Gaithersburg: 301-670-7030
Baltimore: 410-769-5400
Frederick: 301-668-2100
Contact Us For Legal Help

Workers' Compensation Blog

Three Problems Caused by Maryland’s Medical Fee Guide for Workers’ Compensation Claims

Friday, September 16, 2016

By Clifford B. Sobin, Esq.

The Workers’ Compensation Commission regulates the amount a Maryland medical provider can charge for treating work related injuries. The permitted amounts are found in a document entitled, “Guide of Medical and Surgical Fees”. The medical provider may not charge the injured worker an amount in excess of the amount provided in the fee guide.

These rules cause difficulties in three areas:

1) When the treatment is out of state. In that case, Maryland fee guides do not restrict the health care provider from charging whatever they want. Nevertheless, the workers’ compensation insurance company will only pay an amount called for in the fee guide – the injured worker is stuck for the difference. Although the statute permits the Commission to Order a higher payment when special circumstances permit, it almost always declines to do so. Therefore, it is crucial that an injured employee explicitly obtain the agreement of the out of state health care provider to accept the fee schedule before becoming a patient.

2) When the claim is initially denied. If the workers’ compensation insurance company denies a claim, usually if there is a medical insurer, bills will be paid by the medical insurer while a hearing is pending. As a result the claimant may pay a deductible and the health insurer will pay pursuant to its fee schedule. Problems can occur when the claim subsequently becomes compensable. This may result in:

  1. payments being yanked from the medical provider by the health insurer; or
  2. issues concerning who reimburses the claimant for co-pay expenses (health care provider or workers’ compensation insurer) as well as what happens if the medical insurer has paid more to the health care provider than the fee schedule permits.

3) Difficulty in finding medical providers. Many physicians, especially orthopedic surgeons and neurosurgeons, are refusing to accept patients who rely on workers’ compensation insurers to pay for the medical treatment. This is due to the reduced rates, increased documentation, and uncertainty or delay of payment which is part and parcel to administering a workers’ compensation claim.

Please do not hesitate to contact us at Berman, Sobin, Gross, Feldman & Darby LLP in order to assist you in these matters

Recent Posts


Tags

Transportation Reimbursement Laws and Regulations Attorney Cliff Sobin Attorney Alan Gross FMLA Personal Injury Medicare and Workers Compensation National Holidays Liabililty Physical Training Injuries for Firefighters MSPRC Wrongful Death Claim Disability Insurance Medical Travel Expense Maryland Workers Comp Attorney Ken Berman Teachers Occupational Diseases Injured Courier Worker Workers Compensation for Firefighters Workers Compensation Fraud Workers Compensation Lawyer MSEA Firefighters Permanent Disability Injured School Bus Drivers Accident Report Fire Fighters Dependent Attorney Gretchen Rogers Average Weekly Wage Criteria Occupational Hazards Death Benefits Attorney Allyson Bloom Firefighters and Hearing Loss Unemployment Benefits Coming and Going rule, D.C. attorney Attorney Julie Mirman Maryland Workers Compensation Hearing Maryland Workers' Compensation Claim – Is My Injury Covered? Vocational Rehabilitation Benefits Work Related Injury workers Compensation Act Workers Compensation win for 911 dispatcher Veterans Medical Workers’ Comp Attorney Maryland Lawyer Temporary Total Disability Railroad Injuries Injured Fire Fighters Coming and Going rule Attorney Charles Schultz Attorney Matt Darby attorney Natalie Whittingham Police Officers Claims Process Maryland Workers Compensation Commissioners DC Workers' Compensation Maryland Fire Fighters Opioids Workers Compensation for Police Officers Workers Compensation and Bankruptcy Incident Report Attorney Lauren Pisano Denial auto accident attorney Workers Compensation Claim Auto Accidents Attorney Robert Hagans Attorney Nicole Lambdin Benefits Prescription Medication Side Effects Injury Report Attorney Ari Laric Independent Medical Evaluation injured railroad workers Damages Auto Injury Vocational Rehabilitation Maryland Workers Compensation Procedure Mileage Reimbursement Attorney Matthew Engler Corrections Officers Workers Compensation Benefits for Teachers

Archive

RSS

What Our Clients Say

Known for our unwavering commitment to clients, for our integrity, and for delivering the best results, our clients continue to refer their friends, families and neighbors to us for their legal needs.


"One year ago today I made the call to your office. The best decision I could make. I wanted to share with you how impressed I am with your staff and your professionalism."

Heather P.


"Craig did a great job representing me! He's the lawyer I have trusted with my legal needs because he's professional, knowledgeable, and keeps me informed about my case."

Jaclyn K.


" wanted to thank you, in writing, for your kindness and prompt response. Customer service is a dying art, and you gave me hope for my family."

Karla


"I would like to express my gratitude for your efforts and dedication for my disability case. It's has been quite a long and upsetting process but you have handled my case in an extremely competent and responsible manner."

Leo H.


"I have recommended Mr. Feldman to several of my friends and colleagues and have heard nothing but excellent reviews. He is the best lawyer I have ever used."

Martin


"I received the check today. I could not believe it until I saw the check. Thank you so much. You have improved my family's quality of life tenfold."

Mike F.


"These guys go above and beyond! They always have your best interest in mind."

Mike W.


"I would like to express my thanks to Amanda Knott and Gretchen Rogers for their patience with me through my ordeal with my workers comp claim. I was impressed from the very beginning when I spoke with G. Rogers on the phone and although she did not have to, she met with me personally and walked me through the steps of what to expect in this process."

Mr Sagal


"You have been kind throughout this process and I appreciate your professionalism as well as your gentle concern. Thanks for helping us and all the others who need your legal expertise. We are grateful."

Nancy F.


"Thanks to Mr. Shultz's aggressive and professional work ethic style I was able to receive the medical services and compensation pertaining to my case."

Navdeep C.


"I can honestly say this firm is simply TOP NOTCH! They not only have handled countless cases for my members that require their services, they also have gone well beyond their "scope" to help some of my folks in other areas of need. "

Rick H.


"I wanted to compliment your law firm on having Amanda Knott as a paralegal. She worked tirelessly for almost 2 years making sure I understood what was happening and at the same time keeping all my records straight and in order, which allowed Gretchen Rogers to represent me in the best way possibl"

Terrye G


"The attention and professional care the staff has taken toward my needs has always been excellent. I have no complaints nor worries that my issues discussed are not addressed."

Tim T.


"I just got off the phone with Craig and let him know how thankful we are to you, him and Ken for all your efforts – you are all really terrific to work with!"

Val K.


Locations Throughout Maryland, Virginia & Washington DC

Gaithersburg Office

481 N. Frederick Avenue, Suite 300
Gaithersburg, MD 20877
301-670-7030 / 800-248-3352
Fax: 301-670-9492

Lutherville Office

1301 York Road, Suite 600
Lutherville, MD 21093
410-769-5400 / 800-248-3352
Fax: 410-769-9200

Frederick Office

30 W. Patrick Street, Suite 105
Frederick, MD 21701
301-668-2100 / 800-827-2667
Fax: 301-668-2000


TOP