Common Questions asked regarding Maryland Workers Compensation Cases
COMMON QUESTIONS Go to the answers
What is Average Weekly Wage and Temporary Total
Were you “working” at the time of the injury Answer
-Required or Volunteer
What is the timeline of a workers compensation case Answer
-Independent Medical Evaluation Answer
Did I Settle my claim or go to Permanency Answer
-Indemnity v. Medical
What about Volunteer firefighters and Emergency staff Answer
Workers’ Comp is paying for everything, do I still need an attorney Answer
Temporary Total Disability- How is the amount paid to the employee determined and what is average weekly wage?Answer
Temporary Total Disability (ttd) is the amount of money the employers’ insurance company is responsible to pay an injured worker while the worker is held out of work by a physician. To obtain these benefits the employee must be completely disabled for this temporary period. If the employee is able to work light duty then the he or she may not be entitled to the payments. An employee’s ttd rate is determined by finding two thirds of the average weekly wage (aww). Calculation is done by multiplying .666 x aww= ttd. The average weekly wage is determined by the 14 paychecks prior to the accident.
Most often determining the ttd rate and the aww amount is fairly cut and dry, however some issues can arise. For starters, it should be noted that ttd rates are limited by the Maryland State Average weekly wage. This is adjusted each year and in 2013 the State Average Weekly Wage (SAWW) was $990. So, for example: Injured work X was making $3,000 a week when she was injured in 2013. X would only be entitled to $990 a week in ttd benefits.
Periodically an employer will pay the employee full salary for a period while the injured worker is out because of the work injury. This is a benefit that should be appreciated, however it can raise serious legal ramifications with the cases’ Statute of Limitations. An attorney should be consulted to discuss this.
Another concern that may come to mind when dealing with an employees’ entitlement to ttd benefits is if the employee’s wages are especially low. For instance a crossing guard only making $30.00 a week would be entitled to very minimal ttd payments. Maryland law does guarantee a minimal payment to the injured employee of $50.00 per week regardless of how low their weekly wages may have been.
Sometimes yes and sometimes no.
By this time you have likely heard of the ice bucket challenge and this unprecedented effort to raise awareness of the horrific Amyotrophic Lateral Sclerosis (ALS or Lou Gehrig’s disease). There is no doubt that the amount of awareness and money this challenge has raised is of benefit to our society. You may have seen a group of firefighters, or police officers, or even a veterinarian clinic performing the challenge. The question arises as to whether these employees would be covered under workers’ compensation in the event they were injured while completing the challenge. Maryland law is not clear but tends to favor the employee.
Maryland law states that if you were in the course of employment, and the task you were performing arises out of your employment, then the claim is Compensable. Here is a list of arguments that are often made to determine if you were injured “arising out of and in the course of employment.”
•Participation was required by your supervisor.
•You were paid while completing the challenge.
•You were urged to participate.
•The video can be used as marketing for the company.
•The task at hand is something that is secondary to your duties at work but you are still expected to complete these tasks on occasion.
The simple answer is that it depends on the complexity of the case and the nature of the injury.There are a few milestones that usually take place in each workers’ compensation case.
The first step is to file the claim with the Maryland Workers’ Compensation Commission. This should be done as soon as practicable as there are certain deadlines that may bar the claim completely leaving the injured worker without medical care and without any source of income should the employee no longer be able to work. Often there is confusion as to how to file the claim and an attorney can help with this. Simply misstating the correct body part on the claim form can leave the claimant without future medical care.
Once the claim is filed the insurance company will have a period where they can investigate the claim and determine whether they will accept the claim as compensable or challenge the claim on various grounds. These include but are not limited to whether the claimant was injured at work, whether the event alleged ever happened, and whether the need for treatment is because of the alleged incident or because of some underlying health issues. There are also some statutory arguments that can be made which include, but not limited to lack of notice to the employer, statute of limitations, willful misconduct by or on behalf of the employee.
Once it is determined that the claimant did sustain a compensable injury the insurance company will have an ongoing ability to challenge portions of the case. It is not unusual for the Insurer to question the treatment which is recommended by the Claimant’s doctor. This could include refusal to authorize physical therapy, medication, support braces, injections, or surgery.News
The insurance adjuster will arrange an “Independent Medical Evaluation” which will be performed by a doctor who is paid by the insurance company. There are some truly independent medical evaluators but for the most part the Independent Medical Evaluation (IME) will be heading in the direction favorable to the insurance company. Once this report is complete the insurance company will challenge the treatment and the only resolution for the claimant is to request a hearing before the Workers’ Compensation Commission.
According to Maryland Law an employee who has sustained a compensable workers compensation claim is entitled to Temporary Total Disability (ttd) benefits while being held out of work by the treating physician. TTD benefits are to be paid at the rate of 2/3 of the Claimants average weekly wage. The assistance of an attorney is needed to determine the average weekly wage. Often the Insurer will stop these ttd benefits at any time, refuse to pay these benefits, or pay these benefits at a lower rate than the Claimant is entitled. Insurers will often use an IME to justify there termination of TTD benefits. An attorney can help get these benefits reinstated.
