| VIOLATION |
SPECIFIC STATUTES |
SPECIFIC REGULATIONS |
GENERAL STATUTES |
GENERAL REGULATIONS |
PENALTIES |
| PAID TO |
CRITERIA |
| Conduct at mediation |
313(4)(5) |
15.5 |
313(2) |
|
A)Varies |
| A) The board may impose sanctions against a party who does
not cooperate or produce requested materials(includes failure
to attend a scheduled mediation). |
| B) The Board may assess a forfeiture in the amount
of $100 against any employer or representative of the employee,
employer or insurer who participates in mediation without full
authority to make decisions regarding the claim. |
|
| B) Workers' Compensation Board Administration Fund |
| Delay in payment of benefits |
205(3) |
15.3(1)(2)(3) |
152.10
205(1)(2) |
1.1(5)
8.4 |
Worker |
When there is not an ongoing dispute, if weekly compensation benefits
or accrued weekly benefits are not paid within 30 days after becoming
due and payable, $50 per day must be added and paid to the worker
for each day over 30 days in which the benefits are not paid.
Not more than $1,500 in total may be added pursuant to this subsection. |
| Delay in payment of medical bills |
205(4) |
15.3(1)(4)(5) |
206 |
5.7(2)
7.3(8) |
Provider or Employee |
Where there is no ongoing dispute, if medical bills are not paid
within 30 days after the carrier has received notice of nonpayment
by certified mail, $50 or the amount of the bill due, whichever is
less, must be added and paid to the Workers' Compensation Board Administrative
Fund for each day over 30 days in which the medical bills are not
paid.
Not more than $1,500 in total may be added pursuant to this subsection. |
| Failure to file form or to file form timely |
360(1) |
15.9 |
153.4
357.1 |
1.1(1)(3)(5)
1.7
8.1
8.11
8.12
8.13
8.16
8.18(1) |
General Fund |
The board may assess a civil penalty not to exceed $100 for each
violation on any person who fails to file for complete any report
or form required by this Act or rules adopted under this act; or
who fails to file or complete such a report or form within the time
limits specified in this Act or rules adopted under this Act. |
| Failure to file medical report |
208(2)(A) |
5.19(1) |
207 |
|
Workers' Compensation Board Administrative Fund |
Except for claims for medial benefits only, within 5 business days
from the completeion of a medical examination or within 5 business
days from the date notice of injury is given to the employer, whichever
is later, the health care provider treating the employee shall forward
to the employer and the employee a diagnostic medical report, on
forms prescribed by the board, for the injury for which compensation
is being claimed.
The board may assess penalties up to $500 per violation on health
care providers who fail to comply with the 5-day requirement. |
| Failure to Insure |
324(3) |
15.7 |
401
403 |
1.10 |
Employment Rehabilitiation Fund |
The failure of any employer to procure insurance coverage for the
payment of compensation and other benefits to the employer's employees
constitutes a failure to secure payment of compensation and the employer
is liable to pay a civil penalty of up to $10,000 or an amount equal
to 108% of the premium, calculated using Maine Employers' Mutal Insurance
Company's standard discount premium, that should have been paid during
the period the employer failed to secure coverage, whichever is larger. |
| Failure to pay assessment |
154(8) |
|
154 |
|
Workers' Compensation Board Administrative Fund |
Any insurance company, association or self-insured employer subject
to an assessment that willfully fails to pay, commits a civil violation
for which a forfeiture of not more than $500 may be adjudged fro
each day following the due date for which payment is not made. |
| Failure to pay compensation |
324(2) |
15.6 |
324(1) |
8.6
8.18(2) |
A) of each day's forfeiture amount, the first $50 is paid to the
employee to whom compensation is due. The remainder must be paid
to the Workers' Compensation Board Adminsitrative Fund.
B) Employee |
A) If an employer or insurance carrier fails to pay compensation
within 10 days receipt of board decree or approved agreement, the
board shall assess against the employer or insurance carrier a forfeiture
of up to $200 for each day of noncompliance.
B) If a forfeiture is assessed against any employer or insurance
carrier on petiton by an eployee, the employer or insurance carrier
shall pay reasonable costs and attorney's fees related to the forfeiture,
as determined by the board. |
| Fraud or willful violation |
360(2) |
15.10 |
153(5)(B)(E) |
1.1(1)(2)(3)(5)
1.5
8 |
General Fund |
The board may assess, after hearing, a civil penalty in an amount
not to exceed $1,000 for an individual and $10,000 for a corporation,
partnership or other legal entity for any willful violation of this
Act, fraud or intentional misrepresentation. |
| Pattern of questionable claims handling techniques |
359(2) |
15.8 |
153(5)(B)(E) |
1.1(1)(2)(3)(5)
1.5
8 |
Workers' Compensation Board Administrative Fund |
In addition to any other penalty assessment permitted under this
Act, the board may assess civil penalties not to exceed $10,000 upon
finding, after hearing, that an employer, insurer, or 3rd-party administrator
for any employer has engaged in a pattern of questionable claims-handling
techniques or repeated unreasonably contested claims. |
