[wcb] WCB Form Revisions Effective 6-1-26

Fri May 15 10:40:25 EDT 2026

On May 12, 2026, the Maine Workers' Compensation Board of Directors voted to adopt changes to the forms listed below. The effective date of these forms is June 1, 2026, with a 90-day grace period to begin using them.

WCB-2 Wage Statement
WCB-2B Fringe Benefits Worksheet
WCB-3 Memorandum of Payment
WCB-3A Memorandum of One-Time Payment (optional)
WCB-4D Discontinuance of Compensation
WCB-4M Modification of Compensation
WCB-8 Certificate of Discontinuance or Reduction of Compensation
WCB-10 Lump Sum Settlement
WCB-11A Statement of Compensation Paid
WCB-11B Statement of Compensation Paid (with instructions)

PDF and Microsoft Word copies of the new forms are attached. Fillable PDFs will be added to the WCB website<https://www.maine.gov/wcb/forms/index.html> before the effective date.

Lindsay Lizzotte
Deputy Director of Information Mgmt.
Maine Workers' Compensation Board
(207) 248-7297

-------------- next part --------------
An HTML attachment was scrubbed...
URL: <http://maillist.informe.org/pipermail/wcb/attachments/20260515/ead8bd83/attachment-0001.htm>
-------------- next part --------------
A non-text attachment was scrubbed...
Name: WCB-2 Wage Statement effective 6-1-2026.pdf
Type: application/pdf
Size: 119824 bytes
Desc: WCB-2 Wage Statement effective 6-1-2026.pdf
URL: <http://maillist.informe.org/pipermail/wcb/attachments/20260515/ead8bd83/attachment-0010.pdf>
-------------- next part --------------
A non-text attachment was scrubbed...
Name: WCB-2B Fringe Benefits Worksheet effective 6-1-2026.pdf
Type: application/pdf
Size: 123501 bytes
Desc: WCB-2B Fringe Benefits Worksheet effective 6-1-2026.pdf
URL: <http://maillist.informe.org/pipermail/wcb/attachments/20260515/ead8bd83/attachment-0011.pdf>
-------------- next part --------------
A non-text attachment was scrubbed...
Name: WCB-3 Memorandum of Payment effective 6-1-2026.pdf
Type: application/pdf
Size: 121270 bytes
Desc: WCB-3 Memorandum of Payment effective 6-1-2026.pdf
URL: <http://maillist.informe.org/pipermail/wcb/attachments/20260515/ead8bd83/attachment-0012.pdf>
-------------- next part --------------
A non-text attachment was scrubbed...
Name: WCB-3A One-Time Payment effective 6-1-2026.pdf
Type: application/pdf
Size: 149977 bytes
Desc: WCB-3A One-Time Payment effective 6-1-2026.pdf
URL: <http://maillist.informe.org/pipermail/wcb/attachments/20260515/ead8bd83/attachment-0013.pdf>
-------------- next part --------------
A non-text attachment was scrubbed...
Name: WCB-4D Disc effective 6-1-2026.pdf
Type: application/pdf
Size: 156134 bytes
Desc: WCB-4D Disc effective 6-1-2026.pdf
URL: <http://maillist.informe.org/pipermail/wcb/attachments/20260515/ead8bd83/attachment-0014.pdf>
-------------- next part --------------
A non-text attachment was scrubbed...
Name: WCB-4M Mod effective 6-1-2026.pdf
Type: application/pdf
Size: 115346 bytes
Desc: WCB-4M Mod effective 6-1-2026.pdf
URL: <http://maillist.informe.org/pipermail/wcb/attachments/20260515/ead8bd83/attachment-0015.pdf>
-------------- next part --------------
A non-text attachment was scrubbed...
Name: WCB-8 Disc or Reduction effective 6-1-2026.pdf
Type: application/pdf
Size: 122998 bytes
Desc: WCB-8 Disc or Reduction effective 6-1-2026.pdf
URL: <http://maillist.informe.org/pipermail/wcb/attachments/20260515/ead8bd83/attachment-0016.pdf>
-------------- next part --------------
A non-text attachment was scrubbed...
Name: WCB-10 LSS effective 6-1-2026.pdf
Type: application/pdf
Size: 93455 bytes
Desc: WCB-10 LSS effective 6-1-2026.pdf
URL: <http://maillist.informe.org/pipermail/wcb/attachments/20260515/ead8bd83/attachment-0017.pdf>
-------------- next part --------------
A non-text attachment was scrubbed...
Name: WCB-11A Statement of Comp Paid effective 6-1-2026.pdf
Type: application/pdf
Size: 90544 bytes
Desc: WCB-11A Statement of Comp Paid effective 6-1-2026.pdf
URL: <http://maillist.informe.org/pipermail/wcb/attachments/20260515/ead8bd83/attachment-0018.pdf>
-------------- next part --------------
