Experiencing a workplace injury is stressful enough, but discovering that your employer or their insurance carrier has disputed your claim can feel like a second blow. In Maryland, the workers’ compensation system works to provide you with medical coverage and wage replacement. However, it is not always a smooth process.
When there is a dispute, it means that the insurance company is challenging your compensation claim. Understanding what needs to happen will help you protect your rights and secure the compensation you deserve.
Common reasons for denial
You will receive a formal document from the Maryland Workers’ Compensation Commission (WCC) indicating “issues” in your claim. In legal terms, “filing issues” is the method your insurer or employer uses to contest your claim.
They may dispute the entire claim or specific parts of it. Maryland law has guidelines that you must follow to successfully file your claim. For example, you may only receive workers’ compensation if your injury arises out of and in the course of your employment.
Your employer might dispute your claim for several reasons, including:
- Lack of Notice: Your employer may argue that you failed to provide written notice of the injury within 10 days of the accident. However, failure to adhere to the 10-day deadline does not automatically bar your claim if there is a valid excuse.
- Pre-existing Conditions: The insurer might claim your current pain does not come from a workplace accident. Instead, it might result from an old injury or a degenerative condition.
- Independent Medical Examination (IME): The insurance company will likely send you to a doctor of their choosing. If that doctor disagrees with your treating physician about your ability to work or the cause of your injury, the insurer will use that report to dispute your benefits.
You will need to present medical records, expert testimony and witness statements if your employer or insurer disputes your claim. In the event of a disputed claim, the Maryland Workers’ Compensation Commission may schedule a hearing.
The Commissioner’s Decision and Your Right to Appeal
After the hearing, the Commissioner will decide to disallow or sustain your claim. If the court rules in your favor, your employer may need to pay retroactive benefits or authorize previously denied medical treatments.
If the decision does not go in your favor, you can appeal. In Maryland, you can request a “rehearing” before the Commission or file an appeal in a Circuit Court.
Why Legal Representation Matters
Navigating the WCC’s rules and countering claim disputes can be complex. If you are facing a dispute, you may wish to consult a legal professional to clarify your next steps. You can effectively fight for the benefits you need by understanding Maryland’s claim processes.