Modification Of Compensation {WCB-4M}

WCB-4M - MODIFICATION OF COMPENSATION. This form is issued by the State of Maine Workers’ Compensation Board and is used to formally notify all parties when an employee’s weekly workers' compensation payments have been modified. The form must be completed and filed by the employer or insurer and includes essential information about the employee, employer, insurer, date and nature of the injury, and the specific body parts affected. It identifies the legal and factual basis for the change in compensation—such as increased or decreased earnings, return to work with restrictions, cost of living adjustments, or offsets due to disability insurance, retirement benefits, or third-party liability. The form outlines both the old and new compensation amounts, the type of benefit affected (e.g., total, partial, fatal, specific loss), and the effective date of the modification. www.FormsWorkflow.com