State News : Maine

NWCDN is a network of law firms dedicated to protecting employers in workers’ compensation claims.


NWCDN Members regularly post articles and summary judgements in workers’ compensations law in your state.  


Select a state from the dropdown menu below to scroll through the state specific archives for updates and opinions on various workers’ compensation laws in your state.


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Maine

VERRILL DANA LLP

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This article discusses the likelihood that employee exposure to COVID-19 at work may result in a recognized work-related injury/illness.

L.D. 1913 represents the first significant amendment of the Maine Workers’ Compensation Act in twenty years, and a much lauded provision of the new law is the amendment of Section 205(9)(B)(2).  As it read prior to amendment, an Employer/Insurer could successfully establish the right to terminate payment of indemnity benefits due to the running of the 520 week period, but be compelled to continue paying indemnity benefits,  Decree notwithstanding, because Section 205(9)(B)(2) specifically directed an employer/insurer to continue paying benefits during the pendency of an appeal.  As one can imagine, ever losing employee appealed the Decree, and so continued the flow of indemnity for as long as it took the Law Court to reject the appeal.

Making matters worse, the right to recover “overpayments” paid pending appeal, found under 39-A M.R.S.A. Section 324(1), exists only for employers/insurers who are paying some level of benefits pursuant to an award of benefits.  So for an employer/insurer who successfully reduces the level of partial indemnity but has to continue paying the pre-Decree level pending the outcome of the appeal, there is a right to recover the overpayment made during appeal, but for an employer/insurer who has prevailed in establishing the cap and terminating indemnity payments, there is no right to recover the windfall to the employee.

L.D. 1913 has fixed this problem by amending the language of Section 205(9)(B)(2) to now allow suspension of indemnity benefits as soon as the Hearing Officer rules on the petition.  An employer/insurer is also now specifically permitted to reduce or discontinue benefits pursuant to a  Decree pending a  motion for further findings of fact or pending an appeal.   These amendments are effective as of August 30, 2012, so any matter decided on or after that date involving a determination of the applicability of the cap will be governed by this new, much more reasonable and business-friendly provision.

Maine Workers’ Compensation Updates, December Edition
1. After Eighteen Long Years, At Last A Medical Fee Schedule That Addresses Hospital Costs
The Maine Workers’ Compensation Board has finally succeeded in crafting a Medical Fee Schedule that addresses the ever-increasing costs of work-related in-patient, out-patient, ambulant care and surgical center costs. Ever since the massive overhaul of the law in 1992 (effective 1/1/93) Maine has labored without a Fee Schedule addressing these critical areas in the health care billing spectrum. With the new rule, adopted on December 11, 2011, facility costs for workers’ compensation payers will be brought into line with those costs paid by private 3rd party payers. The hope is that the new Fee Schedule will reduce costs in the workers’ compensation system, particularly for facility fees.
The Board is continuing to analyze data on private 3rd party payer rates for professional services and hopefully will have updated recommendations on that topic in the New Year.

2. Changes afoot for unemployed injured workers
39-A M.R.S.A. §214 has long contained a little-if-ever used provision requiring insurance carriers or self-insureds to notify the Bureau of Employment Services of the name of any injured employee who is unemployed and to whom the insurer or self-insured is paying workers’ compensation benefits. Executive Director Paul Sighinolfi has communicated his intent to begin requiring compliance with this provision, as well as the companion provision directing the Bureau of Employment Services to give priority to finding employment for such persons and to notify the Board, in writing, if any such person refuses a “bona fide offer of reasonable employment”. Under Section 214(1), refusal of a “bona fide offer of reasonable employment” subjects the injured worker to the risk of a suspension of indemnity benefits “during the period of refusal”, a fairly significant incentive to encourage return to work. A group is being organized affiliated with the Workers’ Compensation Coordinating Council to brainstorm ways to ensure the most reasonable and cost-effective application of these provisions, and to avoid any unintended pitfalls for employers and insurers subject to the provisions of the Maine Workers’ Compensation Act.

NCCI has announced that it is filing with the Maine Bureau of Insurance a proposed average premium rate decrease of 6.9% for 2012. It had earlier announced a rate reduction of 3.2%, but revised the rate to take into account the promulgated medical fee schedule finally adopted by the Board in December of 2011. NCCI calculated an additional rate reduction attributable to the newly adopted medical fee schedule projected to be 3.8% , with the resulting overall reduction of 6.9%.