Definition of Workers

1
Definition of Workers Compensation Insurance

• Workers' Compensation Insurance is compulsory,
  meaning employers are required to provide
  workers compensation insurance for their
  employees. Workers Compensation Insurance
  provides for benefits for occupational injuries
  or disease suffered by an employee regardless of
  fault. Workers Compensation is an exclusive
  remedy for the coverage of work related injuries
  by the employer.

2
Workers Compensation Act

• Only those personal injuries that arise out of
  and in the course of employment are covered by
  the Maine Workers Compensation Act.
• An injury arises out of and in course of
  employment when it occurs while and because the
  employee is at work.

3
When To File A First Report of Injury

• Employee alleges an injury and requires medical
  attention and/or loses 1 or more days from work.
• Employee has 30 days to provide notice of injury.
• First Reports must be filed with the WCB
  electronically if the employee has lost 1 or
  more days from work. Failure to comply results in
  100.00 penalty assessed by the WCB.

4
Questions Asked of Employer

• Was employee performing work duties when injured?
• Any personnel issues?
• Aware of employees outside activities?
• Witnesses
• Aware of prior claims or pre-existing conditions?

5
Red Flags

• Injury reported prior to layoff or retirement
• Job performance, attendance, disciplinary issues
• Concurrent employment
• Lack of medical documentation
• Employed short time
• Exaggerated systoms

6
Workers Compensation Benefits

• Seven day waiting period
• Weekly lost time benefits capped _at_ 520 weeks
• For injuries on or after 1/1/2013, the
  compensation rate is 2/3 the gross average weekly
  wage rather than 80 of the after-tax average
  weekly wage.
• Compensation for total incapacity

7
Workers Compensation Benefits

• Compensation for partial incapacity.
• Payment of death benefits (500 weeks) to the
  dependents of a worker whose death was work
  related.
• Payment for the loss of a specific body part.
• Maximum Compensation Rate is determined by date
  of injury and the amounts change annually on
  July 1st.

8
Workers Compensation Coverages

• Eye Glasses
• Medical Doctor/Chiropratic
• Orthopedic Devices/Hearing Aids
• Dental
• Mileage
• Prescriptions

9
Wage Statements

• Must be filed with WCB within 30 days of
  knowledge of a claim for compensation.
• Enter Employees gross earnings for the past 52
  weeks of payroll.
• Week 52 is the payroll week that includes the
  date of injury. Week 1 is payroll week from
  approximately one year prior to date of injury.

10
Fringe Benefit Worksheet

• Must be filed with WCB within 30 days of
  knowledge of a claim for compensation.
• Provide the cost of the fringe benefits being
  paid by the employer at the time of injury.
• Employers must notify insurer within (7) days
  when fringe benefits cease from being paid by
  employer.

11
W/C, Re-Employment Reasonable Accommodation

• Light Duty/Alternative Work
• If employee refuses bona fide offer of reasonable
  employment without good and reasonable cause, may
  be disqualified from incapacity benefits
• Establish parameters for duration of any modified
  job assignment
• Coordinate strategy with claims management team.
  Avoid discrimination claims 

12
Reinstatement

• Injured employee can seek reinstatement to
  his/her former position if the position is
  available and suitable to his/her physical
  condition.
• Otherwise, can seek reinstatement to any other
  available position suitable to the employees
  physical condition.

13
Reinstatement

• Do not have to reinstate to any position for
  which the employee is not qualified .
• Obligation to reinstate continues for one year
  from the date of injury, unless an employer has
  over 200 employees, then three years from the
  date of injury.

14
Litigation Trends

• Injuries that occur before or after work
• Injuries that occur as a result of violence
• Injuries that occur while an employee is
  traveling
• Injuries that occur from non-work activity or
  during non-work time
• Injuries that result from unexplained events,
  including falls
• Pre-existing conditions, mental/stress injuries
• Gradual injuries