Maine Workers' Compensation Board Forms

This form is used for reporting employment status in the state of Maine. It helps the state government collect information about individuals' employment situations.

This Form is used for employees in Maine to report their return to work after a work-related injury.

This form is used for requesting an independent medical examination in the state of Maine for workers' compensation purposes.

This form is used for requesting an award of fees and disbursements in the state of Maine.

This form is used for filing a petition in Maine to determine the average weekly wage for workers' compensation benefits.

This Form is used for filing a petition for compensation in case of a fatal work-related incident in the state of Maine.

This Form is used for filing a Petition for Award of Compensation for occupational diseases in Maine.

This form is used for filing a petition to determine the extent of permanent impairment in the state of Maine.

This Form is used for filing a petition to request payment for medical and related services in the state of Maine.

This form is used for filing a petition to address discrimination in the state of Maine.

This document is used in Maine to file a petition for an extension of benefits due to extreme financial hardship. It is based on the Maine Revised Statutes, Title 39-A, Section 213(1).

This form is used for filing a petition to review extended benefits awarded due to extreme financial hardship in Maine.

This form is used for employees in Maine to report their return to work after an injury or illness. It helps employers and the Workers' Compensation Board track the progress of the employee's recovery.

This form is used for applying for predetermination of independent contractor status in Maine. It helps establish a rebuttable presumption for independent contractors.

This form is used for filing a petition to determine eligibility for rehabilitation services in Maine under the 39-a M.R.S.A. 217(2) statute.

This document is used for applying for the Wage Credit Employment Rehabilitation Fund in Maine.

This form is used for applying for a waiver in the state of Maine.

This form is used for petitioning a review of incapacity in the state of Maine.

This form is used for an employee in Maine to petition for review of incapacity and request a provisional order related to workers' compensation.

This form is used for healthcare providers in Maine to petition for payment of medical and related services.

This form is used for keeping a record of work search activities in the state of Maine. It is used by individuals who are receiving workers' compensation benefits and are required to actively search for new employment opportunities.

This form is used for filing a petition to terminate benefit entitlement in the state of Maine under workers' compensation.

This Form is used for filing a Notice of Intent to Appeal a decision in a workers' compensation case in the state of Maine.

This form is used for filing a complaint for penalties under section 205(3) of Title 39-A in the state of Maine.

This document is used for joint scheduling in the state of Maine.

This form is used for filing a petition for forfeiture in accordance with Maine law 39-a 324(2).