilization review activities.
Code of Maine Rules › 90 - INDEPENDENT AGENCIES › 351 - WORKERS' COMPENSATION BOARD › Chapter 8 - PROCEDURES FOR PAYMENT › Section 351-8-1

Current through 2024-29, July 17, 2024
The initial Statement of Compensation Paid, Interim Report
				  (WCB-11) shall be filed with the Board within 195 days of the date of an injury
				  where indemnity payments have been made, and as a Final Report when no further
				  payments are anticipated. Subsequent Statements of Compensation Paid (WCB-11)
				  shall thereafter be filed with the Board within fifteen (15) days of each
				  anniversary date of an injury when payments of any type have been made since
				  the previous Statement of Compensation Paid (WCB-11). The Statement of
				  Compensation Paid (WCB-11) is required when only medical payments are made
				  subsequent to the filing of a Final Report. There is no requirement to file the
				  Statement of Compensation Paid on claims when payments are made for medical
				  only services and no indemnity was ever paid on the claim.
Code of Maine Rules › 90 - INDEPENDENT AGENCIES › 351 - WORKERS' COMPENSATION BOARD › Chapter 8 - PROCEDURES FOR PAYMENT › Section 351-8-2

Current through 2024-29, July 17, 2024
In cases in which the employee's claim is only for medical
				  expenses, the employer may file a single Notice of Controversy for purposes of
				  contesting all present and future claims for medical expenses accrued until the
				  Board enters an order resolving the Notice of Controversy. A copy of this
				  Notice of Controversy must be sent to health care provider if the
				  reasonableness of the health care provider's bill is being contested. Except as
				  provided in W.C.B. Rule Ch. 5, the employer is not required to file a Notice of
				  Controversy contesting a claim for medical expenses if there is already a
				  pending Notice of Controversy indicating a dispute on the employee's claim for
				  compensation for the same date of injury.
Code of Maine Rules › 90 - INDEPENDENT AGENCIES › 351 - WORKERS' COMPENSATION BOARD › Chapter 8 - PROCEDURES FOR PAYMENT › Section 351-8-3

Current through 2024-29, July 17, 2024
When an employee is paid 1/2 day or more wages on the date of
				  injury, the date of injury will not be considered a day of
				  incapacity.
Code of Maine Rules › 90 - INDEPENDENT AGENCIES › 351 - WORKERS' COMPENSATION BOARD › Chapter 8 - PROCEDURES FOR PAYMENT › Section 351-8-4

Current through 2024-29, July 17, 2024
Incapacity compensation benefit payments shall be paid weekly
				  and directly to the employee entitled to that compensation at that employee's
				  last known mailing address, or at any place that employee
				  designates.
Code of Maine Rules › 90 - INDEPENDENT AGENCIES › 351 - WORKERS' COMPENSATION BOARD › Chapter 8 - PROCEDURES FOR PAYMENT › Section 351-8-5

Current through 2024-29, July 17, 2024
If the employee's date of injury is on or after January 1,
				  2013, the employee's incapacity benefits must be calculated by multiplying the
				  employee's gross average weekly wage by two (2) and then dividing that amount
				  by three (3).
Code of Maine Rules › 90 - INDEPENDENT AGENCIES › 351 - WORKERS' COMPENSATION BOARD › Chapter 8 - PROCEDURES FOR PAYMENT › Section 351-8-6

Current through 2024-29, July 17, 2024
The employer is obligated to make all payments of benefits
				  ordered by an Administrative Law Judge of the Workers' Compensation Board
				  pending the issuance of further findings of fact and conclusions of law
				  requested pursuant to
				  39-A M.R.S.A.
				  §318 and pending any appellate
				  process.
Code of Maine Rules › 90 - INDEPENDENT AGENCIES › 351 - WORKERS' COMPENSATION BOARD › Chapter 8 - PROCEDURES FOR PAYMENT › Section 351-8-7

Current through 2024-29, July 17, 2024
Interest on awards of compensation must be calculated by the
				  employer and paid to the employee pursuant to
				  39-A M.R.S.A.
				  §205(6). Interest must
				  be paid to the employee even if there is no express language in the decision of
				  the mediator or Administrative Law Judge ordering such payment. Interest must
				  be calculated using the formulae and table contained in Appendix
				  I.
Code of Maine Rules › 90 - INDEPENDENT AGENCIES › 351 - WORKERS' COMPENSATION BOARD › Chapter 8 - PROCEDURES FOR PAYMENT › Section 351-8-8

