If you are injured on the job in Maryland there are certain things you need to know when dealing with workers compensation.
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Many people are first exposed to the Maryland workers compensation system later in their lives and at that point being unfamiliar with the process is much more concerning and perhaps troubling. There are a handful of scenarios for which the injured worker needs to be aware and prepared. It is important the employee is prepared for these possibilities because if it happens when they least expect it a rash decision could be made that could damage the workers comp case.
Denial of Medical Treatment
At some point medical treatment the Maryland injured worker is receiving may be cut of by the workers compensation adjuster. This could come unexpectedly often occurring when the injured worker was thinking the case was moving along just fine. If treatment is denied it usually indicates that the adjuster is reviewing the case expenses and the natural progression of the treatment and is now ready to start putting up a fight. This is not the end-all-be-all of the case and what the adjuster does and says is certainly not law. This is the time to lawyer up and call a qualified Maryland workers comp attorney. If the injured worker is serious about getting the treatment being prescribed a lawyer can help.
Second Opinion or Independent Medical Evaluation (IME)
At some point the adjuster may schedule the injured worker for what they refer to as a Second Opinion or an Independent Medical Evaluation. This is never good news. These are scheduled only for the adjusters benefit and it should be known by every injured Maryland worker the IME doctor is most often not going to review the case the same as if they were the treating doctor themselves. The injured worker is obligated to attend the IME however they are not obligated to go out of their way to obtain medical films or records, nor are they obligated to attend an IME that has been scheduled for a time that is unreasonable.
The purpose of the IME is to obtain a medical opinion that the insurance company can rely on when they deny the treatment being recommended. IME’s are the Maryland insurance adjusters evidence and support for their arguments going forward. If an IME is schedule the injured worker should expect that a treatment denial will shortly follow.F
Lost Wages Benefits While Out of Work
Temporary Total Disability benefits are paid to injured Maryland employees while they are unable to work according to a doctors orders. IME’s are also used by the workers compensation insurance company to deny payment of lost wages or temporary total disability. Often a treating physician will hold the injured worker out of work so that the injured can get the rest and treatment necessary for optimal recovery. If the out of work period lasts for an extended period of time then the adjuster may schedule an IME and request the IME physician comment on the injured employees work capacity. Sometimes all the treatment is approved however the adjuster focuses her time and energy on the indemnity portion of the case and is simply not willing to pay the Maryland injured worker. In order for the adjuster to form her argument against paying temporary total benefits she will schedule an IME.
If light duty is being offered by the employer it may be in the best interest of the employee to attempt the light duty. This is something that should be discussed with a good Maryland workers compensation attorney before deciding.
Health Insurance versus Workers Comp Insurance
The most common sense resolution often enters the mind of the injured worker when the workers compensation insurer denies treatment- Why can’t I just use my health insurance for treatment? It is sometimes the better alternative if the health insurer is willing to pay to do so; however this decision should not be made without consulting a Maryland attorney first. More often than not if there is a work injury involved the health insurer only willingly pays after the treatment has been ordered “not related” by the Maryland Workers Compensation Commission. For the injured worker this means they have to wait until a hearing is requested and takes place at the Commission, often a lengthy period of time.
A person that is injured at work, and is covered under the Maryland Workers Compensation article is obligated to use workers compensation rather than their health insurance. The arduous process can place a great deal of burden on the injured worker. A treatment regime that would take three or four under health insurance could possibly take a year or longer if the workers compensation insurer fights the treatment.
Unfortunately, if the injured workers health insurance will not pay for the treatment then the injured worker is forced to go through some hoops to get the treatment authorized under the workers compensation policy.