Appealing a Maryland Workers’ Compensation Denial

Following an injury sustained at work, employees typically file a workers’ compensation claim. However, sometimes these claims are denied. If an individual feels that their claim was denied in error, they can appeal the validity of the claim itself. If an individual is interested in appealing a Maryland workers’ compensation denial, they should consult an experienced workers’ compensation attorney who could help them recover the benefits that they deserve.

Reasons for Denial

The Workers’ Compensation Commission accepts claims which meet the requirements of accepted injury which occurred in the course and scope of employment. A worker’s compensation claim could be denied if the three-part statutory definition is not met, or if the injured worker is deemed an independent contractor rather than an employee.

Even if a claim is accepted, benefits can be cut short.  For example, the employer-insurer might feel that the worker had preexisting conditions to a certain body part and was not injured to the extent that he or she claims.

Those are the kinds of things that go more towards permanency and the scope of treatment, and the types of things where issues are filed throughout the case. However, an initial denial usually occurs because the applicant does not fit within the statutory definition or is an independent contractor.

Determining Independant Contractors

There are certain factors to determine whether or not a person is an independent contractor or an employee. It usually goes to the level of control that the supervisor has over the worker. If the worker has to be at work by 8’o’clock every day until 4’o’clock every afternoon, and they are supervised heavily throughout the day, the supervisor dictates certain things that must be done at specific points during the day, and they are paid with a W2, that sounds like an employee.

If there is somebody who the supervisor really does not have that much control over in terms of their daily activities, get 1099, do not have a specific schedule,  and similar factors sounds a little bit more like an independent contractor, and an independent contractor generally is not entitled to worker’s compensation benefits.

Process of Appeals

At the beginning stages of appealing a Maryland workers’ compensation denial, the attorney can file issues to set a hearing for when the applicant disagrees with the number of benefits, nature/extent of permanency, or some other issue that can arise based upon the applicant’s circumstances.

After a hearing is tried and the Commissioner decides the issue, if the applicant disagrees with the decision then the lawyer can, if necessary, file an appeal with the applicable circuit court. The particular circuit court will depend on where the incident happened. The lawyer will represent the plaintiff their and even appeal it further, if necessary to the Court of Special Appeals and finally to the Court of Appeals.

Filing a Notice of Appeal

A person can file a notice of appeal in ciruit court, or they can ask for a reconsideration. They would have to know the reason of the denial because they may deny the additional treatment that they need, they may deny the whole claim, or only part of the claim. Then what a person would need to do is compile an appeal and have the evidence that would support the fact that they were incorrect in denying that claim.

Essential Pieces of the Process

When appealing a Maryland workers’ compensation denial, it is important to follow the worker’s compensation guidelines to the letter in order to prevent questions arising that could prevent the work-related injury from being compensated. To avoid these questions, individuals should be sure to:

  • Report their injury to the employer as soon as possible
  • Keep track of everything (including all documents)
  • Follow through with all of treatment and recommendations
  • Show up for all doctor’s appointments

Steps to Take to Ensure That Future Medical Treatment is Not Denied

If you want to ensure that future medical treatment is not denied, make sure to do what the doctor tells you too and comply with the treatment because if a person is non-compliant, they are not going to continue to pay for it or approve it. The other thing is if/when you enter a full and final settlement with the employer and insurer, you are foregoing any future medical treatment. A person needs to make sure that they are well before considering a full and final settlement. If you intend on appealing a Maryland workers’ compensation denial, consult a knowledgeable workers’ compensation lawyer that could help.