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Workers' Compensation Blog

How Maryland Workers’ Compensation Law Is Made And Changed

Saturday, January 19, 2013

Three types of laws impact the Workers’ Compensation process. They are:

  1. Statutes,
  2. Regulations, and
  3. Appellate decisions.

In addition, the Workers’ Compensation Commission develops specific policies that guide them but do not bind them.


The starting point for workers’ compensation is statutory law. A statute is a written law. If it is not covered by a statute, it cannot be done, no matter how unfair something may seem to you.

Statutes start as “bills”. They are written and voted on by the Maryland Legislature. If both the Maryland House of Delegates and the Maryland Senate approves the “bill” it goes to the Governor. If the Governor signs it, the “bill” becomes law.

Before the legislature votes, testimony is taken from both those in favor of the bill and those against it. This occurs in designated House and Senate Committees and often preliminarily in front of a designated Legislative Oversight Committee.

Lobbyists and special interest groups are heavily involved in the process. As a result, changes often take years.


The Workers’ Compensation Commission has the authority to create mandatory regulations. It is the purpose of a regulation to identify and determine precisely how the intent of a statute will be carried out. A regulation cannot create new law. It can only clarify a statute and provide procedures for its implementation.

Before a regulation is enacted, it must be circulated to the general public and hearings are held where anybody may speak in favor or against it. Regulations usually take several months to travel from an idea to reality. As with statutes, lobbyists and special interest groups are heavily involved in the process.

Appellate Law

Appellate law is created by the Court of Special Appeals, which must hear every appeal, and the Court of Appeals which only hears appeals it chooses to be worthy of consideration (almost always only after the Court of Special Appeals has heard the case). Appellate decisions interpret statutes, regulations, the Constitution and other Appellate cases. The Courts may not create new law (although some criticize them for seemingly doing so), they may only interpret existing law.

By Clifford Sobin, Esq.

What Are Your Medical Treatment Rights Under Maryland Workers’ Compensation Law

Saturday, September 01, 2012

The easy answer is that you have the right to medical treatment reasonably related to your injury on the job. Furthermore, once accepted by the workers’ compensation insurance carrier, you do not have to pay deductible or co-pay if the medical provider is in Maryland (see my next blog article for out of state treatment issues). Your Treatment rights include payment of:

  • Hospital bills
  • Prescriptions
  • Doctor bills
  • Physical Therapy bills
  • Mileage reimbursements for travel to health care providers
  • Medically necessary equipment

However, there is also a hard truth. You have the right to claim treatment, but the insurance company may object, delay or ignore your request. Unfortunately, the solution often requires a hearing before the Maryland Workers’ Compensation Commission. At the hearing, your testimony and medical reports from your doctors are presented for a Commissioner’s consideration.

How can this be you might ask? It is because the injured worker always has the burden to prove the treatement requested is:

  1. Related to the injury on the job; and
  2. Reasonably likely to be beneficial

Therefore your right to medical care under a Workers’ Compensation claim is not as extensive as when you make an insurance claim with a medical insurance provider. In that instance, you and/or your employer has paid an insurance premium that entitles you to payments for medical care. Workers’ compensation settings are adversarial, your right to payment flows from your injury, not a contract. Nevertheless, the medical protection that flows from an accepted Workers’ Compensation claim may be crucial to your recovery and your financial wellbeing.

By Clifford B.Sobin, Esq.

Do You Need An Attorney For Your Maryland Workers’ Compensation Claim?

Tuesday, July 17, 2012

If You have been injured at work and have been dealing with the insurance company’s adjuster without any problems (for now), should you still hire a lawyer?

The short answer is YES.

Insurance company adjusters often formulate their questions in a way that encourages people to reveal more information than is needed or required. They will then use that information against you later on. For example, an adjuster may ask if you’ve ever had any prior injuries, prompting you to tell them about every medical condition or injury you’ve ever sustained, instead of limiting it to the body part that you just injured. They may also take recorded statements and focus on areas that will assist with defending against your claim. In addition:

  • The insurance company adjusters have access to the lawyers at their company, who provide them with the most recent court decisions and advise them about the law. Shouldn’t you also have a lawyer to advise you?
  • Your employer, who pays premiums to the insurance company, also has access to the lawyers at the insurance company who can advise them about the law. If your employer has a lawyer, shouldn’t you?
  • It does not cost you anything up front to have a lawyer for a Maryland Workers’ Compensation case. Your attorney will only be paid out of any compensation you are awarded in your case and only with the permission of the Maryland Workers’ Compensation Commission. Your lawyer cannot seperately bill you or charge you for their time. Your attorney will not receive a fee if you do not receive compensation.

