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Maryland Workers' Compensation: Expert medical evidence

An issue that arises in Maryland Workers' Compensation is whether there is adequate medical evidence in the record to support a claim. In a new, unpublished opinion, the Court of Special Appeals of Maryland sheds light on "minimum evidence" required to link medical treatment back to earlier covered injury. 

Substantial evidence 

Board of Education of Montgomery County, Maryland v. Darlene M. Hamilton looks at whether a woman who had a work-related back injury in 1991 adequately linked medical expenses from treatment years later to that previous injury. If her evidence were sufficient, Workers' Compensation would cover those medical bills 24 years after the original injury, which had been the basis for a valid Workers' Compensation claim.

Hamilton was a cosmetology teacher who, while giving instruction in 1991, fell off an unstable stool, injuring her back. In her original claim, the injury caused a permanent partial disability of 35 percent loss of body use, with five percent linked to pre-existing condition. 

Nine years later, she had spinal fusion surgery for the injury. Ten years after that, her treating orthopedic doctor wrote in Hamilton's chart that she had spinal degeneration "related to original injury/surgery with her back." She had medical appointments and an MRI five years later in 2015 and 2016. 

Medical expert testimony 

The employer challenged coverage of the 2015 and 2016 medical bills, saying that Hamilton had not proven by substantial evidence a link between that treatment and the original injury because she should have provided testimony by a medical expert. 

The court disagrees, saying that the doctor's notes in which he said the later degeneration was related to the original injury were sufficient. The question of whether medical testimony was required must be determined case by case, looking at the level of medical complication. 

The court explains that in four circumstances, the medical question will "almost always" be complicated enough to require expert testimony. One of those situations was present here: "significant passage of time [24 years] between the initial injury and the onset of the trauma requiring treatment." 

Because of this, expert testimony was required. Significantly, the court says, "documentary evidence is accepted, and perhaps preferred" for this purpose, rather than live testimony. The medical notes directly linking the early injury with the much later medical treatment were sufficient evidence, so the employer must pay the medical bills.

This was a fair interpretation of the law. It must be noted by the Reader that an Unpublished Opinion is not binding on a lower court but may be persuasive authority.

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