A non-text attachment was scrubbed...
Name: WCB-11B Statement of Comp Paid effective 6-1-2026.pdf
Type: application/pdf
Size: 92566 bytes
Desc: WCB-11B Statement of Comp Paid effective 6-1-2026.pdf
URL: <http://maillist.informe.org/pipermail/wcb/attachments/20260515/ead8bd83/attachment-0019.pdf>
-------------- next part --------------
A non-text attachment was scrubbed...
Name: WCB-2 Wage Statement effective 6-1-2026.docx
Type: application/vnd.openxmlformats-officedocument.wordprocessingml.document
Size: 27339 bytes
Desc: WCB-2 Wage Statement effective 6-1-2026.docx
URL: <http://maillist.informe.org/pipermail/wcb/attachments/20260515/ead8bd83/attachment-0010.docx>
-------------- next part --------------
A non-text attachment was scrubbed...
Name: WCB-2B Fringe Benefits Worksheet effective 6-1-2026.docx
Type: application/vnd.openxmlformats-officedocument.wordprocessingml.document
Size: 37230 bytes
Desc: WCB-2B Fringe Benefits Worksheet effective 6-1-2026.docx
URL: <http://maillist.informe.org/pipermail/wcb/attachments/20260515/ead8bd83/attachment-0011.docx>
-------------- next part --------------
A non-text attachment was scrubbed...
Name: WCB-3 Memorandum of Payment effective 6-1-2026.docx
Type: application/vnd.openxmlformats-officedocument.wordprocessingml.document
Size: 36996 bytes
Desc: WCB-3 Memorandum of Payment effective 6-1-2026.docx
URL: <http://maillist.informe.org/pipermail/wcb/attachments/20260515/ead8bd83/attachment-0012.docx>
-------------- next part --------------
A non-text attachment was scrubbed...
Name: WCB-3A One-Time Payment effective 6-1-2026.docx
Type: application/vnd.openxmlformats-officedocument.wordprocessingml.document
Size: 35363 bytes
Desc: WCB-3A One-Time Payment effective 6-1-2026.docx
URL: <http://maillist.informe.org/pipermail/wcb/attachments/20260515/ead8bd83/attachment-0013.docx>
-------------- next part --------------
A non-text attachment was scrubbed...
Name: WCB-4D Disc effective 6-1-2026.docx
Type: application/vnd.openxmlformats-officedocument.wordprocessingml.document
Size: 38036 bytes
Desc: WCB-4D Disc effective 6-1-2026.docx
URL: <http://maillist.informe.org/pipermail/wcb/attachments/20260515/ead8bd83/attachment-0014.docx>
-------------- next part --------------
A non-text attachment was scrubbed...
Name: WCB-4M Mod effective 6-1-2026.docx
Type: application/vnd.openxmlformats-officedocument.wordprocessingml.document
Size: 35167 bytes
Desc: WCB-4M Mod effective 6-1-2026.docx
URL: <http://maillist.informe.org/pipermail/wcb/attachments/20260515/ead8bd83/attachment-0015.docx>
-------------- next part --------------
A non-text attachment was scrubbed...
Name: WCB-8 Disc or Reduction effective 6-1-2026.docx
Type: application/vnd.openxmlformats-officedocument.wordprocessingml.document
Size: 26131 bytes
Desc: WCB-8 Disc or Reduction effective 6-1-2026.docx
URL: <http://maillist.informe.org/pipermail/wcb/attachments/20260515/ead8bd83/attachment-0016.docx>
-------------- next part --------------
A non-text attachment was scrubbed...
Name: WCB-10 LSS effective 6-1-2026.docx
Type: application/vnd.openxmlformats-officedocument.wordprocessingml.document
Size: 28333 bytes
Desc: WCB-10 LSS effective 6-1-2026.docx
URL: <http://maillist.informe.org/pipermail/wcb/attachments/20260515/ead8bd83/attachment-0017.docx>
-------------- next part --------------
A non-text attachment was scrubbed...
Name: WCB-11A Statement of Comp Paid effective 6-1-2026.docx
Type: application/vnd.openxmlformats-officedocument.wordprocessingml.document
Size: 29627 bytes
Desc: WCB-11A Statement of Comp Paid effective 6-1-2026.docx
URL: <http://maillist.informe.org/pipermail/wcb/attachments/20260515/ead8bd83/attachment-0018.docx>
-------------- next part --------------
A non-text attachment was scrubbed...
Name: WCB-11B Statement of Comp Paid effective 6-1-2026.docx
Type: application/vnd.openxmlformats-officedocument.wordprocessingml.document
Size: 30409 bytes
Desc: WCB-11B Statement of Comp Paid effective 6-1-2026.docx
URL: <http://maillist.informe.org/pipermail/wcb/attachments/20260515/ead8bd83/attachment-0019.docx>