NOTICE
* Apply for Social Security old-age insurance benefits. (You cannot be compelled to apply for early federal old-age insurance benefits.)
* You may apply at a local Social Security office; or
* Online at: http://www.ssa.gov/pgm/retirement.htm.
* To understand your rights and responsibilities with respect to your application for and receipt of Social Security benefits, and the Workers' Compensation Act, you should consider seeking advice from an attorney or other expert in Social Security and Workers' Compensation laws.
* You must provide proof to us that you have applied for benefits.
* Proof of application must be mailed to us within 14 days after you submit your application to the Social Security Administration at the following address:
[INSERT EMPLOYER/INSURER ADDRESS]
* Proof of application includes:
A letter from you, or your attorney or advocate establishing you filed the required application;
* You must complete, sign and return the enclosed authorization form, approved by the Social Security Administration, to release benefit information. Please note, your employer/insurer can only use this form to determine if you are entitled to receive Social Security benefits and, if so, the amount of the benefit you are receiving and the period of time you are or have been receiving Social Security benefits.
NOTICE
The enclosed release previously signed by you has expired. Pursuant to 39-A M.R.S.A. §221(6), you are required to sign and return the enclosed release within 30 days after receipt of this notice.
If you fail to provide proof of application or sign and return the enclosed form we may, with the approval of the Workers' Compensation Board, discontinue your compensation benefits until the proof of application and/or the authority for release of information is provided. Compensation benefits withheld must be reimbursed to you when the required proof of application, or the authority for release of information, or both, has been provided.
90- 351 C.M.R. ch. 9, § 3