When to call a lawyer for your Maine workers’ compensation claim
Maine attracts nearly 25 million visitors each year. But that means plenty of Mainers are hard at work keeping the magic alive in Vacationland, as it’s known.
While Maine is particularly known for its blueberry production (the state grows about 90% of the blueberries sold in the U.S.) and maple syrup, producing more than 600,000 gallons each year, manufacturing is the largest sector of the state’s economy. Specifically, Maine is known for its manufacturing and production of paper, wood products, electronics, food products and textiles.
While picking berries and tapping maple trees aren’t inherently dangerous occupations, there’s risk in any job... even if you spend your days behind a desk or on the phone. That’s why if you’re employed in Maine, it’s important to understand the workers’ compensation system and when you might qualify for benefits.
Maine workers’ compensation laws
Workers’ compensation is available to employees in every state, though each state has slightly different requirements and benefits.
In general, here’s how it works: An employer is required to carry workers’ compensation insurance for every employee. If an employee is injured at work, they have the right to make a claim on that insurance to recover costs for medical treatment, lost wages, and some other costs. This benefits both the employer and the employee. The employee receives quick payment of no-fault insurance, which means that unlike a personal injury lawsuit, they don’t have to prove that anyone was negligent or liable for their injury—only that they were injured at work.
It also insulates the employer from liability; the employee can’t sue the employer for costs related to the injury, which saves the employer from lengthy and expensive litigation.
If you’re injured at work, you need to prove the following in order to receive Maine workers’ compensation benefits:
1. The injury happened at work, which means it doesn’t have to be directly related to your job. Any injury or accident that happens within your workplace would qualify you for benefits;
2. The injury happened outside your regular work site, but you were engaged in duties required for your job at the time you were hurt;
3. The injury developed gradually over time as a result of an activity or condition related to your work. This could be an injury like carpal tunnel syndrome or other musculoskeletal problem that results from repetitive motion, strain, lifting or positioning; it could also be an illness from exposure to a chemical or toxin in your work environment. For instance, this could include hearing loss from repeated exposure to very loud noise, a respiratory disease like asbestosis, or other long-term health effects;
4. The injury cost you money in the form of medical treatment or lost wages from time out of work during your recovery or as the result of a disability that was caused by the accident or illness.
It can be difficult to prove that your illness or condition resulted from conditions at work because you’ll need to show that there is no other reason for you to be suffering from that illness or issue; you’d need a doctor to rule out genetics, other behavioral and environmental factors (for instance, whether you’ve been exposed to the chemical or toxin someplace other than your work or if you’re a smoker, etc.) and other potential causes of the illness.
Do you need a Maine workers’ compensation lawyer?
If the injury is from a single incident or accident, you’ve reached full recovery and your related expenses are fixed with no anticipated future costs, and the insurance company has approved your claim, you might not need a lawyer.
However, if you’re dealing with an ongoing injury or illness that requires future treatment or has left you with a full or partial disability, you should contact a lawyer. Once you accept a settlement, you can’t make an additional claim years later if treatment costs more than you expected, unless you’re still within the statute of limitations (deadline) for your claim. An experienced workers’ compensation lawyer will be able to anticipate your future costs and ensure that the amount you receive from the insurance company will cover not just your costs today, but your future costs as well.
Maine workers’ compensation benefits
If you’re injured in a work-related accident, you can recover the following benefits:
- Weekly payments for time off from work during your recovery if you miss more than seven days of work. If you miss more than 14 days, you will receive all of your lost wages, including the first seven days. The weekly benefit for lost wages is ⅔ of your average weekly wage, up to a state maximum that is adjusted annually;
- Medical treatment, including surgeries, doctor or hospital visits, prescription medications, diagnostics like CT scans or MRIs, etc.;
- Payment for the loss of a specific body part or its functioning;
- Vocational retraining and rehabilitation if you can’t return to the job you had prior to the injury; and
- Death benefits to the surviving dependents of an employee who dies as the result of a work injury.
How to make a claim for Maine workers’ compensation benefits
Notify your employer
You are required to notify your employer (a supervisor or manager) within 30 days of the injury.
Visit the required health care provider
Your employer might have a selected health care provider. You must receive your first 10 days of treatment from that provider. After 10 days, you may change providers as long as you inform the employer of the new provider. If you choose to see your own provider or a provider of your choice, the employer can require you to get a second opinion if they disagree with the treatment plan or diagnosis.
Your employer’s responsibilities
Once you report the injury to your employer, they are required to complete a First Report of Injury within seven days and provide you a copy. If you’re unable to work, they must pay your claim for lost time within 14 days. If the employer disagrees with the claim, they must submit a Notice of Controversy to the Maine Workers’ Compensation Board and send a copy to you.
Is my employer required to offer me my old job back after an injury?
If your doctor clears you to return to work, your employer must return you to your previous job if it has not been filled. If the job is no longer available or if the injury prevents you from doing that particular job, the employer must give you a different job function that you’re able to do in your current condition. The employer is also required to make a reasonable accommodation for your injury if necessary as long as it doesn’t place undue hardship on the employer.
Your employer may not discriminate against you for filing a Maine workers’ compensation claim or for testifying in a workers’ compensation claim. If you believe you’re being discriminated against for one of these reasons, you may file a Petition to Remedy Discrimination with the Workers’ Compensation Board.
Handling disputes over claim settlement
If there’s a dispute between you and your employer or the insurer about your claim, a Workers’ Compensation Board Troubleshooter will contact you and work to resolve the issue. If you can’t reach an agreement with the help of the Troubleshooter, then the Board will schedule a mediation.
The mediation would involve a professional who is trained to help the parties negotiate and reach an agreement. However, if that attempt fails, then you may request a hearing. The hearing is your opportunity to present your case to an Administrative Law Judge. Both you and your employer would present evidence and the Administrative Law Judge issues a binding opinion.
If you’re unsatisfied with the judge’s decision, you can file an appeal with the Appellate Division of the Maine Workers’ Compensation Board. If the judge issues a finding of fact, it is not subject to appeal.
If you need to participate in mediation or a hearing, or if you need to file an appeal, you should contact a Maine workers’ compensation lawyer. These cases can be complex; you don’t want to lose the compensation you deserve and need in order to remain financially afloat following an injury.
The basis for personal injury law is fairly straightforward:
If you're injured because of someone's negligence, then you're entitled to recover for your financial losses related to the injury.
The premise for the workers' compensation system is similar:
Your employer is required to have specific insurance that provides benefits if you're injured at work.