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A common misconception among those that are hurt at work is to compare a work injury to an ordinary personal injury lawsuit. The Maryland workers compensation process is full of hurdles, deadlines, and challenges that most are not prepared to handle. This is one good reason obtaining a Maryland workers comp attorney at the early stages of a work injury case can prove to be a wise decision. Treatment, compensation, reimbursements, and medical diagnostics can all be challenged by the Workers’ Compensation Insurer repeatedly and throughout the life of the claim. Continue reading to get an overview of the process but take note that this is not a complete picture of the process.
If one is unfortunate enough to be injured on the job in Maryland he or she will likely be exposed to the workers compensation system immediately. It may begin with the employer advising the injured to go to the company’s medical provider for evaluation and treatment. Larger medical facilities, like Concentra Medical Center, Occupational Health, and Patient First are often used by employers throughout the state when a work injury occurs. From this point the injured worker is at the insurance company’s mercy as they are now treating with a facility the insurance company has carefully selected. Note an injured worker in Maryland is under no legal obligation to treat with the company doctor and may choose their own physician as long as they accept workers compensation payments; However complications arise when it is company policy to go to the company’s physician after a work injury. This places the employee in the vulnerable position of choosing medical care over the potential termination from employment.
The injured will have to file a workers compensation claim with the Maryland Workers Compensation Commission. Filing a claim with the insurance company and/or the employer is NOT ENOUGH to be protected by law. There is a very common misconception that if the injured is dealing with an insurance adjuster then the claim has been filed. Failure to file a claim with the Maryland Workers’ Compensation Commission (MWCC) can lead to a complete bar of the claim!
Once a claim is filed with the MWCC the insurance company will have a period of time, referred to as the Consideration Date, to challenge the case on a number of grounds. The most common defense the workers comp insurer raise at this point is that the accident did not happen, or the accident happened but the injury is of a pre-existing nature. To substantiate the insurance adjusters defense they will likely send you to an Independent Medical Evaluation (IME). Under Maryland workers comp laws the injured employee is obligated to attend this appointment.
When the case is challenged by the workers comp adjuster the injured employee is forced to develop their own case against the insurance company. Simply going to the hearing and testifying that he or she was injured at work will not be enough evidence to prevail. At the very least there must be certain language in the medical records to indicate that the injury occurred at work and the medical issues the injured employee is having resulted from the work accident. This language is often difficult or impossible to obtain from medical providers that have been selected by the insurance company. The absence of the language can prove to be fatal to the injured workers claim and exactly what the insurance company needed to avoid continuing benefits. A Maryland workers compensation attorney can ensure the treating physician is one familiar with the workers comp process or explain how the process works to the physician. All hearings are scheduled at one of the seven Maryland Workers’ Compensation Commission sites.
While the injured worker is held out of work by his or her treating provider he or she is entitled to temporary total benefits (see Definitions Page). Sometimes these benefits are paid timely and willingly by the workers comp insurer/employer and sometimes the injured worker will be stuck waiting for months with no income. While Maryland law does mandate that these benefits are paid to the injured worker, often it is necessary to go to a hearing. If the claim has already been filed with the MWCC and the consideration date has passed a hearing with the compensation commission can be requested immediately. If however the consideration date has not passed a hearing cannot be requested. Maryland workers comp attorney’s hands are tied from filing for a hearing until this consideration date passes. Hearings are typically set a few months from the date of the filing, however, it is not unheard of to have to wait longer for a hearing date or have it come sooner. Many workers live pay check to pay check and this multiple month waiting period can cause significant turmoil at home for the injured worker. There are certain, but limited circumstances where this waiting period can be expedited by filing an emergency hearing with the MWCC.
As previously stated, there are numerous hurdles in any given Maryland workers compensation case. The case can be challenged at the very beginning of the claim filing process. The entitlement to lost wages can be challenged by the workers comp insurer REPEATEDLY AND AT ANYTIME during the life of the claim. Most problematic, in this author’s opinion, is the comp insurers’ ability to control medical treatment. Many injured workers just want to get the treatment they need and return to the workforce without delay. What is troubling is that medical treatment can also be challenged repeatedly by the workman’s comp adjuster. Something as ordinary as obtaining an MRI can take over four months to obtain authorization. The delay may be because the insurance adjuster wants an IME performed, but occasionally its simply because the file is collecting dust on their bottom shelf.
Once treatment has been completed and the injured employee has returned to work the next stage is to have the employee compensated for any permanent injury. If the employee is fortunate enough to have recovered completely then compensation for permanent injury is non-existent. To determine, what is referred to as permanency, the employee will be seen by a specialist qualified to evaluate permanent impairments according to the American Medical Association Guide for the Evaluation of Permanent Impairment 4th Edition. There are only a certain amount of Physicians capable of performing these evaluations in the state of Maryland and the selection of the physician can prove to be imperative for most cases. There are physicians routinely used by Insurance companies and others routinely used by the injured worker and his/her attorney. Once the workers compensation insurer has had the opportunity to obtain their permanency evaluation negotiations can begin. Should the parties fail to come to a reasonable resolution a hearing before the workers compensation commission will be requested.
People occasionally show reluctance when it comes to the permanency stage of their workman’s comp case because of the misconception that this is the point where a lawsuit against their employer is being filed. If the employee is at all concerned about having medical treatment in the future, say one or two years from the treating physician’s discharge, having a permanency evaluation and moving to obtain compensation is imperative. Once permanency is concluded the severity of the employees injury will be substantiated and better solidify the chances of obtaining future treatment using the workers compensation insurance.
In limited circumstances the injured worker is not physically able to return to work in the same capacity because of the work injury he or she sustained. Occasionally an employer will provide an alternative position to the employee and the return to work is a much smoother transition. In this circumstance the injured worker would be provided a light duty position. More often the employer is not able to accommodate and the hurt worker is left without income. Maryland workers comp Law provides that the workers comp insurer is responsible to provide Vocational Rehabilitation Counseling and benefits to the employee who is left disabled and unable to return to work in the same capacity. A mutually agreeable Vocational Counselor is selected by the insurer and the employees workers comp lawyer who will then assist the injured worker in finding employment that is suitable, gainful, and within their physical capacity. While this job search occurs the work comp insurer is obligated to pay lost wage payments to the injured employee.
It is important to keep in mind that Vocational Rehabilitation can prove to be extremely costly to the comp insurer. Because of the often exorbitant expense, the insurance adjuster is looking for any reason to terminate lost wage payments and Vocational Counseling. The hurt worker must take care to be completely compliant with the vocational counselor to avoid termination of Maryland workers compensation benefits.
Subsequent to permanency and the re-entry into the work force the injured employee is able to reopen their case and obtain further treatment should their condition worsen. Unless the case is settled, future treatment may be an option. A reopening of the case is not automatic and is often met with much more hostility from the workers compensation insurer. A Maryland workers compensation attorney will also be needed in the event the injured worker wants to reopen their case.
For a Free Consult call +1 (410) 937-1659 and speak with Maryland Workers Compensation Attorney Andrew M. Rodabaugh