Current through 2024-29, July 17, 2024
A. If the injured employee's date of injury
				is prior to January 1, 2013, partial benefits are calculated at a rate of 80%
				of the difference between the employee's after-tax average weekly wage before
				the injury and the after-tax average weekly wage that the employee is able to
				earn after the injury, but not more than the maximum benefit under section 211.
				To calculate partial benefits:
1. Determine
				the 80% rate for the employee's pre-injury average weekly wage using the Weekly
				Benefit Table in effect at the time of the employee's injury.
2. Determine the 80% rate for the employee's
				post-injury weekly earnings using the Benefit Table used in step 1
				above.
3. The difference between
				the post-injury rate and the pre-injury rate is the partial benefit
				amount.
Code of Maine Rules › 90 - INDEPENDENT AGENCIES › 351 - WORKERS' COMPENSATION BOARD › Chapter 8 - PROCEDURES FOR PAYMENT › Section 351-8-9

Current through 2024-29, July 17, 2024
For dates of injury prior to January 1, 2013, form WCB-2A
				  shall be completed based on the employee's federal tax return filed for the
				  calendar year prior to the employee's date of injury, unless the employee
				  demonstrates a change in marital status or number of dependents since the
				  calendar year for which the tax return was filed.
Code of Maine Rules › 90 - INDEPENDENT AGENCIES › 351 - WORKERS' COMPENSATION BOARD › Chapter 8 - PROCEDURES FOR PAYMENT › Section 351-8-10

Current through 2024-29, July 17, 2024
If an employee is released to return to work without
				  restrictions or limitations due to the injury before exhausting the seven day
				  waiting period, a Notice of Controversy is not required to be filed regarding
				  incapacity benefits unless the employee makes a specific claim for
				  benefits.
Code of Maine Rules › 90 - INDEPENDENT AGENCIES › 351 - WORKERS' COMPENSATION BOARD › Chapter 8 - PROCEDURES FOR PAYMENT › Section 351-8-11

Current through 2024-29, July 17, 2024
Reductions or discontinuances pursuant to
				  39-A M.R.S.A.
				  §205(9)(A) are governed
				  by this section.
1. Except as provided
				in paragraph (2) of this sub-section, reductions and discontinuances pursuant
				to
				39-A M.R.S.A.
				§205(9)(A) must be
				based on the employee's actual earnings.
2. An employer may discontinue benefits
				regardless of the employee's actual earnings if:
A. The employee returns to work without
				restrictions or limitations, due to the injury for which benefits are being
				paid, according to the employee's treating health care providers; and
B. There are no conflicting medical records
				with respect to the lack of restrictions or limitations due to the injury for
				which benefits are being paid.
C.
				For purposes of this subsection, return to work includes periods where:
(1) The employee is released to return to
				work without restrictions or limitations due to the injury for which benefits
				are being paid by the employee's treating health care providers;
(2) There are no conflicting medical records
				with respect to the lack of restrictions or limitations due to the injury for
				which benefits are being paid; and
(3) The employee, instead of returning to
				work, receives vacation pay, "paid time off" or its equivalent, or holiday pay
				instead of regular wages.
Code of Maine Rules › 90 - INDEPENDENT AGENCIES › 351 - WORKERS' COMPENSATION BOARD › Chapter 8 - PROCEDURES FOR PAYMENT › Section 351-8-12

Current through 2024-29, July 17, 2024
When an employer or insurer makes payments of compensation
				  pursuant to an agreement by the parties or a decision of the Board, the
				  employer or insurer shall document such payments by completing the appropriate
				  sections of Form WCB-3, Form WCB-4, and/or Form WCB-11.
Code of Maine Rules › 90 - INDEPENDENT AGENCIES › 351 - WORKERS' COMPENSATION BOARD › Chapter 8 - PROCEDURES FOR PAYMENT › Section 351-8-13

