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Why Would My Workers’ Comp Claim Get Denied?

Workers who suffer injuries while performing their duties or become ill because of the work environment usually benefit from workers’ compensation. In Maryland, the law requires most employers to purchase workers’ compensation insurance for the protection of their employees. This ensures that workers get some form of income even if they can’t work. However, it’s not an automatic award of benefits. Your workers' compensation claim may get denied. This can be a hard blow if you have to take time off work and your bills are piling up. While a rejection of your claim will be disappointing, you can appeal it. The first thing you need to do is understand why the claim was denied. Here, we’ll look at some of the reasons claims get denied and what to do if you receive a claim rejection. A Maryland attorney that handles workers’ comp can help you to fight for the compensation you deserve.

How Workers' Compensation Works in Maryland

The workers’ compensation system provides a range of benefits including:
  • Temporary partial disability benefits
  • Permanent total disability benefits
  • Permanent partial disability benefits
  • Vocational rehabilitation
  • Wage replacement
Not every worker who suffered an injury while at work is eligible for compensation. The harm the employee suffered must be an accident, arise out of employment, and arise in the course of employment. An exception is made for occupational diseases since these don’t need to be accidental. These are caused by the worker's job environment. Occupational illnesses include asbestosis, lung disease and some skin and eye conditions caused by exposure to toxins. As long as the illness is work-related, workers can get compensation for these conditions. Employees typically can’t get compensation for mental injuries. However, the Maryland Court of Appeals has on occasion allowed post-traumatic stress disorder to be included on a claim. Meanwhile, injuries or illnesses which are due to drug or alcohol abuse aren’t covered. Neither are injuries that are self-inflicted.

Why a Workers’ Compensation Claim May Get Denied

As any Maryland workers’ comp attorney will tell you, there are many reasons why a claim may be denied. It could be because:
  • You failed to file the claim in time
  • Your employer doesn’t believe the injury or illness occurred at work
  • You or your employer made a mistake on the claim form
Your claim may also be denied if your employer makes certain claims about you. For example, they may say you:
  • Injured yourself intentionally
  • Weren’t using the required safety equipment when the accident occurred
  • Were under the influence of drugs or alcohol.

Appealing a Workers' Compensation Claim Denial

If you don’t agree with your employer’s assessment or the decision of the Commission, you can file an appeal. You will have to request a hearing with the Commission and specify the issue which you believe they got wrong. Your issues form must be mailed to your employer’s insurer and the Commission. During the hearing, your attorney will present evidence to support your claim. This may include testimony from your doctor or eyewitness reports about how the accident occurred.  If your appeal is successful, the Commission will publish an order stating how much you’re owed. If either you or your employer disagrees with the order, you can lodge an appeal in the Maryland Court. You can request a rehearing within 15 days if that hearing doesn’t go in your favor. However, this will only be granted if there is new evidence or the Commissioner made a legal error. If a rehearing is denied, you have the right to appeal to the Circuit Court. The court will uphold the Commission’s decision or send your claim back for reconsideration. If this all sounds too complicated, it’s because the system is complex. You will need an experienced attorney to assist you with the process. Even though the laws surrounding workers’ comp seem simple, insurance companies don’t like paying out claims. If there’s even the smallest reason to deny your claim, they will take advantage of it. You will be forced to prove that you deserve to access workers’ compensation benefits. If your claim has been denied, you need to contact an attorney about filing an appeal.

Reach Out to Pinder Plotkin LLC Today to Discuss Your Case

If you’ve recently suffered a work-related injury or illness, you’re likely facing a variety of negative effects. Don’t assume a denial means you’ll never be able to get compensation. With a competent Maryland workers’ compensation law firm on your side, you’ll stand a much better chance than you would alone. Contact Pinder Plotkin LLC to schedule a consultation today.