Maryland Workers Compensation adjusters may deny treatment, lost wages, job training, reimbursements, compensation, surgery, diagnostics, medications, transportation and more.
Denials are not always issued and some, perhaps a large portion of cases flow seemingly smooth from the beginning to the end. Sometimes injured workers are paid timely while out of work and all treatment is approved leading to an uninterrupted return to work. If an injured worker is serious about preserving their future rights to compensation and medical treatment they should at least consult an attorney to discuss what if anything needs to be done for their protection.
For a free consultation call +1 (410) 937-1659 OR Email Maryland workers compensation attorney Andrew M. Rodabaugh.
There is a common misunderstanding there is only one hearing in every Maryland workers compensation case which decides if the injured worker will receive workers compensation benefits. Those claiming workers compensation benefits often get confused when denials and lack of authorization comes about after the initial hearing. For many, being involved in the system means being involved in an ongoing and never ending battle. While an attorney can help obtain the workers compensation benefits the insurers and adjuster have the power to terminate treatment, terminate payments, and withhold authorization at any given time.
Whether or not workers comp fights will vary on a case by case basis and some injured employees will receive complete and ongoing benefits with no interruption. Nonetheless employees should be aware of the potential termination of benefits.
What Maryland workers compensation benefits will adjusters deny?
- Injured Maryland workers are entitled by law to receive lost wage payments (temporary total disability) while being held out of work by a physician. Workers comp adjusters will look for a reason to terminate these benefits. The most common reason is that the injured worker has not provided an out of work note by a treating physician.
- Another workers compensation benefit afforded to the injured employee is medical treatment to the injured body part. The insurance case manager may terminate medical treatment by either withholding authorization or sending a denial of authorization for medical treatment to the treating doctor or facility. Workers comp may also simply tell the injured worker that he or she may no longer seek medical treatment under the Maryland workers compensation claim. At any time in the life of the case and regarding any form of treatment denials of medical authorization may arise.
- Along with withholding authorization, if the injured worker already received medical treatment by a physician workers comp may refuse to pay for the bills. This can often leave the injured worker with continuous bills and possibly debt collection notices. The adjuster may refuse to pay any bill whether it be for an x-ray, physical therapy, surgery or more.
- Once the case moves to permanency the injured worker may begin receiving permanent partial disability payments. It is in the workers comp adjusters power to stop these payments.
- There is a possibility that any workers compensation benefit received be terminated at any time though there are certain times that terminations are more likely to take place than others. Some other benefits that are subject to termination are vocational rehabilitation benefits, pain management benefits, transportation benefits, and temporary total disability benefits.
How do they avoid providing Maryland Workers Compensation Benefits
- The most often used method to terminate benefits by the work comp adjuster is an Independent Medical Evaluation (IME). This is a second opinion by a doctor of the insurance companies choosing. The adjuster will often request the IME doctor to comment on the injured workers ability to work. Even if the injured worker has an out of work not by their treating provider the adjuster is within her legal right to terminate lost wage payments if the IME doctor indicates that the injured worker is able to work. The adjuster will also ask the IME doctor to indicate whether past, present, and future treatment is related to the work accident. In the event the IME doctor indicates past treatment was not related to the work accident the adjuster may refuse to pay for past medical expenses. If the IME doctor indicates that the present treatment is not related to the work accident then treatment may immediately be denied which will prevent the injured from getting authorization for follow up care. And if the IME doctor indicates that there is no necessity for any future treatment the adjuster will not only withhold authorization but he or she may also attempt to end the workers comp case completely.
- On occasion workers comp adjusters may require the injured worker to strictly comply with certain requirements. For example: to qualify for lost wages a worker must have an out of work note. Some adjusters are less forgiving than others if there is a day or two that the out of work notes do not cover. In these circumstances there is an undue burden on the injured worker to ensure that each and every out of work note covers consecutive days with no gaps.Some case workers may be quick to terminate medical treatment authorization if the injured fails to attend appointments. Most of the time a missed appointment every now and again is forgivable but depending on the adjuster, authorizations for doctors appointments and treatment may stop if even one appointment is missed. Unfortunately for the injured worker they must be especially prudent in scheduling appointments.
- Permanent Partial Disability payments may be halted by the adjuster in the event that the injured worker returns to the capacity of not being able to work. Under Maryland law an injured worker can not received temporary total disability (ttd) payments and permanent partial disability (ppd) payments at the same time. An over zealous adjuster may jump at the opportunity to terminate the ppd payments if the claimant returns to medical treatment. While this is legally not acceptable, it may be justifiable as far as the adjuster is concerned.
What the injured worker can do to obtain continuing Maryland Workers Compensation Benefits
- It is in the best interest of the injured worker to have a Maryland workers compensation attorney represent them so they have someone they can contact with questions and advice.
- If the injured employee continues to remain unrepresented then they should do what they can to keep the workers comp adjuster happy and not give them a reason to terminate the workers compensation benefits. The problem the injured worker may face is that doing what they can to keep the adjuster happy is likely not going to be in their best interest.
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