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Maryland Workers Compensation Appeal

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Maryland Workers Compensation Appeal

It is helpful to understand what is meant by an appeal.  Generally, an appeal under the law is a procedural effort to have a decision reversed by a court with a higher degree of authority.  This may mean appealing a case from the Maryland Workers Compensation Commission to the applicable state court, or this may mean appealing a decision from the applicable state court to a higher court.  Often the term appeal is loosely used to refer to appealing an adjusters’ denial to the Maryland Workers Compensation Commission (MDWCC).

Maryland Workers Compensation Appeal of the adjusters decision

Often I am asked if I the workers comp adjusters denial can be appealed.  Basically yes!  The answer I give is that a claim can be filed with the Maryland Workers Compensation Commission (MDWCC) and we can ensure that all the legal rights are obtained for the injured worker by use of the legal process.  Until a claim is filed with the Maryland Workers Compensation Commission there is no way to legally force the adjuster to authorize something.  Filing a claim with the MDWCC is not ordinarily referred to as an Appeal among those in the legal community, however it is essentially the same thought.  The adjusters decision is not the final legal decision.  An injured worker can legally challenge a Maryland workers comp adjuster who has denied a benefit by appealing to the workers comp commission.

The request for a hearing before the workers compensation commission is basically a Maryland workers compensation appeal of the adjuster.  Hearings become necessary when the adjuster denies something and the injured worker wants that something.

The need for a hearing before the Commission can arise for a number of reasons including to obtain a permanency award, seek medical treatment authorization, recover lost wages, reimbursements, or for any issue that may arise in a Maryland Workers Comp case.  While most hearings are requested by the injured worker and their Maryland work injury lawyer, hearings can also be requested by the defense, medical providers, or set in by the Motion of the Commission.  Some examples of why the defense would file for a hearing: to seek a credit for over payment of lost wages, seek approval for a drug reduction program, to determine the correct average weekly wage, challenging the accident took place, or challenging the cause of the injuries.

Treating physicians can file for a hearing before the Maryland Workers Compensation Commission in order to obtain payment for medical services provided.  This can be done by requesting a hearing for payment of bills, or by filing a claim for medical services.  This is arguably a Maryland workers compensation appeal of the adjuster filed by the physician.

On occasion a Maryland Workers Compensation Commissioner will set a case in for hearing.  This is most often done when there are complications with a settlement but can also be set in for any number of reasons.

Maryland Workers Compensation Appeals of the Commissions decision

There is another form of Maryland workers compensation “appeal” that is an option for an injured worker only after they have filed their claim with the Maryland Workers Compensation Commission and there after had a hearing.  Once the administrative hearing takes place, the party that is dissatisfied with the Commission decision has the option to appeal the case to the applicable Circuit Court.  Each Maryland county has one circuit court that hears workers compensation cases for residents and employers within their jurisdiction.  Choosing the proper Circuit Court can be difficult and should be left up to a qualified attorney, however if no attorney is willing to provide representation the injured worker may have no choice but to represent themselves.

A Maryland workers compensation appeal to a Maryland Circuit Court is not an easy undertaking and whenever possible legal representation should be retained.  The process is much more time consuming and intricate, furthermore can cost $3,000 or more before a new trial even takes place.

An appeal of a Maryland Workers’ Compensation Commission decision is similar to an appeal de novo, however in practice they are actually appeals are quasi de novo in nature.  A true de novo appeal is a trial “of new” meaning the parties will have an opportunity to litigate the case all over from the very beginning.  A quasi de novo Maryland Workers Compensation appeal can take the form of a de novo appeal however they are presented to the judge or jury in a less formal fashion.  The parties may chose to present all new evidence ( like de novo), or they may chose to present the same evidence, less evidence, or on rare occasions no evidence.

