Maine Workers’ Compensation Payment Primer

Maine Workers’ Compensation Payment Primer Office of Monitoring, Audit and Enforcement

Purpose of Payment Primer • This primer and associated quiz are designed as exercises for Insurance Adjusters to gain familiarity with computing accurate Average Weekly Wage (AWW) and Compensation Rates. • These examples are fictional for the purposes of this exercise.

Joe is injured on 11-11-2003 and missed 13 days of work. The AWW is $413/week and the filing status is “married” . What is his comp rate? How much in indemnity benefits are paid to this claimant? Comp rate = $290.95/week from the 2003 table ($290.95/7) * 6 =$249.39 Example #1

Sally is injured on 11-11-2003 and missed 15 days of work. The AWW is $413/week and the filing status is “head of household” with two dependents. What is the comp rate? How much indemnity benefits are paid to this claimant? Comp rate = $294.69/week from the 2003 table ($294.69/7) *15 = $631.48 is the total amount of benefits that would be paid to this employee. Example #2

Brian is injured on 11-11-2003 and missed 5 days of work. The AWW is $413/week and the filing status is “married joint” with two dependents. What is the comp rate? How much indemnity benefits are paid to this claimant? Comp Rate is $296.45. No benefits are due as the employee returned to work within the waiting period. Example #3

Samantha is injured on 11-11-2003 and misses 6 days, then returns to work. She then subsequently misses an additional 5 days and returns to work again. Later, she again misses another 5 days and returns to work to full duty. (The AWW is $420/week and the filing status is “married”.) What is the comp rate? How much indemnity benefits are paid to this employee? Example #4

Comp rate = $295.45/week from the 2003 table. Indemnity Payments EE is initially due 4 days of compensation, 6+5=11 minus the 7 day waiting period = 4 days. ($295.45/7)*4 = $168.83 For the third period of incapacity, the waiting period must be picked up. ($295.45/7) * 16 =$675.31 minus the $168.83 that was already paid = $506.49 $675.31 is due in all Example #4 - Answer

Sam is injured on 10-20-2003 and is out on total for 12 days. He then returns to work part time for 4 hours/day for 5 days and then is back to work full time. (The AWW is $416/week and the employee works a 40 hour work week. The filing status is “single with zero dependents”). What is the compensation rate for this claimant? How much compensation is due to thisemployee? Example #5

Comp rate = $269.46 from the 2003 benefits table. The employee is initially due 5 days of compensation at the total rate (12 days minus the waiting period of 7 days = 5 days) ($269.46/7) * 5 = $192.47 is payable for the initial period of total. For the period of partial, the comp rate for the partial period must be subtracted from the comp rate for the total period and the employee is due the difference in addition to whatever wages were earned that week. AWW for total period = $416/ week - Comp rate = $269.46; AWW for partial period= ($416/40) *20 = $208 - Comp rate = $147.87 $269.46 – $147.87 = $121.59is payablefor the partial period. Because the claim has gone beyond 14 days, the waiting period must also be picked up and the employee is due $269.46 in addition to the other monies. Total indemnity due (total & partial): $192.47 + $121.59 + $269.46 = $583.52 Example #5 - Answer

Maine Workers’ Compensation Payment Primer