Maine treating health care providers report on injured workers with the M-1 at the initial visit, during ongoing treatment and when treatment ends. It records the examination, diagnosis, the provider's opinion on causation, the treatment plan, and work capacity as regular, modified or none, with restrictions. The Workers' Compensation Board prescribes this form, and insurers may withhold payment for reports not on it.
The treating health care provider completes the whole form, including the employee, employer and injury block and the examination, diagnosis, causation, treatment and work-capacity sections.
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M-1 Diagnostic Medical Report
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Within 5 business days of the examination or of notice of the injury, then every 30 days while treatment continues, and within 5 working days after treatment ends. Late reports can lead to withheld payment for the report and to Board penalties.
The provider sends it to the employer and to the employee under 39-A M.R.S.A. section 208(2). If a bill for related services goes unpaid, the Board's form WCB-190A is the Provider's Petition for Payment of Medical and Related Services.