Maine Release of Claims for Personal Injuries by Employee

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Multi-State
Control #:
US-0630BG
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This form is a release of claims for personal injuries by an employee.
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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.

Are my workers' compensation benefits considered taxable income? In most states, workers' compensation benefits are considered reportable but not taxable income. We encourage you to contact a tax professional if you have additional questions.

Injured at work? You must tell your employer within 30 days of your injury, or when you learn of your injury, that you have been injured. If you wait more than 30 days after the injury, you will lose the right to claim workers' compensation benefits.

For emergencies, immediately call 911. For non-emergency situations, contact and coordinate care with pre-arranged medical facilities as established with your workers' compensation insurance carrier's medical provider network. In-network care helps ensure prompt and efficient care for the employee.

Step 1: The employee must report the disablement, in writing, to his/her employer as soon as possible or within 12 months from the date the disability occurred. Step 2: The employer must report work-related injury to the Fund within 7 days, or the work-related disease to the fund within 14 days.

Injury? Your employer must complete a First Report of Injury within 7 days. Your employer must give you a copy of the First Report of Injury. If you lose a day's work because of your injury, your employer must also file the First Report of Injury with the Workers' Compensation Board.

Employers are obliged by law to pay injured employees compensation for the first three months of their injury or sick leave. However, employers are requested to state in the Injury on Duty Form if they are prepared to make additional compensation payments after that period.

If you miss more than 7 days of work because of an injury, you are entitled to receive weekly compensation benefits. If you lose between 7 and 13 days, you will be paid for those days. If you miss more than 14 days, you will be paid for all of the days that you have missed.

How do I file a workers compensation claim in my state? You must tell your employer that you were injured within 30 days of the injury. Your employer then has 7 days to file a First Report of Injury and give you a copy.

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Maine Release of Claims for Personal Injuries by Employee