How to Appeal a Denied Workers’ Compensation Claim in Maryland

September 24, 2023

You may have been shocked and angered when you received notice that your Workers’ Compensation claim has been denied. You were counting on the benefits to help you through a rough time until you could fully return to work. Maryland law clearly states that the insurance company does not get the final say when you have applied for benefits. You can appeal the denial. The first thing that you should do is consult a Workers’ Compensation attorney to assess your legal options and put you in a position where you could appeal.

Why Your Claim May Have Been Denied

The insurance company would need to explain the reasons for its denial of your claim. Common reasons for claim denial include:

• The injury was a pre-existing condition and not the aggravation of a pre-existing condition.
• The injury did not occur on the job or was unrelated to your job.
• The insurance company claims that you were not injured.
• You did not follow the claim requirements or failed to give the employer notice within the required timeframe.

Converting your denial to benefits could be as simple as having your lawyer communicate with the insurance company and clear up any misunderstanding that caused them to deny your claim. The insurance company does not want to spend money to defend your appeal only to be ordered to pay benefits.

Filing an Appeal for a Denied Claim

If you cannot resolve the dispute with the insurance company, you can file an appeal with the Maryland Workers’ Compensation Commission (MWCC). You have 60 days from the date of denial to file an appeal. Then, your case would become a contested one that is decided by an informal litigation process. You would begin your appeal by submitting a form stating the issues you think were wrongly decided.

The next step would be for a hearing in front of the MWCC. Your attorney and the insurance company would have the right to present evidence and witnesses for your side of the story.

Here is some evidence that you can present to prove your case:

• Medical records
• Testimony from a doctor
• Testimony from other witnesses who saw the accident
• Employment records
• Accident statements
• Your testimony

The administrative law judge would review your case and decide whether you have shown that you are entitled to benefits. They will issue a decision on your case. You can take your case further if you do not win your initial appeal. You can request a review from the MWCC. You could also take your case to the Maryland Circuit Court.

Many claimants will have their initial claim denied and be forced to go through the appeals process. Many appellants will eventually settle with the insurance company, paying them part or all of their benefits. Others may win their appeal entirely when a commissioner rules in their favor.

Hiring a Workers’ Compensation Lawyer

Regardless, you have less chance of a favorable result without an experienced Workers’ Compensation attorney. Even if you began your claim without a lawyer, the insurance company could take you far more seriously when they realize you have hired a lawyer. A lawyer knows how to find the weak parts in the insurance company’s arguments and to effectively present your case.

Contact a Baltimore Workers’ Compensation Lawyer at LeViness, Tolzman & Hamilton for Legal Assistance

If you have a complex case or your claim has been denied, contact a Baltimore Workers’ Compensation lawyer at LeViness, Tolzman & Hamilton. We can represent you, whether it is helping you file your claim or appeal a denial. Call 800-547-4LAW (4529) or contact us online 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.