Insurance Adjusters and Necessary Medical Treatment in Maryland Workers’ Compensation Claims

Insurance adjusters and obtaining necessary medical treatment in Maryland workers’ compensation claims are unquestionably tied together. When you are harmed within the scope of your employment, it is your right to file a claim for the benefits you need. Under the law, you are actually required to file a claim with the Maryland Workers’ Compensation Commission before the insurer is permitted to pay you any benefits!  Often, however, insurance companies look to deny these benefits. Do not let this happen. Choose to have a legal advocate at your side who could rebuke denials and ensure that your paperwork meets all legal standards.

Common Injuries that Lead to Claims

There are two kinds of claims, there is an accidental injury, and there is an occupational disease. An accidental injury is something that happens, suddenly arises, and comes from employment. Something falls on them at work, they slip and fall at work, or they are involved in a crash while they are working. Those are accidental injuries.

That can lead to orthopedic injuries, burns, neurological conditions, psychological conditions and a host of other possible problems. The occupational diseases are illnesses that arise over time caused by the inherent hazards of employment. The worker’s job might involve working with chemicals and those chemicals ultimately cause them skin sensitivity or affect their lungs and cause them problems breathing, and this could be an occupational disease.

The other types of injuries are mental and emotional. If they are robbed, they may have PTSD and they may have other issues coming out of the mental part. They can also have mental and emotional injuries.

Suppose the injured worker is a truck driver who breaks his leg. He cannot drive, so they are not working for months, they are stuck at home recovering, and they are miserable because they do not know if they are going to be able to go back to the career they love, and they start to become depressed and anxious. Those would be covered because they arose out of the work injury.

When is Seeking Medical Treatment a Necessity

In Maryland, an injured worker has the absolute right to choose his or her own treatment providers. Other states are different, but in Maryland, they can choose their own, the insurer cannot force them to get treatment at a place of their preference. However, they can force them to be evaluated, but they get to pick their own treatment.

Do Insurance Adjusters Have Any Control Over Medical Treatment Sought?

In Maryland, not very much, however, in cases with significant injuries, insurance adjusters frequently assign nurse case managers to a file and when a lawyer is representing an injured worker. When a claimant has representation, the adjuster is no longer allowed to talk to them nor is the attorney.

However, with the attorney’s permission, the nurse case manager can work with the claimant and usually, the attorney lets someone do that because they could be a huge help. Until they prove that they are going to be a hindrance, the attorney usually lets case managers be involved. A nurse case manager could have a lot of influence in steering a claimant who cannot dictate legally.

The nurse could help. They could steer someone to people that they either think are good, or if not a good nurse case manager or is someone with other goals, that person could steer them to a doctor who is going to really hurt their case and restrict their treatment. The insurance companies cannot directly dictate in Maryland but they could steer.

Sometimes, the insurance company does not like the treating doctor and, although the claimant had the right to pick that doctor, the adjuster will find a reason to stop paying for the treatment and disability benefits. Although they require justification, Maryland rarely penalizes them for arbitrary actions.

It could take two to three months to get a hearing because the WCC does not grant emergency hearings very easily. Then when they get to the hearing, typically the worst that is going to happen is that they will be ordered to do what they should have done months before. They do that frequently as a way of discouraging the claimant from the course of action.

Plan for Insurance Companies and Required Medical Treatment in Maryland Workers’ Compensation Claims Today

When it comes to insurance adjusters and necessary medical treatment in Maryland workers’ compensation claims, companies often look for any reason to deny a claim. This could range from simple volition to errors in paperwork. Do not let insurance companies bully you out of your legal workers’ compensation rights. Work with an attorney who holds your interests at heart.