Current through 2024-29, July 17, 2024
If the employer or insurer disputes a medical bill on a claim
				  for which a First Report was never filed, the employer or insurer shall file a
				  First Report with the Notice of Controversy as set forth in W.C.B. Rule Ch. 3,
				  §
									4.
Code of Maine Rules › 90 - INDEPENDENT AGENCIES › 351 - WORKERS' COMPENSATION BOARD › Chapter 8 - PROCEDURES FOR PAYMENT › Section 351-8-15

Current through 2024-29, July 17, 2024
Pursuant to P.L. 2009, c. 280, reductions and/or
				  discontinuances based on earnings when an employee returns to work with a
				  different employer and an employer/insurer has filed a 21-day certificate of
				  discontinuance or a Petition for Review are governed by this section.
1. Actual documented earnings must be
				provided by the employee or the employee's representative to the
				employer/insurer within 7 days of the employee's return to work as required by
				 39-A M.R.S.A.
				§308(1). Actual
				documented earnings must be received by the employer/insurer from the employee
				or the employee's representative in writing. The documentation may be pay stubs
				or other suitable written evidence to substantiate the discontinuance or
				reduction.
2.
Reduction or
				discontinuance pursuant to §205(9)(B)(1)
A. When benefits are discontinued or reduced
				pursuant to §205(9)(B)(1), actual documented earnings means the written
				documentation relied upon by the employer/insurer to justify the reduction or
				discontinuance indicated in the 21-day certificate of discontinuance.
B. The employer/insurer must include, with
				the 21-day certificate of discontinuance, form WCB-231A (Employee's Return to
				Work Report) along with the following statement:
NOTICE
Your weekly benefits will be reduced or discontinued each
				  week to the amount shown on the 21-day certificate of discontinuance. You are
				  required to provide documentation to the insurer of your weekly earnings for
				  the 21-day period by completing the enclosed "Employee's Return to Work
				  Report." If you fail to provide documentation, the reduction or discontinuance
				  shown on the 21-day certificate of discontinuance shall remain in effect and
				  your benefits will not be adjusted.
C. Within 14 calendar days after the
				expiration of the 21-day period, or within 14 days after receipt of
				documentation from the employee if the documentation is received after the
				expiration of the 21-day period, the employer/insurer shall file with the Board
				the documentation it has received along with an amended form WCB-8 which shall
				also include any necessary adjustments based on the documentation received by
				the employer/insurer.
Code of Maine Rules › 90 - INDEPENDENT AGENCIES › 351 - WORKERS' COMPENSATION BOARD › Chapter 8 - PROCEDURES FOR PAYMENT › Section 351-8-16

Current through 2024-29, July 17, 2024
When an employee loses a day or more from work that does not
				  result in the filing of a Memorandum of Payment or a Notice of Controversy, the
				  employer/insurer shall notify the Board of the employee's return to work date,
				  if the date was not included on the original First Report, by filing an 02
				  First Report using the IAIABC Claims Release 3 format. The employee's return to
				  work date shall be filed within seven (7) days of the employee's return to
				  work.
Code of Maine Rules › 90 - INDEPENDENT AGENCIES › 351 - WORKERS' COMPENSATION BOARD › Chapter 8 - PROCEDURES FOR PAYMENT › Section 351-8-17

Current through 2024-29, July 17, 2024
The employer/insurer shall send the Employee's Return to Work
				  Report (WCB-231) to the employee when filing the Memorandum of Payment pursuant
				  to
				  39-A M.R.S.A.
				  §205(7).
Code of Maine Rules › 90 - INDEPENDENT AGENCIES › 351 - WORKERS' COMPENSATION BOARD › Chapter 8 - PROCEDURES FOR PAYMENT › Section 351-8-18