Your lawyer can assist you with all aspects of your case, including obtaining:

  • Your wages
  • Your medical records
  • Medical treatment approvals

Your attorney will also represent you before the Workers’ Compensation Commission, when a hearing is required. Hearings are somewhat informal, but hidden behind the informality are technicalities that often require the assistance of a lawyer; such as presenting evidence in the proper manner, cross examining witnesses where required, making appropriate objections, and ensuring the evidence meets the burden of proof required to present your case.

In addition, without an attorney you could be missing out on benefits that you don’t even know you are entitled too, such as:

  • Temporary Total Disability Benefits paid based on an accurate average weekly wage
  • Permanent Disability Benefits at the correct level
  • Vocational Rehabilitation
  • Mileage reimbursements
  • Medical treatment

Please feel free to contact us at Berman, Sobin, Gross, Feldman & Darby, LLP, should you have any questions.

By Ken Berman

How Long Does It Take For My Maryland Workers’ Compensation Hearing To Be Scheduled?

Tuesday, July 10, 2012

The Short answer is – it depends.

Generally, hearings are scheduled within three to four months after they are requested. However, some cases take longer and others less. The following things seem to impact the timing of hearings:

  • Location of the hearing (some locations are inherently busier than others)
  • Number of hearing requests filed within the same time period
  • Last minute cancellation of a full Commission docket due to weather
  • Number of cases that were continued after being scheduled.
  • Priority given to some issues over others
  • Inclusion of the Subsequent Injury Fund or Uninsured Employer’s Fund as a party

As a result, it is impossible to determine with confidence how long it will take for a hearing to be scheduled and the one claimant may wait much longer than another, even if the hearing requests are made on the same day.

There are two exceptions to the three to four month norm for having your hearing scheduled:

  • The first is if the issue only involves vocational rehabilitation. If the appropriate forms are filed, a Workers’ Compensation Commissioner will attempt to mediate the dispute over the phone within 24 hours of the forms being filed. If that is not successful, a hearing will be scheduled within several business days of the failed phone conference. However, the Commission will not any issue other than Vocational Rehabilitation to be heard at the expedited hearing.
  • The second exception is if an emergency hearing is granted. While it is true that an emergency hearing can be requested for any issue, it is equally true that they are infrequently granted. The purpose must be an emergency that far exceeds the fact that the insurance company is refusing to pay. There must be significant demonstrable impact as a result of a delay, beyond what other claimants will normally experience for the same delay, to have a chance of having the request granted. Generally, it is recommended not to ask for an emergency hearing unless there is a high likelihood of it being granted.

By Clifford B. Sobin, Esq.

More Cancers Presumed To Be Caused By The Job – Just Not Yet

Wednesday, June 06, 2012

Maryland fire fighters and fire instructors both paid and most volunteers, paramedics, most volunteer rescue squad members and advanced life support unit members, and State Fire Marshals are eligible to claim a presumption under Maryland Workers’ Compensation law that certain cancers are caused by their jobs. Until May 31, 2013, the cancers are:

  • Leukemia
  • Pancreatic Cancer
  • Prostate Cancer
  • Rectal Cancer
  • Throat Cancer

As a result of new laws passed in April of 2012, for Workers’ Compensation claims filed on June 1, 2013, or later, the list of presumptive cancers increases to include:

  • Multiple Myeloma
  • Non-Hodgkin’s Lymphoma
  • Brain Cancer
  • Testicular Cancer
  • Breast Cancer

In addition, the new statute created a framework for further study of the relationship of cancers to specified jobs.

The presumption is only applicable if the employee:

  • has had contact with toxic substances in the line of duty capable of causing the cancer;
  • has completed at least 5 years with the same department (will be 10 years after the effective date of the new statute) in the job, or combination of jobs, that are specified as eligible to receive the presumption
  • that the employee is disabled from serving as a result of the cancer in the job that is eligible for the presumption; and
  • is a volunteer – met a suitable standard of physical examination before becoming a volunteer.

Determination of whether a particular cancer originated as a presumptive cancer often requires a detailed review of the medical records, and deciding when to file a claim involves application of the law to the facts. Therefore, legal representation is strongly suggested to protect your rights.

Please do not hesitate to contact us at Berman, Sobin, Gross, Feldman & Darby LLP (301-670-7030) in order to assist you in these matters.

By Clifford B. Sobin, Esq.

Medicare And Old Workers’ Compensation Claims

Thursday, May 10, 2012

A letter from Medicare is in the mail. The envelope doesn’t look much different from others you have received from Medicare. You open it without thinking or much concern.

What it says shocks you.