On occasion the injured worker will get the benefits to which they are entitled without any interruption from the insurance company. The Claimant will return to work and all is well. Or one may think! There is compensation to be paid to the claimant at the end of the case that is vitally important to the case. The claimant is entitled to lifetime medical benefits for the injured body part, but without receiving a permanency award those benefits will eventually be lost. It is important that the Workers’ Compensation Commission determine that there is indeed a permanent impairment otherwise it will be argued that any future treatment is not related to the injury at work. If you have questions about the above or wish to speak to an attorney Andrew is available to speak with you.
Did I Settle My Claim Or Did I Go to Permanency?
There is much confusion among claimants in understanding the status of their claim. What you need to know is there are various avenues of settlement and permanency is a completely separate step in the workers’ compensation process.
Every Maryland workers’ compensation case has two components that are important to know when distinguishing settlement versus permanency. Medical and Indemnity. Medical can include medication, physical therapy, doctor’s visits, diagnostic tests and anything that can be related to the medical treatment. Indemnity is strictly the money side of the case. The claimant may be receiving temporary total benefits while being held out of work. The injured may be receiving payments for vocational services, or may be at the permanency stage of the case.
PERMANENCY- The permanency stage of the case will begin when the doctors have discharged the injured from care and she or he have, for now, benefited as much as possible from the treatment options. The doctor may state the injured worker is as good as she is going to get, there is nothing more to offer to the injured, or she is at the maximum medical improvement. When this happens her attorney will have her evaluated by a physician, usually not the treating physician, to determine what her permanent impairment may be. The doctor decides what he thinks the permanent impairment is by evaluating her in office and applying the American Medical Association Guide to Impairment. The Doctor will come up with a percentage that can then be calculated into a dollar figure. NOTE; this percentage is often greatly inflated to give the injured and her attorney leverage in any kind of settlement or agreement on permanency. Consultation with an attorney is advised to determine the true value of the case. The insurance company will also have their opportunity to evaluate the injured for permanency. Their doctor will evaluate her and use the same steps to determine the percentage impairment. The need for a hearing is the natural consequence of having two different doctors issuing an impairment figure. The defense/insurer’ doctor ordinarily issues a low number; the Claimant’s doctor ordinarily issues a high number.
Once the reports are received the parties can attempt to resolve the permanency of the claimant. If no resolution is obtained than a hearing is requested and will usually be scheduled for three to four months in the future.
One KEY distinction between permanency and settlement is after permanency, if the medical condition worsens, the Claimant can return back to treatment and seek out further indemnity.
SETTLEMENT-In some situations the Insurance company will have an interest in settling the case completely rather than going to a hearing solely on indemnity/permanency- This may be because they do not want to be at risk for continuous and indefinite expenses, it may simply be a company policy to settle cases whenever possible, or there may some other motivation which is not apparent. In any event a settlement ordinarily includes closing the indemnity and the medical portion of the case. This means that the case is forever closed in all respects. There are alternatives to settling the indemnity and medical all at once. In certain cases an insurance company is willing to settle only the indemnity. This would allow the injured worker to seek further treatment under the workers’ compensation insurance but prevent the injured from seeking any further indemnity. In other cases there are Federal Government restrictions as to settling the medical portion of a case. Occasionally a Medicare Set Aside will need to be prepared in order to be compliant with Federal and State Statutory Guidelines.
If an attorney has not been retained by the time the injured employee is ready for permanency or settlement, it is necessary to obtain one at this point. Insurance companies are not in the business of giving away money. They want to save money and will most likely not offer there top figure.
Consider the many volunteer Firefighters, EMT, and Paramedics who place their lives directly at risk on a daily basis. It is fairly common for these employees to be injured on the job. Without some special statutory exception they would be left with medical treatment but no financial assistance while out of work. To determine a volunteers ttd rate and average weekly wage the law provides use of their full time job wages. So, the full time accountant/part-time volunteer firefighter would be paid according to the wages he or she made while working as an accountant.
As you can see the most seemingly simply calculations can be complicated by a number of factors. To ensure that you are receiving an accurate amount of temporary total disability benefits you should contact an experienced attorney.
The short answer is that they have an attorney looking out for their best interest so you should have an attorney looking out for your best interest.
One of the most common questions that I get is in regards to the necessity of an attorney if “workers comp” is seemingly cooperative. The incentive for “workers comp” or the insurer to pay for everything is to keep the injured worker satisfied so they do not retain an attorney and seek ALL of the benefits the law provides. The theory is to keep the injured worker somewhat satisfied and hope that they go away without obtaining full benefits.
In Maryland it is quite difficult for workers compensation Insurers to avoid paying for health benefits if the claim is legitimate and the employee is compliant. Insurers are aware of this so instead of upsetting the injured employee to the point where they “lawyer up,” the insurers will provide the medical benefits in an attempt to keep the injured happy.
There are other benefits that the insurance company does not want you to have and that you will most likely not receive without an attorney. See the benefits page