How Do I Maximize My Workers’ Compensation Claim?June 7, 2021
Every employer in the state of Maryland must purchase Workers’ Compensation insurance. An employee injured on the job is entitled to Workers’ Compensation benefits regardless of who is at fault, unless the employee is guilty of gross misconduct.
Workers’ Compensation claims involve one of two types of injuries: accidental personal injuries or occupational diseases.
Accidental personal injury is defined as one that arises out of and in the course of employment under Maryland statute. That means there must be a proven connection between the injury and an obligation, condition, or incident of employment.
In addition, Workers’ Compensation covers only employees, not independent contractors or other third parties. A genuine employee-employer relationship must exist.
In Maryland, an accidental injury is one that happens by chance or without design, taking place unexpectedly or unintentionally.
An exception to this definition is the second type of Workers’ Compensation injury claim: occupational diseases.
Occupational diseases are illnesses caused by the circumstances surrounding an employee’s job and not a direct injury. For example, many skin, eye, and lung diseases and cancers can be attributed to long-term exposure to toxic workplace substances.
How Does the Workers’ Compensation Process Work?
A Workers’ Compensation claim is not made against the employer, but rather the company’s insurer. The insurance company pays all the benefits and manages the process, although the employer is notified of a claim.
Workers’ Compensation benefits are just like other benefits, so an employee should not hesitate to use them. An employer cannot fire or otherwise treat a claimant differently.
However, it is essential to note that an employee would benefit from an advocate such as a Workers’ Compensation lawyer, assisting the employee the minute a Workers’ Compensation claim is initiated. This is because the employer will not go to bat for an injured employee, nor will the insurer pay total compensation for damages for which an employee may be entitled.
The Claim Process
When an employee is injured or contracts an occupational disease in the course of their employment, the first step is to notify the employer and begin a Workers’ Compensation claim. Then, the employee must seek immediate medical treatment.
The medical provider will run all the appropriate tests, imaging, and other procedures to arrive at a diagnosis and a treatment plan. This plan is followed until the doctor decides the injured employee is at maximum medical improvement and will not get any better or the claimant chooses to stop treatment.
The claimant is paid for time missed from work and associated medical bills.
When a claimant has completed treatment, the doctor, claimant, and the insurance company will determine the employee’s ability to return to the same work they performed at the time of the accident or illness. If they cannot return to their former employment, they will enter vocational rehabilitation until they can find suitable employment or are sufficiently retrained.
Sometimes a worker will never be able to return to a similar job or any job at all. In those cases, they may be eligible for a permanent injury award after a long and complex hearing process.
This is a simplified version of the claim process. An experienced Workers’ Compensation lawyer can guide an injured employee or their loved one through what is, in reality, an often arduous process.
What are Workers’ Compensation Benefits?
In Maryland, various wage reimbursement and medical benefits will be granted an employee depending on the nature of their illness or injury:
- Temporary total disability benefits: When an employee’s injury makes them totally disabled from returning to work during their healing and recovery period.
- Temporary partial disability benefits: When an employee can perform limited or part-time duties while recovering.
- Permanent total disability benefits: When an employee’s injury renders them totally and permanently disabled. In Maryland, this means loss or loss of use of both arms, both feet, both hands, both legs, both eyes, or a combination of any two.
- Permanent partial disability benefits: When a worker’s injuries leave them with a partial but permanent impairment.
- Medical/hospitalization benefits: Generally covers medical and surgical treatments, hospital and nursing services, medicines, medical equipment, and artificial and prosthetic appliances.
- Wage reimbursement benefits: Recovery of wages lost while unable to work, including time spent at required medical examinations.
- Vocational rehabilitation benefits: When an employee cannot do the same work they performed before the accident; these benefits help with retraining, job placement, and other services.
Maximizing a Workers’ Compensation Claim
The Workers’ Compensation insurer is not required to settle with the claimant. They are only concerned with controlling their risks in the future. If they expect a lot of risk for future medical care, for example, they may be willing to settle.
Regardless, an injured or ill employee should have a Workers’ Compensation lawyer on board before responding to an insurance company’s settlement offer or receiving benefits. Insurers will often push the claimant into accepting an offer quickly. Although the offer may look generous when a claimant is facing medical bills and loss of income, it is never enough to cover their full damages.
In addition, a claimant rarely knows all the options available to them. A lawyer can present the options and recommend courses of action.
Finally, a Workers’ Compensation lawyer can advise a claimant on how to maximize their claim, including the following:
- Follow the employer’s procedures and guidelines. The worker needs to do all that is required within deadlines and paying careful attention to rules, policies, and requests for information. Being cooperative is important.
- Start receiving disability checks immediately. The insurer will be more apt to move forward with a settlement when they see checks being paid to the injured worker.
- Broaden the scope of the claim. Workers should report subsequent injuries that are the direct and natural result of the original injury. For example, if a leg injury caused a fall that injured the worker’s wrist, the wrist injury should be reported as part of the claim.
- Maximize the benefit amount. Overtime, side jobs, differentials, and other factors can increase the amount the insurer must pay.
- Do not refuse medical procedures recommended by a doctor. The idea of expensive medical procedures may increase an insurer’s willingness to settle.
- Keep detailed and organized medical records. The injured worker needs to file every piece of paper or electronic communication related to care, rehabilitation, prescriptions, treatment plans, and other medical records. Doctor appointment dates and other relevant timelines should be noted. Organized and detailed records help create a logical timeline of care and inability to work.
- Maintain contact with the employer. The worker should let the employer know what is happening in the treatment plan and when a return to work can be expected, if at all. Open communication may help an employee stay top of mind and not have their job filled while recovering.
- Manage pain if appropriate. Pain management is often costly and may be needed for a long period. This treatment could increase a settlement value.
- Choose words carefully. Workers should not tell a doctor, medical examiner, or others that they feel great or are planning to run a marathon, for example. If an insurer believes medical care is for the long term, they may want to settle more quickly.
- Seek psychological care. Depression and anxiety are not uncommon after a serious accident or illness. Workers should not hesitate to ask for a referral to a specialist.
- Ask for a hearing. Sometimes cases lag, or the insurance adjuster will not evaluate a case for settlement. The worker can find an issue to dispute and ask for an official hearing.
Baltimore Workers’ Compensation Lawyers at LeViness, Tolzman & Hamilton Advocate for Injured Workers
If you or a loved one has been involved in a workplace accident or illness, you have the right to be compensated for your injuries and damages. The Baltimore Workers’ Compensation lawyers at LeViness, Tolzman & Hamilton are skilled in maximizing Workers’ Compensation claims and negotiating fair and just settlements. We will work tirelessly for you to achieve the outcome you deserve. Call us today at 844-556-4LAW (4529) or contact us online for a free consultation.
Located in Baltimore, we serve clients throughout Maryland.