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Workers Compensation for Maine

  • Application For A Certificate Of Independent Status
    File .pdf (60.6 Kbytes)
  • Application For A Certificate Of Independent Status Procedure For Filing A Petition For Forfeiture
    File .pdf (73 Kbytes)
  • Application For Predetermination Of Independent Contractor Status To Establish Conclusive Presumption - Landowner/woodharvester
    File .pdf (72.1 Kbytes)
  • Application For Predetermination Of Independent Contractor Status To Establish Rebuttable Presumption
    File .pdf (72.6 Kbytes)
  • Application For Waiver
    File .pdf (96.5 Kbytes)
  • Application For Waiver Instructions
    File .doc (34 Kbytes)
  • Certificate Authorizing Release Of Benefit Information
    File .pdf (10 Kbytes)
  • Certificate Authorizing Release Of Information
    File .doc (60.5 Kbytes)
  • Certificate Of Discontinuance Or Reduction Of Compensation
    File .pdf (10.2 Kbytes)
  • Complaint Form
    File .pdf (27.8 Kbytes)
  • Consent Between Employer & Employee
    File .pdf (11.7 Kbytes)
  • Discontinuance Or Modification Of Compensation
    File .pdf (10.4 Kbytes)
  • Employee Petition For Review Of Incapacity/request For Provisional Order
    File .doc (77 Kbytes)
  • Employee's Return To Work Report
    File .doc (48.5 Kbytes)
  • Employer's First Report Of Injury
    File .pdf (134.5 Kbytes)
  • Employer's Supplemental Report
    File .doc (59.5 Kbytes)
  • Employment Status Report
    File .doc (49 Kbytes)
  • Feb 25, 2002 Notice Regarding First Report
    File .doc (30 Kbytes)
  • Information For Applicant Licensed In Maine
    File .pdf (21.2 Kbytes)
  • Information For Applicant Not Licensed In Maine
    File .pdf (23.9 Kbytes)
  • Instructions For Completing 1st Report Of Injury
    External Link
  • Limited Certificate Authorizing Written Release Of Medical/health Care Information
    File .doc (35.5 Kbytes)
  • Lump Sum Settlement
    File .pdf (11.1 Kbytes)
  • Memorandum Of Payment
    File .pdf (17.8 Kbytes)
  • Motion For Award Of Fees & Disbursements
    File .doc (14 Kbytes)
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