Current through 2024-29, July 17, 2024
1. The Consent Between Employer and Employee
				(WCB-4A) may be used when the parties have agreed to a voluntary payment of a
				retroactive closed-end period of incapacity, or a modification, reduction or
				discontinuance in ongoing weekly incapacity benefits. The Consent Between
				Employer and Employee (WCB-4A) may be used when the parties agree to
				discontinue or reduce benefits during the 21-day period following the filing of
				a Certificate of Discontinuance or Reduction of Compensation (WCB-8). The
				Consent Between Employer and Employee (WCB-4A) cannot be used to reduce or
				discontinue benefits on a date that is subsequent to the date the parties sign
				the WCB-4A.
2. The WCB-4A shall be
				signed by the employee or a representative of the employee, and a
				representative of the insurer.
3.
				The parties may agree to the pre-injury average weekly wage or may agree to pay
				benefits based upon a provisional wage and reserve the issue of the pre-injury
				average weekly wage for later determination by the Board. In either event, the
				form shall also indicate whether the employee is receiving 100% of the benefits
				at issue for the designated period. If the employee is receiving less than 100%
				of the benefits at issue for the designated period, the form shall indicate the
				percentage of benefits that the employee is receiving.
4. The employer or insurance carrier shall
				make compensation payments within 10 calendar days after the WCB-4A is signed
				by the parties.
5. Signing the
				WCB-4A does not by itself create a compensation payment scheme.
6. The WCB-4A shall be distributed as
				follows:
(1) Workers' Compensation
				Board;
(2) Employee;
(3) Insurer;
(4) Employer.
Code of Maine Rules › 90 - INDEPENDENT AGENCIES › 351 - WORKERS' COMPENSATION BOARD › Chapter 9 - PROCEDURES FOR COORDINATION OF BENEFITS › Section 351-9-1

Current through 2024-29, July 17, 2024
Any reduction in weekly workers' compensation benefits which
				  results from the coordination of benefits described in Title 39-A shall be
				  indicated on the Discontinuance or Modification of Compensation (WCB-4). The
				  employer or insurer shall indicate which type of benefit is the subject of
				  coordination and the mathematical calculations used in determining the new
				  level of weekly compensation benefits.
Code of Maine Rules › 90 - INDEPENDENT AGENCIES › 351 - WORKERS' COMPENSATION BOARD › Chapter 9 - PROCEDURES FOR COORDINATION OF BENEFITS › Section 351-9-2 - Coordination of Benefits Pursuant to section 221(3)

Current through 2024-29, July 17, 2024
1.
Calculation of reduction to
				employee's weekly benefits
A. Except
				as provided in paragraph (B) of this section, when an employee receives
				payments pursuant to a plan or policy subject to §221(1)(B) or (C), the
				amount of the reduction to the employee's weekly benefits is calculated by
				converting the weekly payment into an after-tax amount using the tables of
				average weekly wage and 80% of the after tax average weekly wage published by
				the Board pursuant to
				39-A M.R.S.
				§102(1) and then
				multiplying the applicable 80% of the after-tax amount by 1.25.
B. When an employee receives a benefit that
				is intended to be paid over the employee's lifetime in a lump sum or a periodic
				payment for a permanent or lifetime condition paid over a period less than the
				employee's life expectancy pursuant to a plan or policy subject to
				§221(1)(B) or (C), the amount of the reduction to the employee's weekly
				benefits is calculated by:
(1) Determining
				the employee's life expectancy based on standard actuarial tables in
				weeks;
(2) Determining a weekly
				benefit amount by dividing the lump sum amount by the number of weeks of life
				expectancy determined pursuant to sub-section B paragraph (1) of this
				section;
(3) Converting the weekly
				benefit amount determined pursuant to sub-section B paragraph (2) of this
				section into an after-tax amount using the tables of average weekly wage and
				80% of the after tax average weekly wage published by the Board pursuant to
				 39-A M.R.S.
				§102(1); and,
(4) Multiplying the applicable 80% of the
				after-tax amount by 1.25.
C. This regulation applies retroactively to
				all pending cases including those on appeal.
Code of Maine Rules › 90 - INDEPENDENT AGENCIES › 351 - WORKERS' COMPENSATION BOARD › Chapter 9 - PROCEDURES FOR COORDINATION OF BENEFITS › Section 351-9-3 - Notification and Release of Social Security Benefit Information Pursuant to section 221(4)

Current through 2024-29, July 17, 2024
A.
(1) When an employee is receiving either
				weekly or lump sum payments pursuant to §212 or §213 the
				employer/insurer shall mail a notice, in a form prescribed by the Board, to the
				employee of possible eligibility for Social Security benefits and the
				requirements for establishing proof of those benefits.
(2) Notice must be promptly mailed to the
				employee after the date the employee reaches his or her full retirement age as
				defined by the Social Security Administration.
(3) The notice must be mailed to the Workers'
				Compensation Board at the same time it is sent to the employee.
Code of Maine Rules › 90 - INDEPENDENT AGENCIES › 351 - WORKERS' COMPENSATION BOARD › Chapter 10 - ATTORNEY'S FEES › Section 351-10-1 - Attorney's Fees

