The Maine Workers' Compensation System

The Maine Workers' Compensation System

Office of Monitoring, Audit and Enforcement THE THE MAINE WORKERS MAINE WORKERS COMPENSATION COMPENSATION BOARD BOARD --AN ANOVERVIEW OVERVIEW Revised 3-30-2018

MWCB MWCB MISSION MISSION STATEMENT STATEMENT The general mission of the Maine Workers' Compensation Board is to serve the employees and employers of the State fairly and expeditiously by ensuring compliance with the workers' compensation laws, ensuring the prompt delivery of benefits legally due, promoting the prevention of disputes, utilizing dispute resolution to reduce litigation and facilitating labormanagement cooperation. MAINE MAINEWORKERS WORKERS

COMPENSATION BOARD COMPENSATION BOARD (MWCB) (MWCB) Governed by 7 member panel Appointed by the Governor 3 Appointees from the labor sector 3 Appointees from management sector Executive Director - serves as the Board Chair Also serves as tie breaker MWCB DIVISIONS

CENTRAL OPERATIONS - AUGUSTA Claims Management Unit Performs preliminary monitoring of claims filings Monitors EDI filings Enters all payment forms (WCB-2, WCB-2B, WCB-3, WCB-4, etc.) Reviews AWW calculations

MWCB DIVISIONS CENTRAL OPERATIONS - AUGUSTA Coverage Division Maintains employer and coverage database shared with the Bureau of Labor Standards Monitors EDI submission of policy data Verifies coverage

Coordinates non-filing with Abuse Unit MWCB DIVISIONS MAE UNIT - MONITORING, AUDIT & ENFORCEMENT Monitoring Division Reconciliation & Compliance Reports Monitors performance of industry Publishes Compliance reports

Refers insurers for audit Compiles other WC research MWCB DIVISIONS MAE UNIT - MONITORING, AUDIT & ENFORCEMENT Audit Division Conducts compliance audits of all insurers, selfinsurers, and third party claim administrators (TPAs) per random schedule

Schedule can be superseded by Complaints for Audit (CFA) Audit includes form filing, timeliness and accuracy of benefit payments, and timeliness and accuracy of medical bill payments MWCB DIVISIONS MAE UNIT - MONITORING, AUDIT & ENFORCEMENT (MAE) Enforcement Division Prepares Consent Decrees for violations of Maine Workers Compensation Act of 1992

Coordinates with the Abuse Investigation Unit and Bureau of Insurance MWCB DIVISIONS CENTRAL OPERATIONS - AUGUSTA Abuse Investigation Unit Investigates fraud and abuse violations Prosecutes violations of the Maine Workers Compensation Act of 1992

Coordinates with the Maine Attorney Generals Office DISPUTE DISPUTERESOLUTION RESOLUTION PROCESS PROCESS Sometimes people disagree about what happened, how things happened, or how to recover. Disputes are generally handled in the MWCBs regional offices. DISPUTE RESOLUTION REGIONAL OFFICES 1037 Forest Ave

Portland, ME 04101 1-800-400-6858 1-207-822-0840 106 Hogan Road Bangor, ME 04401 207-941-4550 1-800-400-6856 36 Mollison Way Lewiston, ME 04240 207-753-7700 1-800-400-6857 442 Civic Center Drive Augusta, ME

04330 207-287-2308 1-800-400-6854 1 Vaughn Place 43 Hatch Dr, Ste 110 Caribou, ME 04736 207-498-6428 1-800-400-6855 DISPUTE RESOLUTION Troubleshooting Engages whenever the board is notified of a dispute (lost-time NOC)

Attempts to identify and resolve the issues If troubleshooting fails, file may proceed to mediation DISPUTE RESOLUTION Mediation Mandatory meeting between parties (failure to attend or cooperate may result in sanctions or fines)

Effort to resolve issue(s) in a face to face setting (unless both parties agree to telephone or video conference), moderated by a Board Mediator Mediation agreements are binding and payable within 10 calendar days DISPUTE RESOLUTION Formal Hearing Only engages when petitions are filed Presided over by Administrative Law Judge (formerly Hearing Officer)

Determines final outcome of dispute Appeals can be heard through an Appellate Division made up of panels of no fewer than three full-time hearing officers DISPUTE RESOLUTION Advocates Employee representative requested in lieu of attorney at no cost to the employee

For employees who proceed to mediation and formal hearing QUESTIONS???

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