Maine Workers Compensation Primer 2012-2013 Benefits Calculation

Maine Workers Compensation Payment Primer Office of Monitoring, Audit and Enforcement Basic Training Web Feb 2016

Purpose of Payment Primer This primer is designed for claim administrators to gain familiarity with the calculation of the Weekly Compensation Rate (WCR) and indemnity benefits due. The Weekly Benefit Table is required to determine the WCR for dates of injury prior to 12/31/2012. For injuries on or after 1/1/2013, the WCR is calculated as the AWW divided by three times two.

Example #1 Joe is injured on 1-11-2012 and is unable to work for 13 days. The AWW is $420/week and the filing status is married joint with no dependent children. Comp rate = $310.65/week from the 2012 table MJ-1 What is his comp rate? How much indemnity is due? ($310.65/7) * 6 =$266.27 What would the comp rate be for DOI 1-11-2013? $280.00 (2/3 of $420)

Example #2 Sally is injured on 1-20-2013 and is unable to work for 15 days. The AWW is $420/week and the filing status is head of household with two dependent children. $280.00/week (2/3 of $420) What is the comp rate? How much indemnity is due? ($280.00/7) *15 = $600.00 What would the comp rate be for DOI 12-20-12? $312.10 (HH-2)

Example #3 Brian is injured on 12-31-2012 and is unable to work for 5 days. The AWW is $420/week and the filing status is married joint with one dependent child. Comp rate = $315.90/week from the 2012 table, MJ-2 What is the comp rate? How much indemnity is due? No benefits are due as the employee returned to work within the waiting period. What would the comp rate be if the injury occurred one day later? $280.00 (2/3 of $420)

Example #4 Samantha is injured on 1-1-2013 and is out on total for 6 days, and returns to work. She then subsequently is out for an additional 5 days and returns to work. Later, she is out on total another 5 days and returns to work to full duty. The AWW is $414/week and the filing status is married joint with one dependent. What is the comp rate? Comp rate = $276.00/week (2/3 of $414)

Example #4 - Continued How much indemnity is due? EE is initially due 4 days of compensation for the second period of incapacity 6+5=11 minus the 7 day waiting period = 4 days. ($276.00/7)*4 = $157.71 For the third period of incapacity, the waiting period must be picked up. ($276.00/7) * 16 =$630.86 minus the $157.71 that was already paid = $473.15 Total indemnity due $630.86 What would the comp rate be if the injury had occurred one day earlier? $311.46 (MJ-2)

Example #5 Sam s pay week runs from Monday through Sunday. He is injured on 1-9-2013 and is out on total for 12 days. He then returns to work part time on Monday 1-21-2013 for one week with gross earnings of $208.00, then returns to work full time/full earnings on Monday 1-28-2013. The AWW is $416/week and the filing status is single with zero dependents. What is the weekly compensation rate? Comp rate = $277.33 (2/3 of $416.00) Comp rate one month earlier = $284.30 (S-0)

Example #5 - Continued How much indemnity is due? The EE is initially due 5 days of compensation at the total rate (12 days minus the 7 days waiting period = 5 days) ($277.33/7) * 5 = $198.09. For the week of partial incapacity: Wages for partial period = $208 At $208 the comp rate =$138.67 Therefore indemnity benefits for partial period is ($277.33 (Comp rate for AWW) $138.67(Comp rate for earnings))=$138.66. Because the claim has gone beyond 14 days, the waiting period must also be picked up and the employee is due $277.33 in addition to the other monies. Total indemnity due: $198.09 + $138.66 + 277.33 = $614.08 Total Partial Total

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