A Maryalnd workers compensation appeal of a Commissioner’s decision must be done within 30 days from the date the Order is mailed, however best practice is to file an appeal within 30 days from the date of the Order.  The first procedural step in filing an appeal of the Maryland Workers Compensation Commission decision is to file a petition for judicial review with the applicable circuit court.  The petition must include a copy of the original claim form, all the prior orders, a copy of the order being appealed, and specific language within the petition.  Along with the petition there should be a certificate of mailing to the defense.  It is good practice to include a request for jury at this time as well.  See the Appeal process below↓

Who can file a Maryland workers compensation appeal

Regarding decisions of the adjuster ordinarily there is no need to appeal on behalf of the employer or insurer.  However the Injured worker may appeal virtually any decision made by the adjuster that they are not happy about

Once a hearing before the Workers Compensation Commission takes place any party to that hearing may take an appeal to the applicable County Circuit Court.  Most often it is the injured worker or the insurance company appealing the decisions of the Commission however there are other parties that may also be involved and retain a right to file a Maryland workers compensation appeal.  On occasion a work comp case will involve the Subsequent Injury Fund (SIF).  The SIF is a fund that may provide for additional workers compensation benefits in particular cases.  When the SIF is involved in a case they have a right to appeal decisions of the Commission by which they are aggrieved.

When an employers does not have workers compensation insurance most often the Uninsured Employers Fund will be involved in the case and will maintain a right to appeal any decision of the MDWCC by which they are aggrieved. More on UEF here.

On Occasion a medical provider may have the option to appeal a workers compensation commission decision however this is something that happens vary seldom.

What types of issues can necessitate a Maryland workers compensation appeal?

There are a multitude of reasons an aggrieved party may appeal a decision of the Workers Compensation Commission.  For the injured workers, the same decisions they may have appealed from the adjuster to the Workers Comp Commission may also be appealed from the Commission to the Circuit Court.  These include, but are not limited to:

Authorization for medical treatment If the adjuster denied medical treatment and a subsequent hearing at the Commission was held and again treatment was denied the injured worker may appeal that denial to the applicable Circuit Court.  Common medical treatment denials that are appealed are surgery denials, pain management, physical therapy, or diagnostic tests.

Compensability of the case– If the adjuster denies the workers compensation case from the very beginning a Maryland workers compensation appeal to the Commission and possibly the Circuit Court can be taken.

Lost wages or temporary total disability payments– The adjuster may have declined to pay the injured worker lost wages or temporary total disability for a number of reasons.  If lost wages are owed the injured worker may choose to appeal the adjuster to the Commission.  If a hearing is held before the Commission and the commissioners order is also denying lost wages/temporary total disability the injured worker may choose to file a Maryland workers compensation appeal of the Commission Order to the local Circuit Court.

Permanent Partial Disability Award– It is very rare that a permanency award is provided by the workers compensation adjuster voluntarily and without a claim already pending within the workers compensation commission.  Permanency awards Ordered by the Workers Compensation Commission are occasionally appealed to the applicable Circuit Court when the injured worker feels the award does not adequately reflect their permanent problems, restrictions, and complaints related to the work injury.

Some of the less common– but also appealed decisions include denials of orthopedic casts, splints, or braces, denial of vocational rehabilitation, or denials of consultations or second opinions.

Issues that may cause other parties to file a Maryland workers compensation appeal

The Employer/ Workers Comp Insurance Company has the right to appeal almost any decision of the Maryland workers compensation commission that leaves them aggrieved.  These often include Approval of surgeries or medical treatment, permanent partial disability awards, awards of temporary total disability, or lost compensibility hearings.

The Uninsured Employers Fund maintains all the rights a workers compensation insurance company has and therefore maintains the rights to file a Maryland workers compensation appeal on almost any issue an ordinary workers compensation insurer would be able to appeal.

The Subsequent Injury Fund (SIF) can only appeal a case in which they are a party.  With that said the SIF is not involved in a great majority of the workers compensation claims in Maryland so they have no right to appeal.  If they are implead into any given case they would maintain specific rights to appeal such as if they are liable, the amount of permanency they are liable to pay, or any other legal issue that may arise.  The SIF also has the right to appeal almost all of the same issues the in Employer/ Workers Comp Insurance Company such as back lost wages or medical treatment even though SIF would not be directly affected by many of these issues.

