Paralegal (207) 287-7065
The Abuse Investigation Unit is charged with assessing penalties under several sections of the Act. Section 205(3) requires payment of weekly compensation benefits within 30 days of becoming due and payable when there is no ongoing dispute. Section 205(4) requires payment of medical bills within 30 days of becoming due and payable when there is no ongoing dispute. If these sections are violated, a $50.00 per day penalty, up to a maximum of $1,500.00 must be imposed. Penalties under section 205(3) must be paid to the employee, while section 205(4) penalties are paid to the provider of the medical or health care services, or if the bill was paid by the employee, to the employee who paid for the medical or healthcare services.
Section 324(2) mandates that payments be made within 10 days of any board order or approved agreement. A violation of this section can be penalized by a forfeiture of up to $200.00 per day. The first $50.00 per day is due to the aggrieved employee, the remainder is paid to the Board's Administrative Fund.
Section 324(3) provides penalties for failure to secure required workers' compensation coverage. The maximum penalty is $10,000.00 or an amount equal to 108% of the premium, whichever is larger. Other potential sanctions include loss of corporate status and referral to the Attorney General for criminal prosecution. Penalties assessed under this section are paid to the Board's Employment Rehabilitation Fund.
Section 359(2) provides a penalty of up to $25,000 for any employer, insurer or third-party administrator who engages in a pattern of questionable claims-handling techniques or repeated unreasonably contested claims. Any penalty assessed under this section is payable to the Board's Administrative Fund. The Act also provides that the Board shall certify its findings of any violation of this section to the Superintendent of Insurance, who shall take appropriate action so as to bring any such practices to a halt.
Section 360(1) provides for penalties when a form is not filed within time frames set by rule or statute. Violations of this section carry a maximum penalty of $100.00, payable to the General Fund.
Finally, section 360(2) provides for penalties in cases where a willful violation of the Act, intentional misrepresentation and/or fraud has occurred. The maximum penalty that may be imposed, after hearing, is $1,000.00 for an individual, and $10,000.00 for a corporation, partnership or other legal entity. Repayment of compensation received, or of compensation wrongfully withheld, through a violation of the Act may also be ordered. If a penalty is ordered, it is paid to the General Fund.
The majority of cases that are filed with the Abuse Investigation Unit are brought under sections 360(1) and 324(3), concerning late filings and no-coverage.