Can a Notice be signed electronically?

Yes. Electronic signatures are generally valid under the ESIGN Act (15 U.S.C. §7001) and UETA in most states so long as intent, consent, attribution, and retention requirements are satisfied.

When is notarization required?

Notarization is only required where state law or a filing rule demands it; requirements vary by state and by document type, so confirm with the receiving agency or local rules.

Who may sign for an organization?

An authorized officer or agent with demonstrated authority should sign. For entities, include the signer’s title and evidence of authority when relevant to avoid challenges.

How do I correct a mistake after sending?

Send a corrected notice and include a cover explanation and proof of prior service; preserve both versions and record delivery timestamps for each.

Is remote notarization acceptable?

Remote Online Notarization (RON) is permitted in many states with identity-proofing and audio-video retention requirements; verify state-specific RON rules before relying on it.

What if the recipient ignores the notice?

Log attempts to serve and escalate as required—file an administrative appeal, request alternative service, or proceed to litigation if procedural prerequisites are met.

Electronic Signature
Templates
Other
Notice of Controversy

Notice of Controversy

This template is fully customizable. Edit the text, fill out the fields, and send it for signature. Give it a try!

NOTICE OF CONTROVERSY
THIS IS A DENIAL OF YOUR BENEFITS

1. WCB FILE # (if known):

EMPLOYEE

2. EMPLOYEE LAST NAME:

3. FIRST NAME:

4. MI:

5. EMPLOYEE ID:

6. STREET/P.O. BOX MAILING ADDRESS:

7. CITY:

8. STATE:

TYPE:

9. ZIP:

#:

10. HOME PHONE #: ()

11. DATE OF INJURY:

12. SPECIFIC INJURY OR ILLNESS:

13. BODY PART(S) AFFECTED:

EMPLOYER

14. INSURER/CLAIM ADMIN FILE #:

15. EMPLOYER NAME:

16. EMPLOYER MAILING ADDRESS AND PHONE #:

17. INSURER/CLAIM ADMIN NAME AND ADDRESS:

18. INSURER/CLAIM ADMIN FEIN:

NOTICE TO EMPLOYEE

19. YOUR EMPLOYER/INSURER IS DENYING YOUR WORKERS' COMPENSATION CLAIM OR PART OF IT. THE REASON FOR THE DENIAL IS CHECKED BELOW. IF YOU DISAGREE WITH THIS DENIAL, CONTACT A CLAIMS RESOLUTION SPECIALIST AT THE NEAREST REGIONAL OFFICE LISTED BELOW.

19a. FULL DENIAL REASON

19b. PARTIAL DENIAL REASON

FULL DENIAL EFFECTIVE DATE

20a. DATE OF INITIAL INCAPACITY

CURRENT DTE OF INCAPACITY

20b. DATE EMPLOYER NOTIFIED

*NOTE: Reasons identified in boxes 19a or 19b will not preclude a party from raising additional issues at a later date.

21. COMMENTS:

22. If the employer fails to comply with the provisions of Rule 1.1, the employee must be paid total benefits, with credit for earnings and other statutory offsets, from the date the claim is made in accordance with 39-A M.R.S. § 205(2) and in compliance with 39-A M.R.S. § 204. The employer may discontinue benefits under this subsection when both of the following requirements are met: A. The employer files a Notice of Controversy; and B. The employer pays benefits from the date the claim is made. Payment under Rule 1.1 requires filing of a Memorandum of Payment.

ASSISTANCE IS AVAILABLE AT THE MAINE WORKERS' COMPENSATION BOARD'S REGIONAL OFFICES

AUGUSTA

442 CIVIC CTR DR, STE 225

156 STATE HOUSE STATION

AUGUSTA, ME 04333-0156

(207) 287-2308

1-800-400-6854

BANGOR

106 HOGAN RD

BANGOR, ME

04401-5638

(207) 941-4550

1-800-400-6856

CARIBOU

ONE VAUGHN PL

43 HATCH DR, STE 110

CARIBOU, ME 04736

(207) 498-6428

1-800-400-6855

LEWISTON

36 MOLLISON WAY

LEWISTON, ME

04240-7777

(207) 753-7700

1-800-400-6857

PORTLAND

1037 FOREST AVE, STE 11

PORTLAND, ME

04103

(207) 822-0840

1-800-400-6858

23. NAME (TYPE OR PRINT):

24. TELEPHONE #: ()

25. DATE SENT TO WCB:

E-MAIL ADDRESS:

26. DATE RCVD AT THE WCB (WCB use only):

The State of Maine provides equal opportunity in employment and programs. Auxiliary aids and services are available to individuals with disabilities upon request. For assistance with this form, contact the ADA Coordinator at the Maine Workers' Compensation Board. Telephone: 1-888-801-9087 or TTY Maine Relay 711.