Current through 2024-29, July 17, 2024
1. An attorney may
				charge an employee a fee for services, capped at 30% of benefits
				accrued.
2. If an attorney wishes
				to collect more than 30% of benefits accrued, he or she may do so only with
				pre-approval of a hearing officer.
3. "Benefits accrued" includes benefits past
				due, benefits paid without prejudice acquired and/or retained through the
				services of an attorney and unpaid medical bills. In no case, shall the
				employer/insurer be required to pay an amount for medical services in excess of
				the medical fee schedule regulations or the provider's charges, whichever is
				less.
4. If a case is in litigation
				and is lump sum settled prior to decree, attorney's fees may be collected from
				the employee as follows, subject to the approval of the hearing officer: the
				attorney's fee capped at 30% of benefits accrued in addition to the designated
				percentage set forth in 39-A M.R.S.A. §325(4)(B).
Code of Maine Rules › 90 - INDEPENDENT AGENCIES › 351 - WORKERS' COMPENSATION BOARD › Chapter 10 - ATTORNEY'S FEES › Section 351-10-2 - Disputed Fees

Current through 2024-29, July 17, 2024
1. If attorney's
				fees are charged in accordance with 39-A M.R.S.A. §325 and the provisions
				of this rule and there is no dispute with respect to payment of the fee, then
				board approval of the fee is not necessary.
2. If a dispute arises between an employee
				and his or her attorney regarding the payment of attorney's fees, either the
				employee or his or her counsel may file a motion with a hearing officer. The
				motion must be served on the opposing party and must be filed in the
				appropriate regional office. Within 30 days following the receipt of this
				motion, the opposing party shall submit a written statement of objections to
				the fee for which payment is sought. In issuing an order, the hearing officer
				shall consider the following factors: (1) the complexity of the issues
				presented; (2) the novelty of the questions raised; (3) the quality of the
				representation; (4) the time and labor required; (5) the skills and experience
				of the attorney; and (6) the benefits to the employee.
3. Hearings will be held on fee motions only
				at the discretion of the hearing officer.
Code of Maine Rules › 90 - INDEPENDENT AGENCIES › 351 - WORKERS' COMPENSATION BOARD › Chapter 10 - ATTORNEY'S FEES › Section 351-10-3 - Multiple Dates of Injury

Current through 2024-29, July 17, 2024
1. If there are
				multiple dates of injury and at least one date of injury pre-dates and at least
				one date of injury post-dates January 1, 1993, the provisions of this
				subsection apply. Attorney's fees must be allocated in proportion to one or
				more of the following factors: (1) the role each date of injury played in the
				litigation; (2) the extent to which each party precipitated the need for
				litigation; and (3) the ultimate success of the petition(s) alleging a
				particular date of injury. This analysis must be performed on a case-by-case
				basis.
2. Once the allocation has
				been made, the employer/insurer must pay attorney's fees for any injuries that
				pre-date January 1, 1993 in accordance with 39 M.R.S.A. §110. For injuries
				that post-date January 1, 1993, the attorney may charge the employee a fee in
				accordance with section 1 of this rule.
3. Disputes regarding the appropriate
				allocation of fees must be resolved by motion pursuant to subsection 2 of this
				rule.
Code of Maine Rules › 90 - INDEPENDENT AGENCIES › 351 - WORKERS' COMPENSATION BOARD › Chapter 10 - ATTORNEY'S FEES › Section 351-10-4 - Other Matters

Current through 2024-29, July 17, 2024
1. The employee may
				designate his or her attorney's office as the location where checks are to be
				sent in accordance with 39-A M.R.S.A. §205(1).
Code of Maine Rules › 90 - INDEPENDENT AGENCIES › 351 - WORKERS' COMPENSATION BOARD › Chapter 11 - MEDIATION › Section 351-11-1 - Assignment of Cases

