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Petition for Award of Compensation

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PETITION FOR AWARD OF COMPENSATION - OCCUPATIONAL DISEASE LAW

STATE OF MAINE

WORKERS' COMPENSATION BOARD

27 STATE HOUSE STATION

AUGUSTA, MAINE 04333-0027

EMPLOYEE

NAME:

STREET/P.O. BOX:

CITY, STATE, ZIP:

TELEPHONE NUMBER:

DATE OF BIRTH:

SOCIAL SECURITY NUMBER: XXX-XX-

(only last four digits required)

BOARD FILE NUMBER:

EMPLOYER

NAME:

STREET/P.O. BOX:

CITY, STATE, ZIP:

INSURER

NAME:

STREET/P.O. BOX:

CITY, STATE, ZIP:

NOTICE

A party is not required to file a written response to this petition under 39-A M.R.S.A. §307(3). Upon notice of a claim for incapacity or death benefits, however, the employer/insurer must comply with the provisions of 90 MAR 351 Ch.1. §1 or 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.A. §205(2) and in compliance with 39-A M.R.S.A. §204.

1. Date of incapacity:

MONTH DAY YEAR

2. Date employee gave notice of incapacity:

MONTH DAY YEAR

3. Date of last exposure:

MONTH DAY YEAR

4. Date employment ceased:

MONTH DAY YEAR

5. The exposure occurred

and the employee developed

THEREFORE, the employee asks the board to order benefits pursuant to Title 39 or 39-A, Part 2 (Occupational Disease Law).

SIGNATURE OF PETITIONER

DATED:

MONTH DAY YEAR

FILING INSTRUCTIONS

  1. Mail original petition to the Workers' Compensation Board at the above address by regular mail.
  2. Mail one (1) copy by certified mail, return receipt requested to each other party named in the petition.
  3. Keep one (1) copy for yourself and keep the green certified mail cards when returned to you by the U.S. Post Office.

NAME OF EMPLOYEE'S ATTORNEY OR ADVOCATE (IF ANY)

STREET/P.O. BOX

CITY, STATE, ZIP

TELEPHONE NUMBER

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: (888) 801-9087 or TTY Maine Relay 711. WCB-160 (eff. 1/1/13)

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What the Petition for Award of Compensation Is

A Petition for Award of Compensation is a formal written request filed with a court or administrative tribunal seeking monetary relief for damages, medical expenses, lost earnings, or other compensable losses. It identifies the petitioner, the respondent, the legal basis for the claim, the amount demanded, and supporting facts or evidence. The petition creates the official case record, triggers service and notice requirements, and begins the adjudication timeline that may include hearings, settlement discussions, or judgment. Proper formatting and complete information reduce dismissal and delay risks.

Why a Clear Petition Matters

A well-prepared Petition for Award of Compensation clarifies the legal basis and evidence, shortens processing time, and improves the chance of a favorable outcome. Using precise language and complete attachments helps the adjudicator evaluate entitlement and damages without repeated requests for clarification.

Why a Clear Petition Matters

Who Typically Files or Responds

Parties should confirm jurisdictional filing rules and whether counsel or authorized representatives must sign or make filings on their behalf.

  • Individual claimants seeking wages, medical costs, or statutory benefits from an employer or third party.
  • Employers or insurers responding to claims or filing counterclaims for offsets or overpayments.
  • Attorneys and legal representatives preparing pleadings, evidence lists, and calculation schedules.

Core Components of an Effective Petition for Award of Compensation

A professional petition organizes facts, claims, and relief sought so the decision maker can quickly assess liability and damages.

Caption and Case Data

Court or tribunal name, docket or case number, and caption listing petitioner and respondent. Accurate case identifiers are essential for clerk acceptance and correct record assignment.

Parties and Contact

Full legal names, mailing addresses, counsel information, and authorized representative details. Use the name that matches government IDs or business registrations to avoid service problems.

Statement of Jurisdiction

Concise explanation of why the tribunal has authority to hear the claim, citing statutory or regulatory bases when applicable to prevent early jurisdictional challenges.

Statement of Facts

Chronological facts supporting the claim, including dates, events, and witnesses. Attach exhibits or index them for easy reference at hearing or settlement talks.

Claim for Relief and Calculation

Itemized amounts sought (medical, lost wages, fees). Show calculations and the legal theory for each element to support award determinations and reduce disputes over arithmetic.

