Claims Information & Forms

First Report of Injury
WCB-1.pdf
Adobe Acrobat document [265.9 KB]
Fringe Benefits Worksheet
NEW!!
WCB-2B.pdf
Adobe Acrobat document [99.3 KB]
Supervisor's Report of Injury
*Required for all lost time injuries
Supervisor Report.pdf
Adobe Acrobat document [135.2 KB]
Employee Report of Injury
Employee Report of Injury.pdf
Adobe Acrobat document [193.5 KB]
Medical Release Form
wcb-220-(1).pdf
Adobe Acrobat document [873.2 KB]
Wage Statement
Wage Statement.pdf
Adobe Acrobat document [59.7 KB]
CMS Legal Documentation
CMS Form V3.pdf
Adobe Acrobat document [471.9 KB]
Mileage Reimbursement Form
Mileage Reimbursement Form.pdf
Adobe Acrobat document [20.4 KB]

NEW CLAIM OR OLD CLAIM? 

 

When an employee suffers an injury caused by accident or incident that requires treatment and/or lost time, a First Report of Injury must be filed with the Trust.

 

Sometimes there is confusion – if the injured employee has had a previous injury – as to whether a new claim should be submitted or whether it is covered by the old claim.

 
Here are some guidelines to help us determine whether a new claim should be filed:

 

  • A new occurrence to a different body part: submit a new claim.
  • A new occurrence to the same body part but the injured employee has not been medically released for the injury to that body part: you will likely need to submit a new claim unless it is clear that the new occurrence did not significantly aggravate, accelerate or combine with the old injury to cause the new symptoms.
  • A new occurrence to the same body part but the injured employee has been released from medical care for the original injury: submit a new claim.
  • There is no new occurrence, but there are ongoing symptoms from a previous injury that has not been released from medical care: notify Trust so we can put any bills under the old claim and track for lost time.
  • There is no new occurrence, but there are ongoing symptoms from a previous injury that has already been released from medical care: notify Trust so we can deny the old claim.
  • There is no new occurrence and there have not been payments on the claim for over 6 years: Maine’s statute of limitations applies and neither the employer or the Trust should have further liability, however, the Trust must still be notified so we can defend.

 

Regardless of the scenarios listed above, there are some cases where the Trust will be notified through medical records or petitions claiming that a prior injury is active or that a new incident/accident has occurred. The Trust must defend these accordingly.

Maintaining a safe workplace in accordance with all laws is your responsibility. Our safety information and recommendations relate to underwriting concerns and do not constitute an assumption by us of your obligations to provide a safe workplace. We make no representation or warranty that our activities or information will place you in compliance with the law or that your premises or operations are safe. We exercise no control over your premises or operations and have no responsibility or authority to implement loss control recommendations. You are not entitled to rely upon any loss control activities provided by us, and you may not delegate any of your legal responsibilities to us.

Questions?

Contact us anytime:

 

Tammy Moody

Brianna Perkins

Sue Morang

Brian Parke

 

MMTA Workers' Comp. Trust

PO Box 5198

Augusta, ME 04332-5198

Phone: (207)623-1807

Fax: (207)622-6804