Get Me Wcb M-1 2018-2025

Filling out the ME WCB M-1 form accurately is essential for managing workers' compensation claims. This guide provides step-by-step instructions to help users complete the form online with confidence.

Follow the steps to complete the ME WCB M-1 form seamlessly.

1. Click the ‘Get Form’ button to access the ME WCB M-1 form and open it in the online editor.
2. Begin by entering the employee's name in the designated field. Ensure the information is spelled correctly to avoid any confusion.
3. Fill in the last four digits of the employee's Social Security Number in the respective field for identification purposes.
4. Provide the employee's date of birth. Use the format MM/DD/YYYY to maintain clarity.
5. Enter the employee's phone number. This will allow for communication regarding the claim.
6. Fill in the employer's name and address accurately. This information is necessary for processing the claim.
7. Document the date and time of the injury, selecting AM or PM as appropriate.
8. Indicate whether the injury occurred on employer premises. If not, specify the location of the injury in the provided field.
9. Enter the name and phone number of the supervisor involved, as well as the employer's fax number if available.
10. Describe the nature and cause of the injury. Be as specific as possible to ensure that the injury is well documented.
11. Select whether the examination is initial, progress, or final. Provide the date of the examination.
12. Enter the pertinent ICD-9/10 diagnosis codes. Ensure the codes are correct for proper categorization.
13. Indicate if the diagnoses are work-related by selecting the appropriate option.
14. State whether diagnostic tests have been performed and if the treatment is set to continue. Include dates for follow-up if necessary.
15. Provide an estimated length of treatment and a treatment plan detailing medication, exercises, and other forms of treatment.
16. List any office procedures necessary for treatment and any medical referrals to specialists.
17. Determine the work capacity by selecting from regular duty, no work capacity, or modified work. Describe any restrictions in detail.
18. Complete the section regarding restrictions and recommendations, either listing them or referring to additional information on the back of the form.
19. Sign and date the form as the health care provider. Include your printed name and address.
20. Once all fields are filled out, save the changes made to the form. You can then download, print, or share the completed form as needed.

Start completing your ME WCB M-1 form online today to ensure your workers' compensation claims are processed efficiently.