Workers’ Compensation
Workers’ Compensation 101
If you have been injured at work, you need to know your rights. This FAQ will provide a basic understanding of how workers’ compensation works in Maine.
1. When must I report a work injury?
You must report a work injury to your employer within 90 days. However, you should report a work injury immediately or as soon as possible. If you experience pain on the job, even if it does not prevent you from working, you should report it.
2. Can I see my own doctor?
For the first 10 days, your employer may require you to see the company doctor. After that, you have the right to see the doctor of your choice.
3. When will I hear from the insurance company?
The insurance company is required to accept, pay without prejudice, or deny the claim within 14 days. If the insurance company accepts the claim or pays without prejudice, you will receive a Memorandum of Payment. If the insurance company denies the claim, you will receive a Notice of Controversy stating the reason for the denial.
4. When will I start receiving benefits?
After 7 days of missed work due to your injury, you are entitled to receive weekly compensation benefits beginning on the eighth day. If you miss more than 14 days of work, you will also receive payment retroactive to the date of injury.
5. How much will I get?
For injuries occurring after January 1, 1993, the benefit is 80% of your net (after tax) weekly pay. For most workers, weekly pay is calculated by averaging over the 52 weeks preceding the injury.
6. Can I receive both workers’ compensation and unemployment benefits at the same time?
Usually not. If you have work capacity, you may be eligible for both. However, your workers’ compensation benefits will be reduced by the amount you receive from unemployment. If you have no work capacity, you are not eligible for unemployment.
7. What types of medical treatment are covered?
All reasonable and proper medical, surgical, and hospital services, nursing, medicines, mechanical and surgical aids, as needed, as well as treatment by a specialist, including a chiropractor.
8. What is a troubleshooter?
The troubleshooter is an employee of the Workers’ Compensation Board, the state agency that oversees your claim. The troubleshooter may be able to assist you with smaller issues such as late payments by calling the insurance company for you. However, the troubleshooter is not a lawyer and cannot force the insurance company to pay.
9. Can the insurance company just decide to stop paying?
It depends. If the insurance company is paying without prejudice, it can stop or reduce benefits with 21 days’ notice. However, the insurance company must have a good reason for doing so. Usually, the insurance company bases the decision to stop or reduce benefits on an insurance medical exam or surveillance. If you receive such a notice, call Maine Employee Rights Group as soon as possible. We can provide the Board with medical records and other evidence and seek full reinstatement of benefits pending a hearing.
If the Board has entered an order requiring the insurance company to pay, the insurance company must continue to pay in accordance with the order. If the insurance company wants to stop or reduce benefits, it must petition for a new hearing and show that your circumstances have changed (either you are better or have returned to work or both).
10. What is an insurance medical exam? Do I have to go?
An insurance medical exam is when the insurance company sends you to a doctor of its choosing for evaluation, not treatment. The insurance company has the right to do this at any reasonable time during your claim. The insurance company may call it a “second opinion” but it is for the insurance company’s benefit, not yours. Most often, the insurance company uses the exam results to justify stopping or reducing benefits and/or medical treatment. You are entitled to know what questions the insurance company has asked the doctor. You are also entitled to bring a doctor of your own choosing with you, at the insurance company’s cost. Maine Employee Rights Group works with a physician who often attends these exams with clients.
11. Can my employer fire me?
The law prohibits employers from discriminating against employees for asserting a workers’ compensation claim. These cases are complex and require skilled legal representation. If you win, you will receive full back pay and your attorneys’ fees will be paid by the employer or insurance company.
12. Does my employer have to hold my job?
If you can work, and your job is available, your employer must reinstate you. If your job is not available, your employer must give you another job that is available. However, your employer is not required to create a job for you if none is available. The length of time that you are entitled to reinstatement depends on the size of your employer.
13. My employer cannot / will not accommodate my injury. What do I do?
Call Maine Employee Rights Group. Do not quit. If you quit, you may forfeit your right to benefits. Tell your doctor right away, as he / she may want to refine your work restrictions. If you are terminated or laid off while on restrictions for a work related injury, the insurance company must pay benefits.
14. What is a work search?
If you are out of work and are not totally disabled, you are required to look for work and keep a record of your search. Your goal is to receive total compensation. The only way to receive total compensation is to show the Board that work is unavailable to you in your community as a result of your injury. The way to do this is with a good work search. The Board looks at the number of applications, types of jobs, geographic area, search methods and several other factors to determine whether you are entitled to total compensation.
15. How long can I stay on workers’ comp?
If you are totally disabled, you can stay on workers’ comp for as long as your disability lasts. If you are partially disabled, there is currently a 10 year durational limit on weekly benefits, with some exceptions. There is no durational limit on medical treatment.
16. What if I go back to work?
If you go back to work and are earning the same or more than what you earned prior to your injury, your weekly benefits will stop. If you go back to work and are earning less, you are entitled to partial benefits equal to the difference between 80% of your net earnings prior to your injury and 80% of your net earnings after you return to work.
17. The insurance company wants me to settle. What do I do?
Call Maine Employee Rights Group. Our lawyers know how to evaluate what your claim is worth and will make sure you are getting top dollar.
18. What if I am totally disabled and cannot work at all?
Maine Employee Rights Group can help you figure out how you will live and provide for your family after a career-ending injury. We can help you determine whether you are eligible for social security disability or Maine state disability retirement, and if you are denied, we can handle your appeal. If you have a pension, we can help you determine whether you are eligible and what you need to do to collect.
Don’t go it alone. If you have been injured at work, call Maine Employee Rights Group today for a free legal consultation.