Workers’ Compensation Claims Process

If you are injured on or after January 1, 2013, you have 30 days from the date of injury to report the injury to your employer. When you report the injury, be clear that the injury is work related and that you are making a workers’ compensation claim for lost time and/or payment of medical. Insist that your employer file an injury report and submit the claim to its insurance company. The insurance company will want to take a recorded statement from you. The insurance company has 14 days to decide whether to pay or deny your claim. If they deny the claim, they must file a Notice of Controversy with the Workers’ Compensation Board, copy to you, stating the reason for the denial. The Workers’ Compensation Board will then refer the claim to the troubleshooter. If the troubleshooter is unable to resolve your issue, he will send your claim to mediation. Mediation is an informal meeting of the parties to see if any agreement can be reached. The mediator is simply a facilitator and cannot order the insurance company to pay benefits. If mediation is unsuccessful, the next step is formal hearing. In between mediation and formal hearing, you will work with your lawyer and doctors to develop the medical evidence. It typically takes 4-6 months to get a hearing. At hearing, you will testify under oath. Your employer may also testify. The doctors testify through their medical reports and/or by deposition. The hearing officer will take time to think about the case before making a decision. It typically takes 2-4 months to get a decision.

If you are injured at work, call Maine Employee Rights Group, 207.874.0905, right away so we can help you navigate the claims process.