MEDICAL TREATMENT

An employee sustaining a personal injury arising out of and in the course of employment or disabled by occupational disease is entitled to reasonable and proper medical, surgical and hospital services, nursing, medicines, and mechanical, surgical aids, as needed.

Your employer initially has the right to select your health care provider.  After 10 days from the start of medical treatment, you may select a different health care provider by giving your employer the name of the health care provider and a statement of intention to treat with the new health care provider. Your employer may file a petition objecting to the named health care provider giving reasons for the objection. The issue of the health care provider must be set for mediation. If the objection is not resolved through mediation, after notice to all parties and a hearing, the board may order one of the following:

A. If the employer can not show cause why you should not commence or continue treatment with the health care provider of your choice, the board shall order that your employer is responsible for payment for treatment received from the health care provider; or
B. If the employer can show cause why you should not commence or continue treatment with the health care provider of your choice, the board shall order that the employer is not responsible and that you are responsible for payment for treatment received from the health care provider from the date the order is mailed.

Once you receive treatment from a health care provider of your choice, you may not change health care providers more than once without approval from the employer or the board.  This provision does not limit your right to be treated by a specialist when a referral is made by your chosen health care provider; however, once you have begun treatment with the specialist, you may not seek treatment from a different specialist in the same specialty without prior approval from your employer or the board.

NOTE REGARDING OUT OF STATE MEDICAL TREATMENT:  If you or your employer elect for you to receive medical, surgical and hospital services, nursing, medicines, and mechanical, surgical aids from an out of state health  care provider, the provider might not agree to accept the fees for medical and ancillary services and products in accordance with the Maine Workers’ Compensation Medical Fee Schedule. 

If the health care provider does not accept the payment terms of the Maine Workers’ Compensation Medical Fee Schedule, you may be responsible for the difference between the health care provider’s charges and the amount due under the fee schedule.  As long as the health care provider accepts payment under the fee schedule, you are generally not liable for any portion of the cost of any provided medical and ancillary services and products related to your injury and health care providers may charge you only for the treatment of conditions that are unrelated to your compensable injury or disease. See 39-A M.R.S.A. §206(13).