Current through 2024-29, July 17, 2024
Except as provided in
				   39-A M.R.S.A.
				  §205(9)(D), upon
				  receipt of a Notice of Controversy which was unable to be resolved by the
				  Office of Troubleshooters, or other indication of controversy, the Board shall
				  refer the matter to a mediator who shall mediate the dispute in an expeditious
				  manner. The initial referral and assignment of such disputes shall be based on
				  the residence of the employee as indicated on the Notice of Controversy. The
				  Board will keep a list of towns indicating which areas shall be assigned to the
				  respective regional offices.
In cases where the convenience of the parties or the
				  interest of justice require, a party may make a written request to the Board
				  for the matter to be reassigned or transferred to a different mediator and
				  regional office. Such reassignments and transfers shall be made by the
				  Executive Director. If the written request is not by stipulation of all the
				  parties involved in the proceeding, the Executive Director shall give any party
				  opposing the reassignment or transfer of the case 10 days in which to respond
				  to the moving party's request.
Code of Maine Rules › 90 - INDEPENDENT AGENCIES › 351 - WORKERS' COMPENSATION BOARD › Chapter 11 - MEDIATION › Section 351-11-2 - Confidentiality of Mediation

Current through 2024-29, July 17, 2024
Mediation is most successful when the parties are free to
				  speak candidly and openly about their interests, needs, and desires.
				  Confidentiality also protects unrepresented parties from exploitation by
				  individuals who use mediation for discovery.
1. All statements made during the course of
				mediation are made without prejudice to any party's legal position in the
				dispute being mediated.
2. No
				aspect of a mediation, other than the Record of Mediation, shall be
				discoverable or admissible in any proceeding, other than a Penalty referral,
				governed by the Workers' Compensation Act. Limitations on admissibility and
				discoverability include, but are not limited to, the following:
A. The mediator shall not be called as a
				witness, nor shall discovery be taken from the mediator, nor shall a mediator
				be compelled to produce notes or other evidence of what transpired at
				mediation.
B. Views expressed or
				suggestions made by a party with respect to a possible resolution of the
				dispute, admissions made during mediation, proposals made or views expressed by
				the mediator, or the response of any party to the mediator's proposals are not
				discoverable or admissible.
Code of Maine Rules › 90 - INDEPENDENT AGENCIES › 351 - WORKERS' COMPENSATION BOARD › Chapter 12 - FORMAL HEARINGS › Section 351-12-1 - Filings

Current through 2024-29, July 17, 2024
1. Petitions and other notifications of
				disputes shall be filed with the Board's Central Office in Augusta,
				Maine.
2. Except as specifically
				provided in the
Maine Workers' Compensation Act of 1992
or in
				these rules, any party opposing a motion or wishing to respond to another
				party's submission must file a response not later than 21 days after the filing
				of the motion.
Code of Maine Rules › 90 - INDEPENDENT AGENCIES › 351 - WORKERS' COMPENSATION BOARD › Chapter 12 - FORMAL HEARINGS › Section 351-12-2 - Medical Bills

Current through 2024-29, July 17, 2024
Itemized bills, liens, co-pays, and out of pocket expenses
				  must be filed with petitions for payment of medical and related expenses. This
				  rule does not prohibit a party from seeking a prospective order for payment of
				  medical treatment if payment for that treatment or treatments, or related
				  expenses, has been denied by the opposing party.
Petitions for payment of medical and related expenses can be
				  amended up to the date of the last scheduled hearing.
Payment of medical and related expenses must be made within
				  10 days after a decree is issued or the date the information required in
				  Chapter 5 is received, whichever is later.
Code of Maine Rules › 90 - INDEPENDENT AGENCIES › 351 - WORKERS' COMPENSATION BOARD › Chapter 12 - FORMAL HEARINGS › Section 351-12-3 - Dismissals

Current through 2024-29, July 17, 2024
1. Parties shall be prepared and ready for
				hearing. If the petitioning party is unprepared or fails to appear, the
				Administrative Law Judge shall dismiss the matter unless good cause is shown
				within 30 days.
2. The Board, by
				its own motion, after notice to the parties and in the absence of a showing of
				good cause to the contrary, may dismiss an action for want of prosecution at
				any time more than two years after the last docket entry showing any action
				taken by the petitioning party. That dismissal operates as an adjudication upon
				the merits.
3. Unless otherwise
				indicated, the dismissal of any petition is without prejudice.
Code of Maine Rules › 90 - INDEPENDENT AGENCIES › 351 - WORKERS' COMPENSATION BOARD › Chapter 12 - FORMAL HEARINGS › Section 351-12-5 - Continuances

