Maine's system of workers' compensation is compulsory, meaning that employers are required to provide workers' compensation insurance to their employees. Workers' compensation insurance may be provided through private insurance carriers or self-insurance. Waivers may be permitted to exclude certain employees from coverage, including corporate officers.
Exemptions from coverage may apply to certain employees, including XXX
Medical Benefits are provided to employees entitled to workers' compensation benefits, with no limits on necessary medical care.
The employer chooses the treating physician for the first ten days of treatment, after which time the employee may choose a different physician. The employee may subsequently change treating physicians, but the employer or insurance company may contest the change.
Indemnity benefits are payable to injured workers to help make up for lost income. There is a waiting period of 7 days before a worker is eligible for indemnity benefits, but if the worker's disability lasts more than 14 days indemnity benefits become retroactive to the date of the injury.
Benefits available to injured workers include the following:
Temporary Total Disability (TTD)
Temporary total disability (TTD) benefits are paid to workers who are unable to work due to injury, but who are expected to make full or partial recovery such that they may return to work. Benefits are based upon 2/3 of the worker's average pre-injury weekly wage, subject to a cap, and continue for up to 520 weeks. Offsets may apply for Social Security benefits, retirement benefits, or benefits from disability insurance.
Permanent Total Disability (PTD)
When a worker is not expected to recover from a total disability caused by a work-related injury, and as a result suffers a total loss of earning capacity, the worker becomes eligible for permanent total disability (PTD) benefits. In Maine PTD benefits are calculated based upon 2/3 of the injured worker's average gross weekly wages, subject to a cap, and may continue indefinitely. Benefits are periodically adjusted for inflation. Offsets may apply for Social Security benefits, disability insurance, wage continuation plans, and employer-sponsored retirement plans.
Permanent Partial Disability (PPD)
Once an injured worker has recovered to the maximum possible extent, the worker may be able to return to employment but nonetheless remain partially disabled, and may potentially qualify for permanent partial disability (PPD) benefits. In Maine PPD benefits are determined based on a statutory schedule, based upon 2/3 of the injured worker's average gross weekly wages, subject to a cap. Benefits for unscheduled injuries are normally limited to a maximum of 520 weeks, but a longer period may apply based upon the worker's disability rating and earnings, and ends upon qualification for Social Security retirement benefits.
Temporary Partial Disability (TPD)
When a worker suffers an injury that limits his ability to return to work, resulting in a reduction of income as a result of reduced hours or wages, the injured worker may be eligible to receive a benefit based on the difference between the worker's pre-injury earnings and their reduced, post-injury earnings. In Maine, TPD benefits are paid based upon 2/3 of the difference between the injured worker's pre-injury and post-injury wage, subject to a cap. Benefits may be payable for up to 104 weeks.
Coverage may be available for cumulative trauma, mental stress and occupational hearing loss.
When a worker dies as the result of a work-related injury, workers' compensation pays additional benefits, including a burial allowance, an allowance to the estate for incidental costs, and benefits for a surviving spouse and dependents. Survivor benefits are calculated based on 2/3 of the worker's average weekly wage, subject to a cap in amount and duration. Benefits may continue for minors until the age of 18, the age of 23 if the dependent is a student, or indefinitely in the event of disability if the child is disabled and has no surviving parent. Spousal benefits end upon remarriage.
Attorney fees are limited to 30% of the award after the deduction of expenses.
This article provides a quick overview of the benefits available to injured workers, but the full formulas used for assessment of benefits, coordination of different types of benefits, and assessment of injuries and disability ratings can quickly complicate the determination of benefits. Also, states frequently revise their workers' compensation laws. Most workers who suffer a significant injury or wage loss as the result of a workplace injury will benefit from consulting a workers' compensation lawyer.
The state agency responsible for workers' compensation is:
Maine Workers' Compensation Board
27 State House Station
Augusta, ME 04333-0027
(207) 287-3751 or 1-888-801-9087