Determining the Validity of a Workers’ Compensation Claim in Maryland

Maryland has adopted a no-fault workers’ compensation system similar to that of many other states. This system is designed to compensate injured workers regardless of whether the worker was a fault for the injury or not. However, there are many ways an insurance company could still refuse to pay your claim.

Not all injuries result in valid compensation claims. The insurance companies’ lawyers would carefully scrutinize your claim looking for excuses to deny it. With so much at stake, it could be beneficial to have a Maryland workers’ compensation lawyer guide you through filing a claim. A skilled attorney could also help in determining the compensability of a workers’ compensation claim in Maryland.

Factors Insurance Companies Consider

In Maryland, an injured worker is required to file a workers’ compensation claim to the state Workers’ Compensation Commission. The Commission then forwards the claim to the insurance company, who reviews it to determine its validity. If the insurance company decides the claim is invalid, they deny it.

Insurance companies are thorough. They carefully scrutinize medical records to ensure the injury is legitimate. They also check medical records to confirm a worker follows the doctor’s orders and attends all appointments.

The lawyers for the insurance company would likely also carefully review a worker’s education level and prior wage history. Even if they concede that an injury is valid, they often work to diminish the benefits available. One method of doing this involves diminishing the value of a worker’s future earnings.

The insurance company also performs their own examination. This could include required trips to the company doctor or capacity evaluations to determine if a worker is able to perform their work duties or not.

From the time the Commission notifies an insurance company of a claim, they have 21 days to accept or reject it. If accepted, an injured worker should immediately receive properly-documented benefit payments. Unfortunately, insurance companies frequently deny compensation claims even when they are valid. With the help of a Maryland workers’ compensation attorney, an injured employee could appeal the denial and demand a hearing.

Appealing a Denial

Regardless of the grounds cited by an insurance company for the denial, a worker has the right to seek a hearing with the Maryland Workers’ Compensation Commission. Requesting a hearing only requires the submission of an Issues Form, which an attorney for an injured Maryland worker must identify the issues they disagree with the insurance company about.

At the hearing, both sides are entitled to legal representation. The worker’s attorney could make the case that the denial was inappropriate, while the insurance company’s attorney often defends their decision.

Typically, 1-2 weeks after the hearing, the commissioner will issue a ruling in the form of an Order or Award. If the commissioner agrees the worker’s injuries were valid the insurer must begin paying benefits immediately, even if it files an appeal. If the commissioner rules in favor of the insurance company, the worker could request a formal rehearing or file an appeal.

Help Determining the Validity of a Workers’ Compensation Claim in Maryland from a Lawyer

Workers’ compensation benefits could make the difference between you meeting your financial obligations or not. These benefits are vital to many injured workers, and a denial could have serious consequences.

A seasoned lawyer could help with determining the validity of a workers’ compensation claim in Maryland. For guidance on how to begin your claim, call right away to schedule a confidential consultation.

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