When a Maine worker is injured while at work or becomes unwell because of the job they do, they are typically protected by Maine’s workers' compensation laws which make it compulsory for most companies and organizations to provide insurance protection for their workers. Despite this, workers' compensation is not guaranteed. There are plenty of reasons why workers claims are rejected but this doesn’t mean you have to accept a denial of your claim. However, it’s difficult to challenge the insurer on your own so you should speak with a workers’ comp attorney who will help you to file an appeal so you get the workers’ compensation you deserve. Workers' Compensation Law in Maine Maine has very good workers' compensation laws. They are administered by the Maine Workers’ Compensation Board. Apart from domestic or agricultural workers, employers cover most diseases and injuries which occur while at work. Mental injuries may be covered in certain circumstances, but does not include injuries that have resulted from any form of disciplinary action, job transfers, layoffs, demotions or terminations of employment. The two benefits that a worker will receive include 2/3rds of the worker's average wage paid weekly and the cost of medical treatment. In the majority of situations compensation for partial incapacity may be paid for up to 520 weeks. Why Your Claim Could be Denied Sometimes there is a simple explanation for a workers’ comp denial such as a simple administrative error on the paperwork. Your employer or its insurer may not believe you were at work at the time of the accident or if you have become seriously they may not agree that it is work related. Also there may be some evidence that you were under the influence of drugs and alcohol or you refused to use the safety equipment provided and you subsequently became injured. Other reasons for a denial include: a claim that you did not use safety equipment provided or follow correct procedures; you submitted your information to the employer or the claim itself after the time limit for a workers' comp claim. The Maine Workers' Comp Appeals Process When claims are denied Maine has a dispute resolution process in place for you to use. The process involves a 3 tier agenda which includes: troubleshooting, mediation formal hearing. Throughout the whole dispute resolution process you are required to provide evidence that supports your case. This proof could include a written diagnosis prepared by your physician, which will be evidence of your current disability, your weekly wage stubs which will show what you earn and testimonies written by your work colleagues. These will detail how your injury took place and if your injuries or illness are stress related, what brought them about. If your employer’s insurer is the one responsible for denying your claim it will submit a Notice of Controversy with the Maine Workers’ Compensation Board. This notice will outline the reason for denial. The case will be forwarded to a Board representative who is called a “troubleshooter.” This person will contact both you and the insurer and try to resolve the dispute. If this fails it will go to the mediation stage where an independent mediator is brought to a meeting with you and the insurer to find a solution. If this fails the formal hearing comes next. If this fails you are entitled to appeal to the Appellate Division of the Maine Workers’ Compensation Board within twenty days. A Workers' Comp Attorney May Be Able To Help Despite Maine’s favorable workers’ compensation laws, filing a claim does not necessarily guarantee a workers’ comp payment. Taking on an insurer who has denied your claim without the help of an experienced workers’ comp attorney may not be the best way to make a sucessful appeal. It’s imperative that as soon as you are able you take the information related to your workers’ comp denial to an experienced attorney who will help you through the appeals process.