Current through 2024-29, July 17, 2024
1. A request for a continuance must:
A. Be in writing and can be submitted by
				mail, fax, or other form of electronic transfer;
B. Be filed no later than 7 days before the
				hearing or conference;
C. Indicate
				the reason(s) for the request;
D.
				Indicate whether there is any objection to the request;
E. Indicate whether the employee is
				working;
F. Indicate whether weekly
				benefits are being paid; and,
G.
				Indicate whether medical treatment is being denied.
Code of Maine Rules › 90 - INDEPENDENT AGENCIES › 351 - WORKERS' COMPENSATION BOARD › Chapter 12 - FORMAL HEARINGS › Section 351-12-6 - Conferences

Current through 2024-29, July 17, 2024
1. When one or more parties is unrepresented,
				the Board shall schedule a conference before a hearing is set. The parties are
				not required to fill out the Joint Scheduling Memo as provided in §
									9 before the conference. The Joint
				Scheduling Memo may be filled out at the conference with the Administrative Law
				Judge.
2. Except as provided in
				this section, when all parties are represented, the Board will not schedule a
				conference. The parties shall complete a Joint Scheduling Memo as provided in
				§
									9.
3. The Administrative Law Judge may set a
				case for conference if one or more parties requests a conference or at the
				Administrative Law Judge's initiative. If the petitioning party objects to the
				request, the Administrative Law Judge shall consider the impact of further
				delay on the petitioning party.
Code of Maine Rules › 90 - INDEPENDENT AGENCIES › 351 - WORKERS' COMPENSATION BOARD › Chapter 12 - FORMAL HEARINGS › Section 351-12-8 - Exchange of Information; Discovery

Current through 2024-29, July 17, 2024
1. The parties
				shall complete the exchange of information form found in Appendix II, and
				provide it to the opposing party or parties no later than 30 days after
				mediation or the filing of a petition, whichever is later, and then on a
				continuing basis. The information must be sworn to by the party. If a party is
				represented by counsel, the signature of counsel constitutes that party's
				representation that after due inquiry, that party believes the information to
				be accurate and complete. If a party, in good faith, needs relevant information
				not covered in the questions contained in the exchange of information form,
				that party may ask up to three additional, non-complex questions of reasonable
				length, subject to objection by the opposing party or parties and review by the
				Administrative Law Judge. Subject to the limitations set forth in this rule,
				other information may be exchanged by agreement.
The employee shall provide to the employer any report
				  generated by a physician, surgeon, or chiropractor who attended an examination
				  under
				  39-A
				  M.R.S.A. §207.
2. Discovery motions must be filed in the
				appropriate regional office. Objections to discovery motions must be filed
				within 21 days of their receipt. The Administrative Law Judge may decide the
				motion without a hearing or conference, but may schedule a hearing or
				conference, at the judge's discretion or upon request of one or more
				parties.
3. Witnesses may only be
				deposed by agreement of the parties or by order of the Administrative Law Judge
				pursuant to subsection
				2. Unrepresented employees may not be
				deposed.
4. Except as provided in
				section
				10, depositions of experts must be
				scheduled before the testimonial hearing and completed no later than 45 days
				after the hearing. Additional time may be allowed upon motion to the
				Administrative Law Judge. At the hearing, the parties shall provide the
				Administrative Law Judge with the dates of depositions that have been scheduled
				but are not yet completed.
Code of Maine Rules › 90 - INDEPENDENT AGENCIES › 351 - WORKERS' COMPENSATION BOARD › Chapter 12 - FORMAL HEARINGS › Section 351-12-9 - Joint Scheduling Memorandum

