Maine Workers' Comp Alert: WCB Announces Updates to Several Forms
The Maine Workers’ Compensation Board has revised several forms, which are now available here.
The WCB-4 (Discontinuance/Modification) has been divided into two new forms, WCB-4D (Discontinuance) and WCB-4M (Modification). The Discontinuance, Modification, and Memorandum of Payment forms have been modified with substantive changes. Several others have been adjusted to have consistent headers (see boxes 1-18). Revisions for the Notice of Controversy are only for the paper version of that form.
While the effective date of these forms is September 1, 2020, the Board understands that target date may not be feasible due to this late notice. The Board asks that the new forms be used as soon as possible, but no later than January 1, 2021.
The following forms have been changed/updated:
WCB-2: Wage Statement
WCB-2A: Schedule of Dependent(s) and Filing Status Statement
WCB-2B: Fringe Benefits Worksheet
WCB-3: Memorandum of Payment
WCB-4A: Consent Between Employer and Employee
WCB-4D: Discontinuance of Compensation
WCB-4M: Modification of Compensation
WCB-6: Certificate Authorizing Release of Benefit Information
WCB-7: Certificate Authorizing Release of Unemployment Information
WCB-8: Certificate of Discontinuance or Reduction of Compensation
WCB-9: Notice of Controversy
WCB-10: Lump Sum Settlement
WCB-11: Statement of Compensation Paid