Signature and Verification

Signature block for the petitioner or counsel and any required verification or affidavit language. Ensure signatures and dates conform to filing rules and authentication requirements.

Step-by-Step: Completing the Petition

Follow these sequential steps to prepare and submit a clear Petition for Award of Compensation.

  • 01
    Draft the Petition: Write caption, facts, and claims.
  • 02
    Compile Evidence: Attach records, bills, and witness statements.
  • 03
    Review Compliance: Check jurisdictional forms and requirements.
  • 04
    File and Serve: Submit to clerk and serve opposing parties.

Typical Filing and Case Flow

A petition triggers docketing, service, possible response, and adjudication. The flow below outlines common routing steps.

  • File with Clerk: Court receives and assigns a case number.
  • Serve Parties: Deliver petition and exhibits to respondents.
  • Respondent Answer: Respondent files an answer or motion.
  • Hearing or Conference: Tribunal schedules hearing or settlement conference.

How to Configure an Online Filing Workflow

When submitting digitally, set up fields and routing that match court and service requirements to ensure acceptance.

Field Configuration
Caption Block Auto-populate case name and number
Exhibit Upload Require PDF attachments, max 25 MB
Signatures Enable signer name, date, and checkbox
Service List Add email and mailing addresses for each party

Digital Submission and Platform Requirements

Ensure your eSubmission meets clerk specifications for size, naming, and signature evidence; retain proof of electronic service and confirmation receipts for your record.

  • File Formats: PDF and DOCX accepted
  • Authentication: Email or multi-factor authentication
  • Audit Trail: Detailed logs and timestamps

Security and Compliance Considerations for Electronic Submissions

Encryption: TLS 1.2/1.3 in transit
Data at Rest: AES-256 encrypted storage
Compliance: ESIGN and UETA compliance
HIPAA: HIPAA-compliant with BAA available
Audit Trail: Detailed timestamps and IP logs
Certifications: SOC 2 Type II and ISO 27001

Consequences of an Incomplete or Incorrect Petition

Dismissal Risk: Case may be dismissed or delayed
Sanctions: Court may impose fines or costs
Lost Evidence: Missed deadlines can bar claims
Service Failure: Incorrect service voids filings
Authentication Issues: Invalid signatures hinder enforcement
Tax Consequences: Unreported awards may trigger reporting obligations

Common Mistakes to Avoid

  • Failing to include required exhibits or referencing unfiled attachments which leads to continuances and additional cost.
  • Using imprecise damage calculations without itemized proof, inviting challenges and motions to strike parts of the claim.
  • Entering incorrect party names or addresses that cause defective service and can void the proceeding.
  • Overlooking jurisdictional or filing-format requirements, resulting in clerk rejection or misdocketing of the petition.

Two Practical Examples

These scenarios show how a Petition for Award of Compensation is used in typical disputes and what a complete filing looks like.

Example: Wage Claim

A restaurant server documents unpaid overtime and submits paystubs as exhibits

  • Amounts are calculated by hour and week using pay records
  • The petition includes an itemized damages table, employer contact information, and a request for statutory penalties and costs where allowed.

Example: Medical Expense Recovery

A claimant files to recover out-of-pocket medical bills after an injury

  • Attach itemized medical invoices and physician statements
  • The petition explains causation, attaches medical evidence, and requests awards for treatment costs, related travel, and future care estimates when applicable.

Key Deadlines and Timing Expectations

Be aware of filing and response windows to preserve rights; local court rules often set precise deadlines.

Statute of Limitations:

Varies by claim type and state — file before the statutory deadline

Response Time:

Respondent typically has 20–30 days to answer, depending on jurisdiction

Hearing Scheduling:

Preliminary hearings usually set within 30–90 days after filing

Appeal Deadline:

Short window post-judgment, often 30 days for appeals

Document Retention:

Keep filings and proofs until appeals and enforcement are complete

eSignature Vendor Comparison for Filing and Signing

Common eSignature options and entry-level pricing to consider for preparing and distributing petitions; signNow is listed first for parity in comparison.

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 vendor Varies by vendor Varies by vendor Varies by vendor
Bulk Send Yes Yes Yes Yes No
Audit Trail Yes Yes Yes Yes Yes
Envelope Cap No cap 100 envelopes/user/year Varies Varies Varies

Frequently Asked Questions About the Petition for Award of Compensation

Answers to common practical questions about preparing, filing, signing, and correcting the petition.


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