Some state worker's compensation acts also provide that a formal claim for compensation be made, either to the employer, the compensation board, or to the state commission board with notice to the employer that the claim is being made. This claim or notice of claim is different from the notice of injury and is governed by a different, and sometimes longer, statute of limitations. This form is a generic example that may be referred to when preparing such a form for your particular state. It is for illustrative purposes only. Local laws should be consulted to determine any specific requirements for such a form in a particular jurisdiction.
Maine Notice of Work-Related Injury and Claim for Worker's Compensation
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How to fill out Notice Of Work-Related Injury And Claim For Worker's Compensation?
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FAQ
Injured workers are entitled to wage replacement and medical treatment benefits. Wage replacement is equal to two-thirds of your average weekly wages, subject to a maximum equal to 90 percent of the Maine average weekly wage. In most cases, you may receive partial incapacity compensation for a maximum of 520 weeks.
There is a 7-day "waiting period" before lost wages must be paid by Workers' Compensation.
The good news is no, you do not lose your benefits if you are fired. Your workers' compensation benefits do not end whether your employer has fired you or laid you off. The law requires that you continue to receive wage loss payments and medical benefits through your former employers' insurance company.
These benefits are based on 80 percent of the difference between worker's after-tax earnings before and after an injury, subject to a weekly maximum payment amount. Depending upon the extent of the disability, these payments will either be capped at 364 weeks or will continue for the duration of the disability.
The maximum compensation rate for injuries on or after January 1, 2020 is 125% of the State Average Weekly Wage. Update for 2022: the state average weekly wage (SAWW) to $1,036.13. Provides that the maximum for injuries occurring July 1, 2022, through June 30, 2023, is $1295.16.
After 7 days of missed work due to your injury, you are entitled to receive weekly compensation benefits beginning on the 8th day. If you miss more than 14 days of work, you will then receive payment retroactive to the original date of injury.
Your employer will pay you 2/3 of your average weekly wage. This is called your compensation rate. There is a limit on how much you can receive, and the limit is different for different dates of injury.
Typically, if your new job pays you less than you were making prior to your injury, you can still receive payment for the difference in wages. You can also continue to receive medical benefits for all healthcare costs related to your injury. If you're disabled, you can still receive disability benefits.