WCB-9 (eff. 1/1/13, rev. 1/28/19)

What a Notice of Controversy Is and When it's Used

A Notice of Controversy is a formal written notice used to put another party or an administrative body on notice that a dispute exists and that the sender intends to contest a decision, invoice, claim, or other adverse action. Organizations use this document to preserve procedural rights, trigger dispute-resolution processes, or prompt administrative review. Common contexts include insurance claims, contract disputes, regulatory appeals, and administrative tax or benefit challenges. The notice typically identifies the parties, summarizes the contested facts, states legal grounds, and requests specific relief or further proceedings.

Why a Clear Notice of Controversy Matters

A properly drafted Notice of Controversy documents the dispute, preserves deadlines and defenses, and creates a clear record for administrative or court proceedings. It helps avoid procedural waivers, supports preservation of evidence, and can prompt timely resolution through negotiation or formal appeal.

Who Typically Prepares and Sends a Notice of Controversy

Notices are used by a range of professionals and organizations to protect legal or contractual rights and to begin dispute resolution.

Attorneys and legal departments preparing formal dispute notices for litigation or administrative appeals.
Claims managers and insurers documenting contested claim decisions or reserves.
Business owners, vendors, and contract counterparties asserting rights under agreements or seeking cure/mediation.

Choose the sender based on authority to bind the party (see Who Has Authority to Sign) and applicable procedural rules in the governing jurisdiction.

Core Components of a Professional Notice of Controversy

A professional notice follows a predictable structure so recipients and tribunals can quickly identify the dispute and next steps. Include a clear caption, precise facts, and an explicit request for relief.

Caption

Case caption or identifying header that lists all parties, docket or file number if known, and contact information for sender and primary representative.

Date and Service

The issuance date and method of delivery (mail, email, electronic filing) with proof-of-service language to document when the notice was sent and received.

Statement of Facts

Concise factual summary of the events, dates, and documents giving rise to the dispute, with references to relevant contract clauses or claim numbers.

Legal Grounds

A short statement of the legal or contractual basis for contesting the action, citing statutes, regulations, or agreement provisions where applicable.

Requested Relief

Specific remedies sought (reconsideration, payment, correction, rescission, stay) and any procedural request such as mediation or administrative review.

Signature and Service

Name, title, printed name of signer, signature block, and a certification of service or certificate of mailing/receipt.

Essential Fields to Include

Parties: Full legal names

Contact: Street address and email

File Number: Claim or docket ID

Effective Date: MM/DD/YYYY format

Relief Sought: Specific remedy

Signature: Signer name and capacity

Step-by-Step: Preparing and Serving the Notice

Follow a consistent sequence: draft, verify authority and facts, choose delivery method, serve, and retain proof of service.

01

Draft the Notice: Assemble facts, cite legal grounds, and attach supporting documents.
02

Confirm Authority: Verify signer has corporate or individual authority to act.
03

Select Service Method: Choose certified mail, registered email, or court filing per rules.
04

Retain Proof: Keep delivery receipts, signed PDF copies, and audit logs.

Where to File or Send a Notice of Controversy

The destination depends on the dispute type: opposing party, insurer, agency docket, or court clerk. Match filing rules to the forum.

Opposing Party: Serve the respondent at contract-listed address
Claims/Insurance: Send to claims department with claim ID
Administrative Agency: File with the agency’s appeals or docket unit
Court Filing: File with clerk when initiating judicial review

Customizing an Online Workflow for Notices

Configure an e-filing workflow to collect signatures, route for approval, and preserve an audit trail for each Notice of Controversy.