Current through 2024-29, July 17, 2024
1. The parties
				or their representatives shall confer and complete fully and accurately a Joint
				Scheduling Memorandum. The petitioning party shall file the Joint Scheduling
				Memo with the appropriate regional office no later than 45 days after mediation
				or the filing of a petition, whichever is later. If the Joint Scheduling Memo
				is not received in a timely fashion, the Administrative Law Judge may dismiss
				the pending petitions if the Joint Scheduling Memo is not filed within 21 days
				after notice from the Board that the petitions will be dismissed. An objection
				to the Joint Scheduling Memo must be filed no later than 21 days after its
				submission.
2. A hearing will not
				be scheduled on a petition until the parties file a Joint Scheduling Memo as
				provided in this section.
3. The
				Administrative Law Judge may deem waived legal issues not raised in the Joint
				Scheduling Memo.
4. A Joint
				Scheduling Memo template is included in Appendix I.
Code of Maine Rules › 90 - INDEPENDENT AGENCIES › 351 - WORKERS' COMPENSATION BOARD › Chapter 12 - FORMAL HEARINGS › Section 351-12-10 - Independent Medical Examination

Current through 2024-29, July 17, 2024
1.
Requests
A.
(1) If a §312 examination has been
				requested prior to the filing of the Joint Scheduling Memo, the parties shall
				state on the memo the date of the request, whether the request has been
				approved by the Board's Office of Medical and Rehabilitation Services, and, if
				approved, the name of the examiner and the date of the examination.
(2) If a §207 examination has been
				requested prior to the filing of the Joint Scheduling Memo, the parties shall
				state on the memo the date of the request, the name of the examiner, and the
				date of the examination.
Code of Maine Rules › 90 - INDEPENDENT AGENCIES › 351 - WORKERS' COMPENSATION BOARD › Chapter 12 - FORMAL HEARINGS › Section 351-12-11 - Work Search, Labor Market, and Surveillance Evidence

Current through 2024-29, July 17, 2024
The following rules apply to cases involving work search,
				  labor market or surveillance evidence.
1. No later than 30 days after mediation or
				the filing of a petition, whichever is later, the employee shall provide the
				employer with the work search or labor market evidence that the employee
				intends to introduce into evidence. It is recommended the employee use a
				standardized Workers' Compensation Board work search log and shall include, at
				a minimum, names of prospective employers, dates of application, responses to
				the application, if any, and whether the application was submitted in person,
				by mail, electronically, or by some other means.
2. No later than 21 days after receipt of
				information provided pursuant to subsection
				1, the employer shall provide the
				employee with the labor market evidence that the employer intends to introduce
				into evidence.
3. Work search and
				labor market evidence developed or obtained after the deadlines set forth in
				subsections
				1 and
				2 of this section shall be exchanged no
				later than 7 days before the hearing.
4. Except as provided in subsection
				5 of this section, regardless of
				whether the employer intends to offer the surveillance information into
				evidence, the employer shall provide the surveillance information to the
				employee as follows:
A. The employer shall
				provide all surveillance information to the employee developed since the date
				of injury, or since the last decree, whichever period is shorter, in connection
				with the claim and provide an affirmation that all surveillance information has
				been provided. The employer shall provide the surveillance to the employee
				within 14 days after the employer receives the information from the employee
				under subsection
				8(1) of this chapter
				or Appendix II, and in no event later than 7 days before the hearing.
B. For surveillance information obtained by
				the employer before the submission of the Joint Scheduling Memo, the employer
				shall provide that information to the employee within 14 days after the
				employer receives information from the employee under subsection
				8(1) of this chapter
				or Appendix II.
C. For surveillance
				information obtained by the employer after the submission of the Joint
				Scheduling Memo, the employer shall provide surveillance information to the
				employee no later than 14 days after the employer receives that information,
				and, in no event, later than 7 days before the hearing.
Code of Maine Rules › 90 - INDEPENDENT AGENCIES › 351 - WORKERS' COMPENSATION BOARD › Chapter 12 - FORMAL HEARINGS › Section 351-12-12 - Exhibits

Current through 2024-29, July 17, 2024
1. The parties may mark exhibits submitted
				into the evidentiary record by number and submission date. Absent agreement of
				the parties to the contrary, the Administrative Law Judge may exclude an
				exhibit offered at hearing that was not exchanged by the parties at least 7
				days before the final hearing in the matter.
2. The parties may jointly submit relevant
				medical records and reports as a single, indexed, and tabbed exhibit. The
				reports and records must be in chronological order and grouped together by
				health care provider, unless otherwise specified. Exhibits to which there is an
				objection must be marked separately. The Administrative Law Judge may exclude
				an exhibit that does not comply with this subsection.