Workers’ Compensation Answers
Experiencing an accident or illness related to your job can leave you reeling. You no doubt have many questions about workers’ compensation, your job and the legal process. At The Bayer Law Office, attorney Richard D. Bayer has more than 20 years of experience with Maine workers’ compensation law. He can answer your questions so that you understand the next steps you should take to obtain the benefits you need.
On this page, you will find some of the most-asked questions from his clients.
Does workers’ comp in Maine cover stress?
In Maine, workers’ compensation may in some cases cover an injury due to stress. Benefits payable to an individual who has suffered a stress injury are paid the same as for any other injuries. The injured worker is entitled to have their medical bills paid for by the insurance company or employer, and lost time wages must be paid, too.
The type of stress injury may be a stress reaction, anxiety disorder, post-traumatic stress disorder or any other mental condition that may be caused by work. What is different is that in the case of a stress injury, the injured worker must show, by “clear and convincing evidence,” that the stress at work was the predominant cause of the injury and must also show that the work stress was “extraordinary and unusual” in comparison to the pressures and tensions of the average Maine employee.
There is a special section of the law for law enforcement officers, firefighters or emergency medical services personnel who experience post-traumatic stress disorder, which makes it easier to prove a post-traumatic stress injury.
If you feel you may have suffered a stress injury, you should report it to your employer immediately.
Are there time limitations on giving notice to my employer?
Yes. Under current Maine law, you must tell your employer you are injured within 60 days. This is very important. No matter what, it is very important to tell your employer about your injury immediately after it happens. If there is any question of whether your condition is related to work, you should report it.
It is also important however to know that if you do not think that you met this 60-day requirement, tell your employer as soon as possible. In that case, you should also talk to an attorney, because your claim may be denied.
Although the insurance company may deny the claim because of a lack of timely notice, the law provides for some exceptions. If your employer or their insurance company tells you that you reported the injury too late, you should talk to a lawyer about your claim as soon as possible so that the lawyer may review your particular case.
What if I feel my employer has unlawfully discriminated against me because I got hurt at work?
An employer may not discriminate against an injured worker because of the work injury. Examples include the following: The employer may not fire the injured worker, or demote him or her, or cut his or her pay because of the injury.
The employer may, however, take necessary action which is contrary to the injured worker. Sometimes, the steps taken and the results and lawfulness of such actions are difficult to categorize.
If an employee feels that they have been discriminated against because of an injury, they may file a petition to remedy discrimination. Maine law provides that if the employee can prove unlawful discrimination, an administrative law judge may order that the employer provide reinstatement to the employee’s previous job, payment of back wages, reestablishment of employee benefits and reasonable attorney’s fees.
Do Social Security benefits affect workers’ compensation benefits?
When someone is hurt at work, the immediate process is to seek payment of workers’ compensation benefits from the employer and its insurance company, if applicable.
Weekly payment of benefits under workers’ comp in Maine can be for “partial incapacity” or for “total incapacity.” An example of “partial incapacity” would be an inability to work, due to a doctor’s restrictions, for more than 20 hours per week.
Therefore, a person does not need to be out of work entirely to be entitled to workers’ comp benefits. (Of course, workers’ compensation pays for all reasonable treatment for the injury also.)
In contrast, Social Security pays monthly benefits only for “total disability” under Social Security’s specific definition under federal law. If the injury is one that keeps the person from performing what is known under Social Security law as “substantial gainful activity” for a period of at least 12 months, or can be expected to keep the person unable to perform substantial gainful activity, then the individual may file an application for Social Security Disability benefits.
If an injured worker is receiving both workers’ comp and Social Security Disability benefits at the same time, the Social Security Administration may reduce (offset) the Social Security Disability benefits because the person is being paid workers’ compensation benefits due to the injury.
The offset application and calculation can be complicated, and the decision to apply for Social Security Disability (or even Social Security Retirement) is one that should be made with a complete understanding of the type of Social Security benefits. It is generally advised that the individual should discuss the options with legal counsel.
Does workers’ comp cover an injury while working from home?
If you are injured while you are at home working remotely, it may be covered by Maine workers’ compensation just like any other injury is covered.
If your place of work is, or has become, your home, that does not change the fact that your employer is responsible for injuries that have been caused by work, while you are at work. For example, if you are taking a work file or a computer out of your car to bring into your home office and you suffer an injury to your back in the course of that activity, that is likely going to be covered under workers’ compensation just the same as if you were taking a file or a computer out of your car in the parking lot of your office.
