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The Adjustor's Guide

ADJUSTER'S GUIDE

TO

MAINE WORKERS' COMPENSATION LAW

For The Clients Of

ROBINSON
KRIGER &
McCALLUM

207/772-6565

8TH Edition

ADJUSTER'S GUIDE
TO
MAINE WORKERS' COMPENSATION LAW

Written by the

ROBINSON, KRIGER & McCALLUM
WORKERS' COMPENSATION DEPARTMENT:

John M. McCallum
Richard F. van Antwerp
Lawrence B. Goodglass
Thomas Quartararo
Douglas J. Alofs
Darby C. Urey
Richard D. Bayer
Cara A. Lovejoy

COUNSEL TO EMPLOYERS AND INSURERS
STATEWIDE FOR OVER 30 YEARS

September 2006
Eighth Edition, Copyright ©2006
By Robinson, Kriger & McCallum
12 Portland Pier, P O Box 568
Portland ME 04112-0568
Phone: 207/772-6565
Fax: 207/773-5001
e-mail: attorneys@rkmlegal.com
website: http://www.rkmlegal.com/

                                                                                                Page 

 FORWARD AND DISCLAIMER                                                           1  

 INTRODUCTION TO THE EIGHTH EDITION                                        2

  1. PUTTING THE CURRENT LAW IN PERSPECTIVE                             2

    1. Effective Dates Of Law Amendments                                   2
    2. A Brief History Of Maine WC Amendments                           2
    3. Effective Date And Retroactivity                                          4
    4. Citations In The Guide                                                      6

  2. ORGANISATION Of THE WORKERS' COMPENSATION BOARD          6

  3. ADJUSTER LICENSING                                                              7

  4. COVERED EMPLOYEES                                                              9

    1. Agricultural Employees                                                      9
    2. Maritime Employees                                                         10
    3. Certain Corporate Officers                                                 10
    4. Household Workers                                                          10
    5. Independent Contractors                                                  11
    6. Prisoners                                                                        11
    7. Loggers                                                                          12
    8. Certain Shareholders - Waiver Of Coverage                         12
    9. Maritime And Longshore Workers                                       13

  5. FORMS                                                                                  13

  6. NOTICE                                                                                 17

  7. STATUTES OF LIMITATIONS                                                      18

    1. Two-Year Statute ofLimitations                                          18
    2. Injuries Before 10/17/91-Ten-Year SOL                              19
    3. Injuries on or After 10/17/91-Six-Year SOL                         19
    4. Interplay of Two-Year And Six-Year SOL                             19
    5. Successive Injuries Involving Multiple Carriers                     20
    6. Protective Decrees                                                           20

  8. COMPENSABILITY                                                                   21

    1. Arising Out of and in the Course of Employment                  21
    2. Going and Coming Rule                                                    22
    3. Intentional Injuries and Intoxication                                   23
    4. Gradual Injuries                                                               23
    5. Mental Stress                                                                  23
    6. Pre-Existing Non-Work-Related Conditions                          23
    7. Temporary Aggravation                                                     24
    8. Subsequent Non-Work Related Injuries or Disease               24

  9. DISPUTING CLAIMS: NOTICES OF CONTROVERSY AND THE 14-DAY RULE     24

  10. MEMORANDUM OF PAYMENT                                                      26

  11. WAITING PERIOD                                                                    27

  12. AVERAGE WEEKLY WAGE                                                            28

    1. Pre-Tax Average Weekly Wage                                          28
    2. After-Tax Average Weekly Wage                                        32

  13. SETOFFS: WAGES, SOCIAL SECURITY, EMPLOYEE BENEFIT PLANS & UNEMPLOYMENT BENEFITS                                                         32

    1. Earned Wages                                                                  32
    2. Social Security                                                                  32
    3. Employee Benefit Plans                                                     33
    4. Exception For Scheduled Benefits                                        33
    5. Unemployment Benefits                                                     34

  14. RETIREMENT                                                                           34

  15. MAXIMUM WEEKLY BENEFIT                                                       34

  16. DEATH BENEFITS                                                                      36

    1. Injuries Before 01/01/93                                                   36
    2. Injuries On or After 01/01/93                                             37
    3. Compensation Unpaid at Death                                          37
    4. Statute of Limitations                                                        37
    5. Presumption of Incapacity                                                  37

  17. INFLATION ADJUSTMENT                                                           38

    1. Injuries Between 11/20/87 And 12/31/92: Difference Between 100% Total and 100% Partial Benefits:                                                                         39
    2. Varying Rates                                                                  40
    3. Successive Injuries Covered by Different Carriers                 40
      1. Later Injury on or After 11/20/87 through 12/31/92       40
      2. Later Injury Occurs on 01/01/93 or Afterward                41

  18. INTEREST AND PENALTIES                                                        41

    1. Interest                                                                          41
    2. Penalties                                                                        43

  19. TOTAL INCAPACITY                                                                 44

    1. Injuries Before 11/20/87                                                   45
    2. Injuries 11/20/87 to 12/31/92                                           45
    3. Injuries On and after 01/01/93                                          45
    4. Presumed Total Incapacity                                                46
    5. Specific Loss Benefits                                                        46

