12-702-1 Me. Code R. § XV

Current through 2024-51, December 18, 2024

Section 702-1-XV - [Effective 1/1/2025] Appeals

A. An aggrieved party may appeal the following issues to the Department within 15 business days from the date the decision is issued, except that the period within which an appeal may be filed may be extended for a period not to exceed an additional 15 business days, for good cause shown. Good cause for the late filing of an appeal is at the discretion of the Department. Issues which may be appealed are:

1. Denials of applications for benefits;

2. Issues as to the amount of benefits;

3. Findings that an employer determination of undue hardship is unreasonable;

4. Delay or denial of a claim for benefits due to a finding of reasonable undue hardship;

5. Any fine or penalty imposed, including fines related to late or non-payment of premiums;

6. Disqualification of a self-employed individual;

7. Disapproval or revocation of private plan substitutions;

8. Findings of fraud; and

9. Denial of waiver of overpayments.

B. The Department shall appoint a qualified Hearing Officer, employed or contracted by the Department, to hear any appeal.

C. Hearings on appeals conducted pursuant to this rule shall be adjudicatory proceedings, governed by the Maine Administrative Procedures Act (MAPA), 5 M.R.S. § 9051-9064.

D. Hearings may be conducted by telephone or by video conference.

E. The Hearing Officer shall issue such orders as are necessary for efficient and expeditious processing of an appeal. The Hearing Officer may require exhibits and/or witness lists to be filed in advance of the hearing.

F. A Notice of Hearing must be issued to the appealing party, and to the extent applicable, the covered individual, the employer and the Administrator at least ten (10) business days before the date of the hearing.

G. The Administrator must submit documents to the Hearing Officer relating to the issue on appeal and any reconsideration decision within 5 days after notification by the department. Such documents shall be provided to all parties. The Administrator is not required to appear at the hearing, unless directed to appear by the Hearing Officer.

H. The Hearing Officer will make a decision de novo and is not required to defer to any decision by the Administrator. The Department may designate certain decisions by Hearing Officers to be precedent in similar appeals. The Department may issue written guidance, which will be publicly available, to ensure consistency between Hearing Officers in determining similar issues.

I. Decisions of the Hearing Officer shall be in writing and shall state the Hearing Officer's findings of fact and basis for the decision. Decisions by the Hearing Officer shall constitute final agency action within the meaning of 5 M.R.S. §8002 (4) and shall be reviewable in Superior Court pursuant to 5 M.R.S. §11001 et. seq.

12-702 C.M.R. ch. 1, § XV