(Note that workers’ comp is a “no-fault” system, which means that there does not need to be anyone who was “negligent” in causing an injury. Workers’ compensation is set up to pay for injuries that happen at work – regardless of the cause.)
Repetitive stress injuries can happen at home due to less than optimal workstation desk setups at home, and those may be covered by workers’ comp also.
If you think you may have a gradual injury, you should tell your employer immediately. Please see the section below on giving notice to your employer.
Can I settle my workers’ comp claim? Should I?
Many Maine workers’ compensation claims settle. Usually, this is by a “lump sum settlement.”
A lump sum settlement is an agreement between you and your employer and the insurance company to part ways. The employer or insurance company pays you a sum of money in exchange for ending your claim. The end of the claim means that you will not receive any future lost time weekly checks. Also, the insurance carrier will not pay for any more medical treatment and will not pay for any vocational rehabilitation or any other benefits whatsoever.
The timing of settlement of your claim may depend on whether you will need more treatment, whether the effects of your injury have plateaued, and your future employment prospects, among many other considerations.
Does Maine workers’ compensation cover repetitive stress or “gradual” injuries?
Many injuries at work happen suddenly. However, some come about over time, gradually. Such slow, progressive conditions affecting, for example, the knees, hips, back, neck, shoulders, elbows and other parts of the body are called “gradual injuries” or repetitive stress injuries if they come about because your body is being used to doing something over months, years or decades.
For example, a problem with the joints of the fingers may be a “gradual injury” if you had to flex your fingers and unflex your fingers as part of your job over a long period of time.
Another good example is a baseball pitcher who has a torn rotator cuff from “wear and tear” from doing the same shoulder pitching motion over months or years.
Do I have to go to the doctor my employer tells me to go to?
In Maine, an injured worker is required to see the employer’s selected physician only for the first seven days of treatment. After seven days, you may seek treatment with your own doctor.
You may want to continue to see the employer’s doctor if you feel that they are treating you well. Sometimes, the employer’s doctor will direct you to a specialist like an orthopedic surgeon or a neurologist.
Does the insurance company pay for my mileage to go see a doctor?
Yes. Your employer/insurance company is required to pay for your mileage (and tolls, if applicable) for travel to medical appointments. In addition, the employer’s insurance company is also required to pay for travel to your pharmacy to pick up medications. If treatment is a long distance away, the employer/insurance carrier has to also pay for meals and hotel.
You should keep track of your travel and submit this information to the insurance company every month or two. You can get a form from the WCB here.
Can my employer/insurance company simply deny my claim?
The employer may deny your initial claim by filing a “notice of controversy.” This notice of controversy may cover lost time benefits, medical benefits or both. This denial is automatically forwarded to a claims resolution specialist, and if the disagreement cannot be worked out, the employee may request that the dispute goes to mediation.
If you are already receiving weekly lost time benefits, generally (with limited exceptions) your employer or the insurance company must give you 21 days’ notice before stopping or reducing your weekly lost time benefits. This must be mailed to you via certified mail. You can dispute this by filing a petition with the Maine Workers’ Compensation Board. If you dispute this, an administrative law judge will decide whether you should continue to receive weekly lost time benefits until a final hearing and a final decision. You should have an attorney assist you with this.
How do I pay for a workers’ compensation lawyer?
In Maine, workers’ compensation attorneys representing injured workers generally get paid by a “contingency fee.” This fee is a portion of your settlement or back benefits the lawyer gets for you. There is no upfront fee necessary, which you might be unable to afford.
Maine law caps attorney fees in workers’ compensation matters at a maximum of 10% of a settlement, or 30% of any back benefits (known as “accrued benefits” or “retroactive benefits”) your attorney gets for you.
Speak With A Lawyer To Get More Answers
These answers are merely the tip of the iceberg when it comes to workers’ compensation law. You can contact the Portland office of The Bayer Law Office to speak with Mr. Bayer and ask him more questions in person. You will not pay any fees unless Mr. Bayer recovers compensation for you. To schedule your free initial consultation, call 207-466-6768 or send an email today.
Disclaimer. None of the information provided here is legal advice specific to your case. The information here or communications made with The Bayer Law Office do not create an attorney-client relationship unless a specific attorney-client agreement is signed. Please consult an attorney.