Maine State Library Maine State Documents Workers’ Compensation Board Documents Spring 1-1-2009 MAE News: Newsletter from the Office of Monitoring, Audit and Enforcement, Spring 2009 Maine Workers' Compensation Board Follow this and additional works at:http://statedocs.maine.gov/wcb_docs Recommended Citation Maine Workers' Compensation Board, "MAE News: Newsletter from the Office of Monitoring, Audit and Enforcement, Spring 2009" (2009).Workers’ Compensation Board Documents.Paper 33. http://statedocs.maine.gov/wcb_docs/33 This Document is brought to you for free and open access by Maine State Documents. It has been accepted for inclusion in Workers’ Compensation Board Documents by an authorized administrator of Maine State Documents. For more information, please [email protected]. MAE News Newsletter from the Office of Monitoring, Audit and Enforcement Maine Workers’ Compensation Board Spring 2009 Volume 5, Number 1 Summer Training Sessions to Be Held In Augusta Open training sessions will take place on June 24, 25 and 26, 2009 in the Elkins Training Room on the campus of the former Augusta Mental Health Institute (AMHI). The Elkins Training Room can be found in Room 110 of the Williams Pavilion, which is a building connected to the Eastside Wellness Center (“the gym”) on the AMHI Paul R. Dionne campus across from Riverview Psychiatric Center. Executive Director/Chair The June 24th session will present the Board’s Basic Compliance program that provides Steven P. Minkowsky forms compliance as well as basic payment training. The June 25th session will present Deputy Director of Benefits Administration the Board’s Advanced Compliance program that provides advanced AWW and partial benefit calculation training. The June 26th session will be a special half-day Claims Workshop that offers you the opportunity to go over “nuts and bolts” form filing issues. Office of Monitoring, This is a great opportunity to meet the staff in the Claims Management Unit who work Audit and Enforcement with you on a daily basis. Maine Workers’ Compensation Board To sign up for one or more of these sessions, contact Anne Poulin at (207) 287-7067 or 27 State House Station send her an e-mail at [email protected]. Also, if your company is in need of personalized training on form filing or other compliance issues, please contact Anne Augusta, Maine 04333 Poulin. We can design our training to suit your needs. Contacts: Counting 21 Days for a WCB-8 Kimberlee Barriere When filing a (21-day) Certificate of Discontinuance or Reduction of Compensation, Director WCB-8, please remember to discontinue (Box 19) or reduce (Box 25) benefits no earlier (207) 287-7031 than 21 days after the date that you mail (Box 29) the form to the injured employee (and Board) via Certified Mail. E-mail [email protected] For example: Jeffery Levesque April 13 (date certificate is mailed, Box 29) Monitoring Manager (207) 287-7090 + 21 (days) = May 4 Please pay benefits through this date, which is the effective date E-mail of the discontinuance (Box 19) or reduction (Box 25). [email protected] Additional instructions are available in the Board’s Forms and Petitions Manual. And, remember to save those postmarked Sender’s Receipts! Anne Poulin Secretary Associate (207) 287-7067 Looking to Increase Your MOP Filing Compliance? Keep an Eye Out for Days Mail Did Not Move! E-mail [email protected] In the first quarter of 2009 there were several days when mail did not move. The following were State holidays in Maine during the first quarter of 2009: January 1, Website: January 21 and February 18. Also, on February 13 all State offices were closed due to www.maine.gov/wcb/ snow. If you had a MOP that appears late on your Reconciliation Report due to the mail not moving, you can ask your contact within the Monitoring Division to reconsider your measurement. How Do I Report a Day or More of Sporadic Hours/Wages Lost (Without Looking Like the First Report is Late)? Example 1 (Hours Lost): An employee who ordinarily works five 8-hour days (M-F) is injured on the job. The employee lost 3 hours from work each Monday for 3 weeks (3/23/09, 3/30/09 & 4/6/09) to attend medical appointments (9 hours lost, collectively). Transmit a First Report to the Board via EDI as follows: Paul R. Dionne 1. Box 43 “Date Of Incapacity” (DN56) = 3/23/09 (the initial date disability began) Executive Director/Chair 2. Box 43 “Date Employer Notified” (DN281) = 4/6/09 (the date notified of a day or more collectively lost from work) Steven P. Minkowsky 3. Box 47 (RTW Date) (DN68) = 3/24/09 (the initial return-to-work date) Deputy Director of Benefits Administration Example 2 (Wages Lost): An employee who ordinarily works five 8-hour days (M-F) is injured on the job. The employee’s AWW is $385 (daily wages = $77). The employee Office of Monitoring, lost $32/week for 3 weeks (w/e 3/29/09, 4/5/09 & 4/12/09) due to restricted duty ($96 Audit and Enforcement lost, collectively). Transmit a First Report to the Board via EDI as follows: Maine Workers’ 1. Box 43 “Date Of Incapacity” (DN56) = 3/23/09 (the initial date disability began) Compensation Board 2. Box 43 “Date Employer Notified” (DN281) = 4/13/09 (the date notified of a day or more collectively lost from work) 27 State House Station 3. Box 47 (RTW Date) (DN68) = 3/24/09 (the initial return-to-work date) Augusta, Maine 04333 The First Report will not be late if it is filed within 7 days from the date the employer was notified of a day or more of lost time/wages (Box 43B/DN281). Contacts: Kimberlee Barriere Transaction accepted with errors (“TE”) Director (207) 287-7031 The Board is currently in the midst of implementing computer programming necessary to ensure compliance with Board Rule 3.4(2) regarding application acknowledgement E-mail code “TE”. This change can have major implications regarding the 14-Day Rule for [email protected] Payment of Benefits: A denial can be rejected if there are outstanding TEs on a claim. Jeffery Levesque Rule 3.4(2)(A) defines “application acknowledgement code” as a code used to identify Monitoring Manager (207) 287-7090 whether or not a transaction has been accepted by the Board. Subsection (2) defines application acknowledgement code TE as follows: E-mail [email protected]  The transaction was accepted with errors and the First Report of Injury or Subsequent Report of Injury is filed. The error or errors will be identified in the acknowledgement transmission that is sent by the Board. All identified errors Anne Poulin must be corrected within 14 days after the date the acknowledgement Secretary Associate (207) 287-7067 transmission was sent by the board or prior to any subsequent submission for the same claim, whichever is sooner. E-mail [email protected] Acquired Claims Claims administrators must send FROI “AQ” transactions to report the acquisition of Website: claims previously reported to the Board by the prior claims administrator. The www.maine.gov/wcb/ jurisdiction claim number/WCBN is mandatory for these transactions. Your contact within the Monitoring Division can supply you with a list of claims/WCBNs when you provide written documentation regarding the claims being acquired (this can include coverage notices or e-mails from the account being acquired). Claims administrators should send FROI “AU” transactions to report the acquisition of claims not previously reported to the Board by the prior claims administrator. Reporting a lost time/indemnity claim not previously reported by the prior claims administrator as an original claim (rather than an acquired claim) could result in a potential Sec. 360.1.B penalty.