A Really Basic Overview of Workers' Comp. Procedure in Maine

As I mentioned in another post, Maine workers’ compensation law does not provide people with the right to trial. Instead, it has its own administrative procedure to follow. Of course, I am not going to review every step in the process here, and I doubt that any case requires the use of every procedural mechanism in the workers’ compensation system. But I will show the basic timeline.

1.            A work-related injury or illness occurs. Injury here can refer to anything from a broken leg to a herniated disc, carpal tunnel syndrome, or post-traumatic stress disorder triggered by a bank robbery. The illness might be asbestosis, noise-induced hearing loss, silicosis, cancer caused by radioactive materials, or something else.

2.            A claim for benefits is asserted. This could be a formal petition for benefits or something as informal as asking the manager to call an ambulance.

3.            The claim is accepted, denied, or paid for voluntarily. If the claim is not denied (or rejected or controverted or whatever other term one might prefer), then the next steps are unnecessary.

4.            Troubleshooting occurs. An employee of the Workers’ Compensation Board contacts the parties to see whether something can be worked out or mediation is necessary.

5.            A mediation conference is held. Sometimes the employee and employer can reach an agreement on some of the disputed issues. On relatively rare occasions, the parties do not have to proceed any further in the process.

6.            The parties prepare for hearing. This step can involve a lot of work and has countless variations. The lawyers must exchange medical records, the insurance company may decide to investigate the injured worker to rule out possible fraud, an independent medical examination may be ordered, depositions of witnesses may be held, the list of witnesses for the hearing must be filed, et cetera.

7.            The testimonial hearing is held. Often the case settles before any hearing is held, but if not then a mini-trial is conducted by an administrative law judge. It can last under an hour and require only one witness, or it may take all day and involve a dozen witnesses.

8.            The evidence closes and legal briefs are submitted. The parties then place their fate in the hand of the administrative law judge (ALJ).

9.            A decision is released (sometimes twice). This may resolve everything with finality, but sometimes the parties file motions that address specific issues or ask the judge to reconsider part of the initial decision or even request a reopening of the evidence record. If such motions are filed, a second decision must be issued.

10.         The end is reached (or not). In many cases, the ALJ’s decision (or “order” or “decree”) resolves the dispute forever, and nothing follows. However, if an employee or an employer thinks the ALJ committed a legal error, there may be an appeal to a panel of other ALJs. The decision of the other ALJs may be appealed to the state’s highest court. In rare cases, the ALJ may ask the Board of Directors to review her or his decision, or someone may try to reopen the case because of alleged fraud. Another disagreement between the parties may arise months or years later, in which case the final decision here may affect the outcome of that dispute.