Code of Maine Rules
90 - INDEPENDENT AGENCIES
351 - WORKERS' COMPENSATION BOARD
Chapter 3 - FORM FILING
LIST OF APPENDICES

I. Instructions and

Maine Workers' Compensation Board (MWCB)

Claims Release 3 (CR 3), First Report of Injury (FROI),

Element Requirement Table

II. MWCB CR 3, FROI, Conditional Requirement Table

III. MWCB CR 3, Subsequent Report of Injury (SROI), Element Requirement Table

IV. MWCB CR 3, SROI, Conditional Requirement Table

V. IAIABC CR 3, Data Dictionary, 01/01/2010 Edition

VI. MWCB Proof of Coverage Element Requirement Table

VII. MWCB Proof of Coverage Conditional Requirement Table

VIII. IAIABC Proof of Coverage Release 2.1 Data Dictionary, 06/01/07 Edition

Copies of the Appendices may be requested by contacting the Workers' Compensation Board:

Workers' Compensation Board