(21-DAY) CERTIFICATE OF DISCONTINUANCE OR
REDUCTION OF COMPENSATION, WCB-8
Reporting Requirements
The employer or insurer (which can sometimes be one and the same) must file a 21‑Day Certificate of Discontinuance or Reduction of Compensation when compensation is discontinued or reduced pursuant to 39-A M.R.S.A. §205(9)(B)(1).
A 21‑day Certificate of Discontinuance or Reduction of Compensation must be sent by certified mail to the Board and to the employee (box 29).
Distribution
The Certificate of Discontinuance or Reduction of Compensation is a four-part form that is to be distributed as follows:
Copy 1 to the Workers’ Compensation Board (certified mail) at the following address:
State of Maine
Workers' Compensation Board
27 State House Station
Augusta, Maine 04333-0027
A Certificate of Discontinuance or Reduction of Compensation must be mailed to the employee by certified mail no less than 21 days prior to the effective date (box 19 or box 25) of the form.
Copy 2 to the Employee.
Copy 3 to the Insurer.
Copy 4 to the Employer.
INSTRUCTIONS FOR COMPLETING CERTIFICATE OF
DISCONTINUANCE OR REDUCTION OF COMPENSATION, WCB-8
Identifying Information
- Insurer File Number
This box is provided for use by the insurer. If the insurer file number is known at the time the Certificate of Discontinuance or Reduction of Compensation is filed, enter it here. The Board will record it for reference.
- Employer Name
Enter the employer name as it was entered in box 10 of the Employer’s First Report of Occupational Injury or Disease, WCB-1.
- Employer Mailing Address and Phone Number
Enter the address where the employer receives mail. Also enter the employer’s phone number, including area code.
- Insurer Name
Enter the name of the employer’s workers’ compensation insurance company. If the employer is self‑insured or group self‑insured, indicate this and provide the name of the third‑party administrator if there is one.
- Insurer Mailing Address
Enter the insurer, self-insured, or third-party administrator’s mailing address.
- Social Security Number
Enter the employee's social security number.
- WCB File Number
If the preparer knows this number, enter it here. Doing so will speed up processing this form. EDI users must complete this box.
- Employee Last Name
Enter the employee's last name as entered in box 27 of the Employer's First Report of Occupational Injury or Disease, WCB‑1.
- First Name
Enter the employee's first name as entered in box 28 of the Employer's First Report of Occupational Injury or Disease, WCB‑1.
- M.I.
Enter the employee's middle initial as entered in box 29 of the Employer's First Report of Occupational Injury or Disease, WCB‑1.
- Address – Number and Street
Enter the employee's mailing address.
- City
Enter the city of employee's mailing address.
- State
Enter the state of employee's mailing address.
- Zip
Enter the zip code of employee's mailing address.
- Home Phone Number
Enter the employee's home telephone number, including area code.
- Date of Injury
Enter the date (month, day, year) of injury. This date should be the same as box 42 of the Employer's First Report of Occupational Injury or Disease, WCB‑1.
- Description of Injury or Illness
Enter a complete description of the injury or illness.
- Reason for Discontinuance or Reduction of Benefits
Enter the reason for discontinuing or reducing compensation, and attach any information that the employer, insurer, or self-insured used to support this action.
Discontinuance
- Period of Incapacity
From (Date):
Enter the date (month, day, year) this period of incapacity began. This date should be the same as box 23 of the Memorandum of Payment, WCB-3, for the current incapacity period. NOTE: Enter only one period of incapacity in box 19 per form.
To (Effective Date of Discontinuance):
Enter the date (month, day, year) payment for the incapacity will end (21 days from the date the Certificate of Discontinuance or Reduction of Compensation is mailed, box 29). Do not count the day the Certificate of Discontinuance or Reduction of Compensation is mailed to calculate the 21-day period.
| EXAMPLE: |
May 5 (date certificate is mailed, box 29) |
| |
+21 (days) |
| |
= May 26 (effective date of discontinuance) |
- Weekly Compensation Rate
Enter the weekly compensation rate (in dollars and cents, unless varying rates are paid) used for this period of incapacity. If more than one rate was used, enter the last rate used.
- Compensation Payment to Date of Certificate
Enter the total amount of weekly compensation (in dollars and cents) due to date (date the Certificate of Discontinuance or Reduction of Compensation is mailed) for the current incapacity period.
- Compensation to be Paid for 21-Day Period
Enter the total amount of weekly compensation (in dollars and cents) to be paid for the 21-day notice period.
Reduction
- Old Compensation Rate
Enter the compensation rate (in dollars and cents, unless varying rates are paid) prior to change.
- New Compensation Rate
Enter the new compensation rate (in dollars and cents, unless varying rates are paid). If varying rates will be paid, enter the word "varying."
- Effective Date of Reduction
Enter the date (month, day, year) payment for the incapacity will be reduced (21 days from the date the Certificate of Discontinuance or Reduction of Compensation is mailed, box 29). Do not count the day the Certificate of Discontinuance or Reduction of Compensation is mailed to calculate the 21‑day period.
| EXAMPLE: |
May 5 (date certificate is mailed, box 29) |
| |
+21 (days) |
| |
= May 26 (effective date of discontinuance) |
- Comments
Use this box to enter any additional information, explanation, or clarification.
Preparer Information
- Claim Handler Name
Type or print the claim handler’s name.
- Telephone Number
Enter the claim handler’s telephone number, including area code.
- Date Mailed
Enter the date (month, day, year) the Certificate of Discontinuance or Reduction of Compensation was mailed to the injured employee. This date should be 21 days prior to the effective date shown in box 19 (discontinuance) or box 25 (reduction).
The Certificate of Discontinuance or Reduction of Compensation must be sent by certified mail to both the Board and to the employee.
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