Should a medical provider have to appeal a decision in the workers compensation case it would most likely involve a decision which denies a medical bill when there is no health insurance available to bill.

Maryland Workers Compensation Appeals Process     

For any Maryland Workers Compensation case the legal proceedings begin at the administrative level and are held before the Maryland Workers Compensation Commission.  After almost any administrative hearing the parties have an opportunity to file a Maryland workers compensation appeal to the judicial system.  Jurisdiction over the first appeal is held by the County Circuit Court in which the accident arose, or in which the parties live or do business.

A decision by the insurance company, the adjuster, the case worker, or an employer can not be appealed to the circuit court.  In fact it should not be appealed until the case is before the Commission.  The Maryland Workers Compensation Commission must make a decision before a case can be appealed to the Circuit Courts.  If you have been injured on the job and are being denied by the insurance company, the insurance adjuster, the case worker, workers comp, or an employer do yourself a favor and contact a qualified and experienced workers comp attorney!

Maryland Workers Compensation Cases at the administrative level

The Maryland Workers Compensation Commission has sole jurisdiction to hear Maryland Workers Compensation cases.  It is only after a decision has been rendered that the aggrieved party can request an appeal and move the case into the court system.

Once a Maryland workers compensation appeal is made to the Circuit Court litigation begins!

Discovery during the Maryland workers compensation appeal

The workers compensation insurance defense team will file a response to the petition for judicial review and the discovery process will begin.  The ordinary appeal process will include depositions, interrogatories, and production of documents.  See definitions.  Depositions can be taken of any party, representative, witness, or person involved in the case and often are the first significant cost for the injured worker. 

Scheduling Order

At some point early on in the Appeal process the Circuit Court will issue a scheduling order or will hold a hearing to determine deadlines for the process.  The scheduling order will consist of deadlines for conclusion of discovery, expert witness designations, mediation or alternative dispute resolution, and joiner of parties.  Depending in which court the appeal was filed the scheduling order may also contain a date for a pre-trial hearing and trial date or deadline.

Mediation/Arbitration

Some form of alternative dispute resolution is required in almost every Maryland workers compensation appeal, however the courts can not force the injured Maryland worker to pay for such a service.  Mediation usually costs around $200 an hour and will consist of the parties in the appeal and an impartial mediator who will work to resolve the case and avoid a trial.

Pre-Trial Hearing

A pre-trial hearing will take place at some time during the appeal process and will involve the parties to the appeal and a circuit court judge.  The purpose of the pre-trial hearing in a Maryland workers compensation appeal case can vary depending on the Circuit Court in which the appeal was filed.  Some courts use the pre-trial hearing to provide one last effort to settle or resolve the case before it goes to trial.  Other courts will use the pre-trial hearing simply to establish deadlines for the case and establish a trial date.

The Maryland Workers Compensation Appeal Trial

If the parties fail to resolve the issues that are on appeal the case will go to trial.  Ordinarily workers compensation appeal trials will last no more than two days.  The judge or jury will render their decision which may uphold, or reverse the Maryland Workers Compensation Commission decision.

 

Call Baltimore workers compensation attorney and Baltimore personal injury attorney Andrew M. Rodabaugh for a FREE consultation!  Call Us, Click to email  or just fill out the form at the bottom of the page and Mr. Rodabaugh will contact you!

 

My experience with the law firm of Cohen and Dwin was very professional. Mr Rodabaugh was very kind and easy to talk to in a very professional manner. The receptionists were helpful in guiding me through the procedures. I would definitely recommend Mr Rodabaugh in the future.
David B.CosmotologistBaltimore

 

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Summary
Maryland workers compensation appeals
Service Type
Maryland workers compensation appeals
Provider Name
Andrew M. Rodabaugh Esquire,
Baltimore,Maryland,Maryland- Telephone No.410-937-1659
Area
Baltimore
Description
Maryland workers compensation appeals can be filed in the event the adjuster does not approve a benefit or in the event the workers compensation commission denies a benefit