Memorandum Of Payment {WCB-3}

WCB-3 - MEMORANDUM OF PAYMENT. This form from the State of Maine Workers’ Compensation Board, is used by an employer or insurer to officially report the first payment of compensation to an employee who has been injured or has become ill in a work-related incident. The form documents key details about the injured worker, including their identity, date of injury, nature of the injury, and affected body part(s). It provides information about the employer and insurer, the reason for the payment (such as acceptance of the claim, voluntary payment, or mandatory payment), and the type and amount of compensation paid. The form outlines whether the payment is for total incapacity, partial incapacity, specific loss, or other benefit types, and includes offsets like Social Security, disability insurance, unemployment compensation, or paid time off, which may reduce the net compensation amount. www.FormsWorkflow.com