SUMMARY: This chapter enables the Board to safeguard the limited resources in the fund and thereby serve the greatest number of crime victims by imposing a standard of reasonableness in the amounts of awards for medical and medically related expenses.

§1 Generally: The Board shall award compensation for unreimbursed medical and medically related expenses which the Board determines are reasonable and necessary and which were incurred as a direct result of the crime. Compensation will not be awarded for unrelated, or pre-existing conditions except to the extent that they were exacerbated by the crime. In the Board's determination of reasonable and necessary expenses the following guidelines shall apply; however, the Board may depart from these guidelines if necessary to further the purposes of the statute and if the Board states its reasons therefore in writing:

1. Funeral Expenses: A standard maximum award for funeral expenses shall be $4500.00 with an additional $500.00 award available for a burial marker. The Board may exceed this guideline in exceptional circumstances. The Board shall consider the following factors in deciding whether to award less than the standard maximum:

A. The number of family and household members potentially eligible for benefits under a claim.

B. The number and cost of compensable losses potentially payable under a claim; and

C. Considerations specified in the Victims' Compensation statute.

2. Lost Wages: Awards for lost wages shall be based on the victim's net wages at the time of injury. The Board shall not reimburse for lost income covered by a collateral source. Prior to the granting of an award for lost wages the Board must be provided with:

A. A disability statement from a treating physician or mental health provider demonstrating that the injury or condition is causally related to the crime and specifying when the victim is or will be able to resume work and either:

1. B. Verification of employment from the employer, including dates absent from work, net salary and any available sick or vacation pay or
2. C. Self employed claimants shall provide a copy of the two prior years' tax returns and/or other substantial evidence of lost income or profits.3. Medical Expenses: The victim shall be eligible for compensation for medical care incurred as a result of the crime that is not covered by another source. The Board may award up to 75% of all outstanding medical bills not to exceed the statutory limit. The Board will not pay interest, finance or collection fees as part of the claim.- A. Prior to the granting of an award for medical care costs the claimant must:
3. (1) Submit all bills to insurance providers
4. (2) Exhaust, to the satisfaction of the Board, all other sources of public or private reimbursement including but not limited to: Medicaid, Medicare, Worker Compensation, Social Security, Veterans Benefits, General Relief and Free care, and verify that they have done so.4. Mental Health: A victim, and his or her family members to the extent that family counseling is determined to be necessary to expedite the victims recovery, shall be eligible for compensation for reasonable mental health counseling expenses incurred as a direct result of the crime. Counseling fees will be reimbursed only when treatment is provided by a qualified professional with an acceptable treatment plan.- A. Prior to the granting of an award for counseling, the treatment provider must complete a treatment plan. The plan shall include a diagnosis, treatment goals with target dates for completion and the expected termination date.
5. B. The claimant may request an extension of counseling services beyond the original treatment plan. In this instance the treatment provider shall provide an updated treatment plan.
6. C. In making determinations regarding claims for mental health counseling, the Board may obtain the opinion of a review panel consisting of volunteer members from the mental health counseling community.---

STATUTORY AUTHORITY: 5 M.R.S.A. § 3360-A(7)

EFFECTIVE DATE:

February 19, 1995

NON-SUBSTANTIVE CORRECTIONS:

March 17, 2000 - formatting

AMENDED:

May 27, 2000