  20. PARTIAL INCAPACITY                                                              47

    1. Injuries Before 11/20/87                                                   47
    2. Injuries 11/20/87 to 10/16/91                                           47
    3. Injuries 10/17/91 to 12/31/92                                           48
    4. Injuries On and after 01/01/93                                          48
    5. Fixed Partial Compensation                                               50
    6. Varying Rates Partial Compensation                                   50

  21. WORK SEARCH                                                                        51

    1. Injuries Before 01/01/93                                                   51
    2. Injuries On or After 01/01/93                                             52

  22. PERMANENT IMPAIRMENT                                                          53

    1. Injuries Before 09/23/71                                                   53
    2. Injuries 09/23/71 to 10/02/73                                           54
    3. Injuries 10/03/73 to 06/29/85                                           54
    4. Injuries 06/30/85 to 11/19/87                                           54
    5. Injuries 11/20/87 to 10/16/91                                           54
    6. Injuries From 10/17/91 to 12/31/92                                   55
    7. Injuries On and After 01/01/93                                          55

  23. REHABILITATION                                                                     56

    1. Overview                                                                         56
    2. Wage Credits                                                                   56

  24. MEDICAL SERVICES & PROVIDERS                                              57

    1. Services Covered                                                              57
    2. Initial Choice of Physician                                                  58
    3. Employee's Change of Physician                                         58
    4. Treatment by Specialist                                                     59
    5. Medical Records                                                                59

  25. MEDICAL FEES                                                                         60

    1. Payment Procedure                                                           60
    2. Medical Fee Schedule                                                        61
    3. Medical Fee Schedule--How To Use                                      61
    4. Utilization Review                                                              62

  26. INDEPENDENT MEDICAL EXAMINATIONS                                       62

    1. Section 312 Ime's                                                             62
    2. Section 207 Examinations                                                  63

  27. MAXIMUM MEDICAL IMPROVEMENT                                             64

  28. RETURN TO WORK -- INJURIES BEFORE 01/01/93                        65

  29. RETURN TO WORK -- INJURIES ON OR AFTER 01/01/93                66

    1. Benefit Amount                                                                66
    2. Quitting After Returning to Work                                         67
    3. Termination for Fault                                                         67

  30. REINSTATEMENT AND REFUSAL OF JOB OFFERS                             68

    1. Reinstatement Rights                                                        68
    2. Refusal of Job Offer                                                          68
    3. Resignation From Suitable Post-Injury Employment.              70

  31. REDUCING OR TERMINATING BENEFITS                                       70

    1. General Principles                                                             70
    2. Return to Work                                                                 71
    3. Job Offer Refused/Resignation                                           71
    4. Imprisonment                                                                  71
    5. Payments Without Prejudice--21-Day Notice                         72
    6. Payments With Prejudice--Petition For Review                       73

  32. PETITIONS                                                                              73

  33. DISPUTE RESOLUTION PROCEDURE                                            75

    1. Summary                                                                         75
    2. Troubleshooting                                                                76
    3. Mediation                                                                         76
    4. Arbitration                                                                        77
    5. Apportionment Remedies                                                   78
    6. Discovery Phase                                                                78
    7. Evidence                                                                           80
    8. Appeals                                                                            80
    9. Payments Pending Appeal                                                   82

  34. SETTLEMENT                                                                             82

    1. Valuation                                                                          83
    2. Settlement Procedure                                                         83
    3. Apportionment And Settlements                                           84
    4. Unilateral Petitions By Employee                                          85

  35. APPORTIONMENT                                                                      85

    1. Procedure                                                                         85
    2. Calculation of Benefits                                                        86
    3. Litigation Strategy Regarding Apportionment                         88

  36. ATTORNEY'S FEES                                                                      88

    1. Injuries Before 01/01/84                                                     88
    2. Injuries From 01/01/84 to 06/29/85                                     88
    3. Injuries From 06/30/85 to 12/31/92: "Prevail Rule"                89
    4. Injuries From 01/01/86 to 10/16/91                                     89
    5. Injuries From 10/17/91 to 12/31/92                                     90
    6. Injuries On or After 01/01/93                                               90

  37. DISCRIMINATION                                                                      90

  38. IMMUNITY AND EXCLUSIVITY                                                       92

    1. Legal Rationale                                                                  92
    2. Obtaining and Losing Immunity                                            92
    3. Proof of Immunity                                                              93
    4. Exceptions to Immunity                                                       94
    5. Suits by Third Parties for Indemnification                               95
    6. A Cautionary Note                                                               96

  39. SUBROGATION AND THE EMPLOYER'S STATUTORY LIEN                   96

    1. Principles and Procedure                                                      96
    2. Scope of Lien With Respect to Tort Damages                          98
    3. Uninsured Motorist Benefits                                                  98
    4. Allocation of Lien Among Injuries                                          98

Index                                                                                             100

For a consultation with Robinson, Kriger & McCallum, call (207) 772-6565 or contact us online. Maine Pre-Paid Legal Services Members should call us for assistance.