What Should I Do if Workers’ Compensation Claim Is Denied?April 11, 2023
Injured workers in Maryland trust the state’s Workers’ Compensation system will be available when they need it, but valid claims are denied every year for various reasons. If you are hurt and unable to work, the prospect of a denied claim can be quite unsettling.
Workers’ Compensation is a form of no-fault insurance employers are required to obtain to protect their employees. It provides temporary or permanent benefits for medical costs and a portion of lost income for injured or ill workers. Unlike personal injury claims, Workers’ Compensation is a no-fault system; you do not have to prove negligence to obtain compensation.
Several factors must exist before a Workers’ Compensation claim is approved:
- Employer-employee relationship: Maryland’s Workers’ Compensation statute protects individuals who are classified as employees. This does not include freelancers, independent contractors, or those operating in a partnership or sole-proprietorship.
- Accidental injuries and occupational illnesses: The medical condition in question must have occurred accidentally. Workers cannot intentionally cause an injury to collect benefits.
- Covered injuries: All injuries that happen in the workplace are not covered through Workers’ Compensation. Compensable conditions must “arise out of the employment” and “be in the course of employment.” In other words, the employee must have contracted an illness or suffered an injury while they were at work, or performing the tasks associated with their position. If your claim is approved, you may be eligible for several types of benefits based on the extent and nature of your condition.
Workers’ Compensation claims are denied for a multitude of reasons. Your employer may assert that your injury or illness is covered because it did not happen at work—or you were not performing the duties of your job when you became ill or got hurt.
They can say you intentionally caused your accident, or you got hurt as a result of your own reckless behavior. An employer may deny their employee is even hurt at all, or say their injury is not as severe as their Workers’ Compensation claim states. Some Workers’ Compensation claims are denied because they are not filed by the required date.
If your claim is denied, there is a basic Workers’ Compensation appeal process you can follow.
File an Appeal
If your employer or Workers’ Compensation insurer denies your initial claim for benefits, your next step is to file a claim with the Maryland Workers’ Compensation Commission. You have 30 days after receiving the letter regarding your denial to file your appeal.
The commission notifies your employer of your claim and gives them an opportunity to object. If they object to your claim, the state commission will send you a notice of dispute letting your know your claim has been wholly or partially denied.
After receiving a notice of dispute, you have the right to request a hearing before a Workers’ Compensation commissioner. To do this, you and your lawyer must submit an issues form summarizing the issue(s) you believe were decided incorrectly.
From there, a hearing is scheduled to hear both sides. This proceeding is similar to a civil trial where you and your employer and/or their insurer can present your arguments and provide evidence to support your case.
Request for Reconsideration
If your claim is denied once again, the process is not over. You can request reconsideration or ask for another hearing to present your case. It should be noted, however, that rehearings are generally only granted if new evidence becomes available or it is determined the commissioner made a legal error during the previous hearing.
Circuit Court Appeal
A notice to appear in circuit court to appeal a commissioner’s denial is one of the last remaining options you have to reverse that decision. You can do this in addition to or instead of a request for rehearing.
If you opt to file both a request for rehearing and a court complaint, the court’s ruling takes precedence. If the circuit court rules against you, an appeal to the Maryland appellate courts is your final recourse to resolve your case.
How to Build a Strong Workers’ Compensation Claim?
It is essential to file an accurate and timely Workers’ Compensation claim if you get hurt on the job. As time passes, evidence gets lost, and witnesses often begin to forget key details about your accident.
Also, the longer you wait to notify your employer of a work injury, the harder it can be to make that connection between a work accident and your medical condition. Waiting days or weeks to file a claim opens the door for your employer to deny your claim and say your injury happened off-the-clock.
After a work injury or occupational illness diagnosis, be sure to see your health care provider as soon as possible. Again, any delays in this regard can jeopardize your case. Save all medical records related to your care, including hospital bills, imaging tests, prescriptions, and medical reports. These details are essential to your case.
Benefits of Hiring a Lawyer When Your Workers’ Compensation Claim Is Denied
Experienced Workers’ Compensation lawyers avoid common errors that tend to jeopardize legitimate claims. A skilled lawyer can ensure your claim is accurate, on time, and meets the state’s threshold for covered conditions. They can gather evidence to show your injuries are valid and that they happened while you were working.
When deciding who will represent you, choose a lawyer who is adept at presenting testimony at Workers’ Compensation hearings and cross-examining employer witnesses and insurance companies. They should be qualified to assess your settlement and willing to negotiate when it makes sense to do so.
The right lawyer will not give up after an initial appeal but will instead pursue every legal avenue available until a final determination is made. Legal guidance can mean the difference between a time-consuming appeal process and a quick approval.
Baltimore Workers’ Compensation Lawyers at LeViness, Tolzman & Hamilton Help Injured Workers Across Maryland Navigate the Appeal Process
If your claim has been denied, the Workers’ Compensation appeal process can be confusing. Our Baltimore Workers’ Compensation lawyers at LeViness, Tolzman & Hamilton can help manage your claim. Call us at 800-547-4LAW (4529) or complete our online form to schedule a free consultation.
We have offices in Baltimore, Glen Burnie, Lanham, and Owings Mills, allowing us to represent clients in Maryland, including those in Anne Arundel County, Baltimore County, Carroll County, Harford County, Howard County, Montgomery County, Maryland’s Western Counties, Prince George’s County, Queen Anne’s County, Southern Maryland, and the Eastern Shore, as well as the communities of Catonsville, Essex, Halethorpe, Middle River, Rosedale, Gwynn Oak, Brooklandville, Dundalk, Pikesville, Nottingham, Windsor Mill, Lutherville, Timonium, Sparrows Point, Ridgewood, and Elkridge.