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1. How do I know if I should file a claim?
If the employee requires medical treatment, OR the employee loses one or more days from work. If uncertain, please call MSMA for further guidance.
2. What is “incapacity”?
Incapacity refers to the inability to work, whether or not the employee is scheduled to work.
3. Where should employee seek treatment?
During the first ten days after a claim is made, employer has the right to require the employee to be examined by a medical provider of the employer’s choice. However, if the injury is of an emergent nature, employee should proceed to the nearest health facility.
4. Is there a waiting period before incapacity benefits begin?
There is a seven day waiting period.
5. Is the seven day waiting period working days or calendar days?
6. Does the waiting period have to be consecutive days?
7. Is there a waiting period for medical benefits?
Medical benefits begin on day one for a compensable claim.
8. Are broken eyeglasses covered?
Yes, if the glasses were broken during the compensable incident.
9. Are the number of weeks capped for weekly benefits?
Yes, they are capped at 520 weeks, unless it is determined to be a lifetime claim.
10. How are weekly benefits calculated?
For injuries on or after 1/01/13, the compensation rate is 2/3 of the gross average weekly wage. For injuries prior to 1/01/13, the compensation rate was 80 percent of the after-tax average weekly wage.
11. Is there a maximum weekly benefit amount?
The maximum compensation rate is determined by the date of injury and is annually adjusted by the Workers’ Compensation Board.
12. How long does an employee have to file a claim?
An employee has 30 days from the date of injury (or knowledge of the injury or condition) to file a claim. Even if the employee reports or alleges a claim after the 30 day period, the employer is still required to file a First Report.
13. What is considered actual “notice”?
Any verbal, written, or knowledge of an alleged work related condition or injury may be considered notice. These communications may come from various sources other than the employee, including medical providers, family members, or a legal representative. For further guidance, please contact MSMA staff.
14. Can employee be placed on FMLA simultaneously while employee is losing time from work?
15. How is your modification rate calculated?
Please contact Wendy Douglas, Client Services Manager, at (207) 626-5444 or email@example.com.