The national Workers' Compensation guide explains the system: no-fault benefits, exclusive remedy, the standard policy's Part One (statutory benefits) and Part Two (employers liability), and experience rating. This guide covers how Maine runs it under the Maine Workers' Compensation Act, Title 39-A. The Act is administered by the Workers' Compensation Board. Maine is not a monopolistic state-fund state: employers insure with authorized insurers or self-insure.

Who must carry coverage

• Every private employer must secure compensation for its employees, either by buying a policy or by self-insuring under 39-A M.R.S. 403. This includes an independent contractor who hires employees (401).
• Exemptions (401(1)):
  • employers of domestic service employees
  • employers of certain seasonal or casual agricultural workers, if the employer carries employer's liability coverage of at least $25,000 and medical payments of at least $5,000
• Executive officers of private for-profit corporations count as employees. An owner of at least 20% of the voting stock may waive coverage, as long as the waiver isn't a condition of employment (102(11)).
• Employees of an independent contractor generally aren't the hiring firm's employees, and the insurer can't charge premium for them (102(11)).
• Uninsured employers lose their defenses. In a lawsuit they can't argue the employee's negligence, a co-worker's negligence or assumption of risk (401, 103).

Exclusive remedy

An employer that has secured coverage is immune from civil suits by employees for work injuries. The immunity extends to supervisors, officers and directors (104).

What's covered

• Pre-existing conditions: an aggravation is compensable only if the work contributed to it in a significant manner (201(4)).
• Mental stress: the work stress must be extraordinary and unusual compared with what the average employee faces, and it must be the predominant cause. Good-faith discipline, evaluations and layoffs don't qualify (201(3-A)).
• Ridesharing: injuries in an employer rideshare program used only to get to and from work don't arise out of employment, unless the employee is paid to drive (201(2)).

Benefits

Claims process

• Notice of injury: the employee must notify the employer within 60 days for injuries on or after Jan. 1, 2020 (301).
• First payment or decision: within 14 days after notice, the employer or insurer must accept, pay without prejudice, or deny with a Notice of Controversy (205; Board Rule ch. 1).
• Paying without prejudice: payments can stop and a Notice of Controversy can be filed up to 45 days after notice.
• Late payment penalty: $50 a day for each day past 30 days, capped at $1,500 (205(3)).
• Medical care: the employer picks the first provider. After 10 days of treatment the employee may switch to a provider of the employee's choice. The employee pays nothing for covered care (206).
• Independent exams: the employee must attend an exam by an employer-chosen and employer-paid provider. The employee may have his or her own provider present (207).
• Reinstatement: the employer must offer re-employment for 2 years after the injury, or 3 years if it has more than 200 employees (218).

Policy and rating rules

• Cancellation: a WC policy cancellation takes effect no sooner than 30 days after notice is mailed to the Board and the employer, unless replacement coverage starts sooner (39-A M.R.S. 403).
• Experience rating weights the three most recent years 40% / 35% / 25%, or 60% / 40% with two years (24-A M.R.S. 2382-D).
• Merit rating: an 8% credit for no claims, no change for one claim, and an 8% debit for two or more.
• Retrospective rating is voluntary and needs the insured's prior consent.
• Workers' comp can't be placed in surplus lines (24-A M.R.S. 2002-A). The P&C guaranty association pays covered WC benefits in full.
• Maine's unfair claims practices statute (24-A M.R.S. 2164-D) and the civil action in 2436-A don't apply to workers' comp claims.

Common exam traps

• The Board is the Workers' Compensation Board. Maine is not a monopolistic state-fund state.
• 7-day waiting period, paid back if incapacity runs more than 14 days.
• Benefits are 2/3 of gross average weekly wage. The cap is the higher of $441 or 125% of the state average.
• Employee notice: 60 days. Employer action: 14 days. Employee may change doctors after 10 days.
• Cancellation needs 30 days' notice to the Board and the employer.