For those who have been injured at work, it is a relief to know that workers’ compensation can provide help in the form of payment for lost wages or medical expenses. Nevertheless, most people who have been involved in a workers’ compensation case know that the process of claiming your benefits is not always an easy one.
As you are preparing, filing, and taking steps with your lawyer through the workers’ compensation claim process, one of the most valuable questions you can ask is, “What can go wrong?” Knowing the potential pitfalls of this already complicated endeavor can help you circumnavigate some of the trickier areas and prevent issues which could keep you from receiving benefits.
Common Difficulties in Workers’ Compensation Claims
Our team at Belsky & Horowitz, LLC has an extensive history of providing legal guidance for injured workers in Maryland. While each workers’ compensation case is intricately unique and can pose its own unforeseen challenges, there are certain areas of the process that are likely to become particularly difficult if not handled properly. The following are some of the more common issues than can stand in the way of a successful outcome to your case:
- Inadequate Reporting Procedures. After sustaining injury or incurring disablement on the job, it is your duty to inform your employer that an incident occurred. This report should be made in writing, and it will allow your employer to begin the necessary procedures of contacting their insurance and filing legal documentation. It is imperative to report the issue as soon as possible, as a missed deadline can prevent your case from continuing. Each state has its own legislation regarding timelines. Maryland law specifies a deadline of 10 days for reporting to your employer, nevertheless a claim may still be filed with the Workers’ Compensation Commission within two years of the date of your accident. Issues can also arise if the accident or illness is reported with erroneous facts or mistakes. Make notes, take pictures, and cleanly manage all records to prevent problems stemming from faulty reporting.
- Failure to Seek Treatment. Subsequent to a work-related injury, you may be tempted to skip a visit to the doctor. People who do not promptly see a doctor because they believe their injuries to be minor, prefer to seek relief at home, or are too overwhelmed to pursue medical care make a risky mistake. For both health and legal reasons, it is always best to allow yourself to be seen by a medical professional immediately following your injury. Making certain that your injury is documented is one of the most important aspects of your workers’ compensation case. Your medical record will demonstrate to your employer and their insurance company that an injured occurred. It will also present key details, such as the extent and cause of the injury, that may determine the level and type of benefit you should receive.
- Disregard of Physician Instructions. Taking your medical treatment into your own hands not only places your health in jeopardy, but can also give an insurance company cause to invalidate your claim. Failure to follow medical guidelines such as attending appointments, adhering to a prescribed schedule of medication, undergoing therapy, or staying home from work can give the impression that your injury or illness is not as serious as you have claimed it to be. This kind of evidence can easily undermine the legitimacy of your workers’ compensation claim.
- Preexisting Medical Conditions. Complications can arise if you have a health condition which existed before you sustained your work-related injury or illness. Maryland law stipulates that injuries and illness “arising out of and in the course of employment” qualify for workers’ compensation. To avoid payment, an insurance company may try to prove that an older condition, not an on-the-job accident, caused your need for medical treatment. Even if you had an underlying medical condition prior to your work-related injury, accurate medical records will be able to show that your workplace injury aggravated and worsened your existing condition, or was the cause of an unrelated condition. Comprehensive medical records directly relevant to your injury are indispensable to your case.
- Drugs and Alcohol. In most cases, an employee who is injured solely as a result of being under the influence of drugs or alcohol at the time of injury, is not eligible for workers’ compensation benefits. However, there are circumstances in which employees who fail to pass a drug or alcohol screening are still qualified for benefits. For example, in cases in which it can be shown that the employee was using drugs legally prescribed by a doctor, or that the accident would have occurred regardless of intoxication, a claim may be justified. This can be a very complicated issue. Speak with your lawyer as soon as possible if you believe you may be entitled to benefits you have not received.
- Employer Insurance Violations. Maryland requires every employer to obtain workers’ compensation insurance, and those not in compliance are violating the law. Some employees don’t realize that the law also requires each employer to post an official notice stating that the employer holds insurance, and display it in a prominent site at the workplace. The poster must contain required information including the Employer’s Federal Identification Number (FEIN) and the name of the insurance company. If your employer has failed to follow this law, you will be unable to properly fill out your workers’ compensation claim form.
- Problematic Medical Records. Both you and your employer are required to provide copies of all relevant medical information. As stated earlier, your medical records are central to your case. However, there are several ways your records can harm your case if they are not sufficiently in order. Medical records should be obtained through legal means and reflect information that is accurate, detailed, comprehensive, and directly and solely related to your work injury. Whenever you meet with a treating physician or therapist, be sure to inform them that your injury is work-related, and ask for copies of notes and test results following each examination.
- Knowing When to Appeal a Denial Of Your Claim. In Maryland, your initial claim may be denied for a variety of reasons, either by your employer and their insurance company. A denial may be the consequence of a detail as small as a missed box on a form. An experienced lawyer will be able to advise you on whether it is the right decision to appeal a denial of your claim. During an appeal, you and your attorney will work together to provide evidence which addresses the questions raised against the validity of your claim. Keeping track of your documents and records, following advised medical treatment, and communicating with your lawyer will lay the groundwork for success should you decide to appeal the denial of your claim your case.
Benefit from the Experience of Belsky & Horowitz, LLC
Coping with an injury, illness, or permanent physical damage involves a demanding adjustment and recovery period. During this time, your focus should be on your health, not on legal procedure. We at Belsky & Horowitz, LLC are wholly committed to defending the rights of injured employees. Our comprehensive legal knowledge and stringent standards in practice make us highly successful in recovering losses for our clients. We take care to invest time and effort in your case, anticipating, avoiding, and resolving complications so you don’t have to.
Contact us today to set up an obligation-free discussion with one of our experienced team members.