Top Eleven Things You Need To Know About Workers’ Compensation Claims In Maryland
Workers’ Compensation claims in Maryland can be the some of the most complex claims injury claims to pursue. They sometimes take years to resolve and often result in multiple hearings for claimants and employers alike. Every week injured workers’ call us with questions about whether they can pursue a claim for Workers’ Compensation. Below is a list of answers to the top eleven general questions we get asked about pursuing such a claim. Please note: the following is not legal advice but simply general information on the process itself. For specific legal advice or answers to how these rules may affect your specific case, please call us. This information is only meant to better educate the general public.
- 1. Just because an injury occurs while you are working does NOT mean that you necessarily entitled to workers’ compensation benefits. Only an “employee” who has suffered from an “accidental injury” or “occupational disease” arising out of (or in the course of) employment may qualify for workers’ compensation benefits in Maryland. The definition of what constitutes an “employee,” an “accident injury,” or an “occupational disease,” is sometimes subject to litigation. For example, an independent contractor is not usually entitled to benefits. However, someone who is employed as an “independent contractor,” may be entitled to benefits as an employee if they are not truly an independent contractor. The law looks to various factors in order to make this determination and therefore is often wise to consult with a lawyer if you have any doubt as to whether you are an employee or a contractor.
- 2. You do NOT need an attorney to pursue your claim. However, we would strongly encourage laypersons to at least consult with an experienced Maryland workers’ compensation attorney. Pursuing a claim for benefits can sometimes be riddled with red tape and obstacles.
- 3. You cannot typically sue your employer for injuries sustained in the course of your employment and simultaneously maintain an action for Worker’s Compensation to obtain benefits from the State. In most cases, if you are injured at work, a claim for workers’ compensation is sole remedy available to pursue payment of medical expenses, wages, and compensation for permanent injuries. There may be occasional exceptions to this general rule, under certain circumstances. For example, where a co-employee is negligent, a worker may be able to maintain an action directly against the co-employee, which will often be insured by the employer. Additionally, it may be possible to maintain a claim related to products liability or premises liability depending on the cause and manner of the injury and the related negligence.
- 4. Do NOT simply assume that your employer and their insurance company is going to look out for your best interests. While some employers take care of their own employees, usually the employer will have an insurer who will make most of the decisions regarding whether to pay your claim or deny it. The insurer often has different or competing interests than the employer. For example, your employer’s insurer typically has an attorney to advise them on all legal matters that arise pertaining to claims against the employer. This attorney may make certain recommendations to the insurer such as whether to pay a claim or deny it based on the evidence available. All of these forces working together, (employer, insurer, employer’s counsel) may result in you being forced to contend against a team of experienced claim handlers in order to get what’s fair.
- 5. You have a responsibility to make sure that your employer is properly notified of your claim and/or that your claim is filed with the Maryland Workers’ Compensation Commission within the statutory deadlines. Although, you have most likely notified your employer of your injury and completed a first report of injury, it is imperative that you protect yourself and file a claim with the Commission within these deadlines. Failure to do so may bar your claim in the future.
- 6. It is important to understand the difference between a claim with your employer’s insurance carrier and a claim with the Maryland Workers’ Compensation Commission. These are not the same. When a worker becomes injured, the employer may sometimes file a report of injury to the Workers’ Compensation Commission. However, not all employers do this and some of them don’t do it in a timely fashion. If a first report of injury is completed and filed by your employer, the insurance carrier may establish a claim on your behalf with the Maryland Workers Compensation. However, they may also fail to do this. It is the Workers’ responsibility to see that this is done in a timely fashion.
- 7. Many workers’ compensation claims come with delays. Payment for lost wages (temporary total benefits) can be delayed due lack of medical documentation. Medical treatment can be delayed or denied due to the lack of approval on behalf of an insurance carrier for the employer. If a doctor is orders an expensive test or procedure, prior authorization may be required from the insurance carrier prior to permitting the same. Failure to obtain this authorization may result in the insurance carrier refusing to pay for it. In these cases, the medical treatment facility will not schedule an appointment or provide the recommended treatment and it may be necessary to seek a hearing with the Workers Compensation Commission to get the treatment approved with the consent of the insurance company.
- 8. Hearings require certain evidentiary procedures, which may not be easily understood by laypersons. An experienced lawyer will help you stand on more equal footing against the employer at any such hearings.
- 9. Wages are determined by a wage statement that is provided by your employer. Under the current rule and regulations of the Commission, these wage statements are composed of the average of the wages the employee was earning in the 14 weeks prior to the accidental injury. If an employee has been employed for less than 14 weeks, the period of employment and wages earned are to be reflected on the wage statement.
- 10. All medical bills are subject to the Maryland Workers’ Compensation “Fee Schedule.” What do this mean to an injured worker? This means if a physician accepts a patient as a “workers comp” patient, they are required to accept the amounts for under the approved fee schedule. After payment under the fee schedule is made, the medical provider must write off the remaining balance. Providers are not allowed to balance bill patients for services after receiving payment in this manner.
- 11. In Maryland, an injured worker is not entitled to “pain and suffering” in the same manner as with most other Maryland tort claims. However, they may be entitled to compensation based on any permanent disabilities or loss of use or function of certain parts of their body. The percentage of permanent partial disability is determined based on ratings by medical doctors pursuant to American Medical Association guidelines. There are a number of doctors in the state that are qualified to evaluate you and determine how much permanency sustained as the result of an accident. This is to say nothing of extreme injury cases where the claimant is not partially disabled but totally disabled. The Maryland Compensation laws provide different rates of compensation for individuals that are partially disabled or totally disabled. You should consult with a lawyer to discuss your specific disability percentage.
It is our belief that Maryland Workers’ Compensation claims are complex legal matters that require a great attention to detail. Each case has its own unique facts and circumstances that vary the laws application. Through our experience, we have found that many claims require not only legal representation, but an aggressive and competent legal representation in order to get what’s fair. If you have been involved in a serious work related injury, contact our attorneys today for a free legal consultation. We want to help you get the help you need.
Please note: the following is not legal advice. Do not assume the facts herein are applicable to your case without talking to a lawyer. Each case is unique and results depend on a variety of factors. For more information see the full disclaimer below the article.