Field	Recommended Setting
Notification	Email + delivery receipt
Signing Order	Specify sequential or parallel
Authentication	Email link or SMS code
Retention	Store PDF + audit log

Delivery and eSubmission Options

Choose delivery channels that meet legal and procedural standards for service and evidence.

File Formats: PDF and DOCX preferred
Integrations: CRM and cloud storage
Authentication: Email link, SMS, or stronger

Common Timelines and Response Expectations

Deadlines for responses and appeals vary by forum; act quickly to preserve rights and avoid procedural defaults.

Acknowledgment Period:

Often 7–30 days to acknowledge receipt

Administrative Appeal Deadline:

Commonly 20–60 days depending on agency

Statute of Limitations Impact:

Notice timing can preserve or affect limitations

Court Filing Window:

Follow local rules for filing after exhaustion

Record Retention:

Keep originals until final resolution

Key Milestones from Notice to Final Resolution

Track each milestone to ensure timely service, responses, and escalation; create a calendar with deadlines and reminders.

01

Draft and Review

Prepare notice and obtain internal approvals

02

Service Issued

Send via chosen method and record proof

03

Recipient Response

Receive and log any acknowledgement or counter-notice

04

Next-Step Filing

Initiate appeal, mediation, or litigation as needed

Common Mistakes to Avoid

Using informal language or vague requests that fail to preserve specific legal claims or statutory rights and invite procedural objections.
Missing or misidentifying the proper recipient, which can lead to ineffective service and delay or forfeiture of remedies.
Failing to include a clear effective date, claim number, or required attachments, creating ambiguity about what is disputed and when.
Overlooking signer authority or notarization needs, which can lead to challenges on the notice's validity or enforceability.

Consequences of an Incorrect or Late Notice

Waiver of Rights: Forfeiture of procedural claims

Statute Bar: Claim may be time-barred

Default Ruling: Adverse findings by tribunal

Monetary Exposure: Costs or sanctions possible

Loss of Evidence: Delayed preservation harms case

Administrative Penalty: Fines or regulatory action

eSignature Vendor Comparison for Delivering and Signing Notices

Common capability criteria and typical starting prices for popular eSignature vendors. signNow is listed first to align with platform comparison conventions.

	signNow	DocuSign	Adobe Sign	PandaDoc	HelloSign
Starting Price	$8/user/mo	$15/user/mo	$14/user/mo	$19/user/mo	$15/user/mo
Free Trial	7-day free trial	Varies by plan	Varies by plan	Varies by plan	Varies by plan
Bulk Send	Yes	Yes	Yes	Yes	No
Audit Trail	Yes	Yes	Yes	Yes	Yes
HIPAA Compliant	Yes	Yes	Yes	No	No
Envelope Cap	No cap	100 envelopes/user/year	Varies by plan	Varies by plan	Varies by plan

Frequently Asked Questions

Answers to common questions about validity, signatures, and correcting a Notice of Controversy.

Need help? Contact support

Can a Notice be signed electronically?
Yes. Electronic signatures are generally valid under the ESIGN Act (15 U.S.C. §7001) and UETA in most states so long as intent, consent, attribution, and retention requirements are satisfied.
When is notarization required?
Notarization is only required where state law or a filing rule demands it; requirements vary by state and by document type, so confirm with the receiving agency or local rules.
Who may sign for an organization?
An authorized officer or agent with demonstrated authority should sign. For entities, include the signer’s title and evidence of authority when relevant to avoid challenges.
How do I correct a mistake after sending?
Send a corrected notice and include a cover explanation and proof of prior service; preserve both versions and record delivery timestamps for each.
Is remote notarization acceptable?
Remote Online Notarization (RON) is permitted in many states with identity-proofing and audio-video retention requirements; verify state-specific RON rules before relying on it.
What if the recipient ignores the notice?
Log attempts to serve and escalate as required—file an administrative appeal, request alternative service, or proceed to litigation if procedural prerequisites are met.

Explore Templates

Affidavit of Service by Certified Mail Application for Change of Name for a Minor Child Name Change for a Minor Application for Change of Name for a Family Department of Taxation and Finance Quarterly Inventory Marital Waiver of Notice

be ready to get more

Join over 28 million airSlate SignNow users

Sign Now