Injured at Work – Where Can I Get Medical Treatment (under the Maine Workers’ Compensation Act of 1992)
If you’ve been injured at work – where your injury occurred within the course of your employment, you are entitled to reasonable and proper medical care, paid for by your employer. Depending on your injury, reasonable and proper medical care could include a trip to the hospital, a visit to the doctor’s office, surgical care, and nursing services. Reasonable and proper medical care could also include medicines prescribed related to your work injury, mechanical or surgical aids, and a vast array of other therapeutic treatments.
Initially, your employer has the right to select a health care provider to treat your injury (so long as they are authorized to practice as such under the laws of Maine). But after 10 days from the inception of health care related to your work injury, you have the right to select a different health care provider – one of your choice (please note that you may seek medical care from your preferred provider at any point, but your employer may end up disputing the payment of such treatment if it occurred outside the rules’ applicable time frames).
Your employer has a right to object to you seeing a particular health care provider. If they do so, your employer must file a petition with the Maine Workers’ Compensation Board (the Board) objecting to the named health care provider that you selected, and included in such they must state the reasons for their objection. If this occurs, the Board will first hold a mediation between you and your employer on this issue. If not resolved during mediation, the Board will schedule a prompt hearing on the issue, and an Administrative Law Judge will decide whether your employer has shown cause on why you shouldn’t get medical care from your medical provider of choice. If the Judge rules in your favor, they will order your employer to pay for treatment received from the particular health care provider at issue. If the Judge rules in the favor of your employer, the Judge will order that you are responsible to pay for treatment received from the particular health care provider at issue from the date the Judge’s order is mailed.
It is important to note that once you receive treatment from a health care provider of your choice, you may not change health care providers more than once without approval from your employer or the Board.
Lastly, the rules regarding doctor choice do not limit your right to be treated by a specialist when a referral is made by your health care provider. But it is important to note that once you have begun treatment with a certain type of specialist, you may not seek treatment from a different specialist in the same specialty without prior approval from your employer or the Board.
The above rights do not apply if your work injury claim arises under the Longshore Act. If you’ve been injured at work and have questions about what rights you have regarding medical treatment, or are wondering what rights are applicable in your situation (including questions about the Longshore Act), please do not hesitate to contact us.
In the past several months, we have been faced with perhaps the greatest global health crisis that we will see in our lifetime. COVID-19 has drastically changed nearly every aspect of our lives. One of the biggest changes has been on the employment front. Some workers transitioned to working remotely from home. Others were directed by their employers to stagger their work schedules. Essential workers such as grocery store employees and health care workers have not been so lucky. These front line workers have been called upon to provide essential services. As of April 15, the Maine Workers’ Compensation Board had seen over 200 filed claims asserting rights under the Act. We are likely to see at least three categories of injury claims as a result of COVID-19: (1) COVID-19 diagnoses; (2) orthopedic or soft-tissue injuries as a result of poor ergonomic at-home workstations; and (3) mental stress claims.
Some states have taken action to create a presumption that an employee’s COVID-19 diagnosis arose out of and in the course of employment for the purpose of obtaining workers’ compensation benefits. Maine workers, as of today, do not have such a benefit. Therefore, it is imperative for Maine workers who are diagnosed with COVID-19 to confirm the diagnosis with a medical professional through testing. Once confirmed, the worker should immediately contact an attorney for assistance in processing the claim. Only after confirmed testing can the process be started to gather evidence that the worker was exposed to the illness through their employment.
Besides the obvious work-related injury of a COVID-19 diagnosis, we’re likely to see an increase in claims filed as a result of poor ergonomic conditions as many workers cobble together workstations at their dining room tables and couches. Most workers won’t have the benefit of an ergonomic evaluation in light of COVID-19 circumstances. Workers should not hesitate to see a physician if they are experiencing symptoms related to poor ergonomic conditions.
Finally, the COVID-19 crisis has created stress for all individuals, but especially healthcare workers who have been on the front lines of caring for people who have contracted the disease. Please know first responders who are diagnosed with post-traumatic stress disorder are entitled to a rebuttable presumption in Maine that their diagnosis arose out of and in the course of employment – clearing a path towards workers’ compensation benefits.
Whether you have suffered an injury as a result of COVID-19 or not, we are likely to see the effects of the pandemic continue to impact workers in the months and years ahead.