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What should I do if my employer denied my worker’s comp claim?

Maryland state law created an insurance system designed to help those who suffer a workplace related injury or illness. This system is workers’ compensation.

Those who are injured or become ill as a result of an on-the-job illness or injury can generally receive financial benefits from this program.

What should I do if injured while at work?

Workers should generally let their supervisor know, seek medical treatment as needed and the employer should complete a Report of Injury form. To move forward with a workers’ compensation claim, you then file an Employee Claim Form. This form includes information about the injury. A failure to properly fill out and file the form can result in a delay or even the need to resubmit the forms.

Unfortunately, even when filled out correctly not everyone’s claim for workers’ compensation coverage is approved. The provider or employer may argue that the injured or ill worker did not report the issue in a timely manner or failed to file the paperwork before the deadlines. They could also argue that the issue does not qualify for benefits or that there is not enough evidence to support the claim the injury or illness is work related.

Whatever the reason for the denial, the injured or ill worker can fight back.

How can I fight back if my employer denies my workers’ comp claim?

There are options to challenge a denial of benefits. The process generally moves forward as follows:

#1: Negotiate.

In some cases, you may find success negotiating a resolution. However, it is generally best to have legal counsel at your side to advocate for your interests and better ensure you protect your right to entitled benefits during these negotiations.

#2: Request a hearing.

If negotiations are not fruitful you can request a hearing with the Maryland Workers’ Compensation Commission.

The hearing generally involves you and your employer presenting your side to a Workers’ Compensation Commissioner, who then makes a decision. At the hearing, you share how you were injured or exposed to an illness while at work, what medical treatment you received, and how long you missed work as a result of the illness or injury. It will be necessary to have documentation to defend your claim. This can include copies of medical records and a clear outline of the date of injury or illness exposure event and progression of symptoms and treatment. It will also be necessary to have a statement from your doctor that the injury or illness is related to work and/or the accident alleged on your Claim Form.

If you disagree with the Commissioner’s decision, you can request a rehearing.

#3: File an appeal.

You can also appeal the Commissioner’s decision by filing a Petition for Judicial Review with the circuit court for the county where you live, the location of the business, or the location of accident or exposure.

It is important to note that this process is subject to time limitations. Maryland state law generally requires the worker file an appeal to a denial within 30 days.

#4 Representation

As indicated above, this process can be complicated and the need to present necessary documentation and testimony in a concise manner before the Commissioner is imperative. The Employer/Insurer will be represented by counsel to fight to reduce or eliminate the benefits or Claim, itself.  Workers too are entitled to representation and pursuant to the Md. Workers’ Compensation statute, there can be no fee charged unless the Worker wins. The fee is set by the Commission’s Fee Schedule and is payable only from the Award obtained by your attorney.

If you are injured at work or suffer an illness as a result of the conditions at work you should seek the advice and counsel of an attorney who handles Workers’ Compensation cases on a regular basis.

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