Medicare (actually an outfit called MSPRC) is alerting you that it no longer will pay for treatment or wants money back for bills they have paid. Why?

Because you filed a Workers’ Compensation claim more than ten years ago – it makes no sense to you. The Workers’ Compensation claim was for your right leg, the treatment you now need is oxygen for your lungs!

How Could This Happen?

Insurance companies are now required to send Workers’ Compensation claim information to Medicare. If:

  • bills are coded incorrectly by a medical provider
  • a medical report erroneously says the treatment is for a job related injury
  • Medicare makes a mistake; or
  • who knows why

The letter you get may be a:

  • Rights and Responsibilities Letter (RAR) – The letter informs you that Medicare is aware you have filed a Workers’ Compensation claim. Sixty-five days later a Conditional Payment Letter is sent to you (see below)
  • Conditional Payment Letter (CPL) – This letter specifies what Medicare has paid that it believes are related to your Workers’ Compensation claim.
  • Conditional Payment Notice (CPN) – This letter tells you what you should do if Medicare has paid bills and wants its money back.
  • Demand Letter (DL) – Medicare tells you that you must repay Medicare for the payments listed in the letter. A Demand letter is issued thirty days or more after the Conditional Payment letter.

If payments are not made within sixty days of the Demand Letter and Medicare does not agree to modify or waive the demand interest is charged from the date of the Demand Letter.

If no payments are made within 120 days of the Demand Letter, an “Intent to Refer” letter will be mailed to you. Medicare may send the matter to the Department of the Treasury for collection from 120 days to 240 days from the date of the Demand Letter.

You or your attorney can request a “waiver” after a Demand Letter is issued even if the treatment is related to your old Workers’ Compensation claim. To do so:

  1. you must not be at fault for the overpayment; and
  2. it would cause you financial hardship to repay Medicare .

There also is an appeal process for disputes over more than $130.00.

How to Solve the Problem

The only clear statement that can be made at this time about resolving Medicare/Workers’ Compensation disputes is that there is no clarity. However, the first step is to call the Medicare number listed on the form and find out what the problem is. If there is a clear error by Medicare, your phone call may take care of the problem. It is also possible that some documentation from the Workers’ Compensation claim and/or your medical providers will be required. The issues will be more complicated if the new treatment is for the same part of your body that was the subject of your Workers’ Compensation claim. The argument is, for example, that a back strain of ten year ago could not possibly be related to a need for back surgery now. It is possible medical records will be required to support that position, and/or a hearing before the Workers’ Compensation Commission to determine whether the treatment is related. Even then, Medicare may not agree to be bound by a Commission decision.

The Bottom Line

The only sure thing to say about Medicare and Workers’ Compensation claims is that nothing is sure. Rules and procedures change. Simple issues may be resolvable without an attorney, more complex ones, perhaps not.

By Ken Berman

File A Maryland Workers' Compensation Claim – Reporting Your Injury Is Not Enough!

Tuesday, October 11, 2011

You were injured on the job. You reported your injury to your supervisor and your boss filled out a form that you signed. The insurance company gave you a claim number and paid your medical bills. You had no contact with the Maryland Workers’ Compensation Commission. You thought all was well.

You were wrong.

The form you signed was a First Report of Injury that your employer sent to the insurance company. It was not a Maryland Workers’ Compensation claim form. The insurance company filed the First Report of Injury form with the Maryland Workers’ Compensation Commission. Unfortunately, that does not relieve you of the responsibility to file a claim form. Generally, you have two years to file a claim with the Commission (less when a death occurs as a result of an accidental injury). If you fail to file timely, you will not have any right to claim additional Workers’ Compensation benefits should the insurance company refuse to pay them – and they will.

How do you know if a Workers’ Compensation claim was filed? It is simple. Your claim is properly filed if you received a document titled “Notice of Employee’s Claim” in the mail from the Commission.The document must have a six digit claim number on the top right side that is preceded by the letter “B” or “W” (“W” is used when you file on-line). The Commission will only send you the document if you signed the front and the back of a claim form and mailed it to them.

All too often an injured employee’s failure to file a claim is caused by an insurance company that voluntarily approves and pays for medical treatment. This lulls the employee into complacency but trouble rears its ugly head when the employee’s condition worsens or if the employee has a new injury. If it has been more than two years from the accident the insurance company’s tone will suddenly change. A friend no longer, the insurance adjuster will usually respond in one way – denied! If an unfortunate worker suffers a new injury on the job, the insurance company may try to defend the claim or limit the benefits payable by arguing that the injuries are related to the old claim that was not filed timely.

There are arguments we can raise to extend the filing period beyond the two year period specified by the law. However, they are very fact specific and will only be successful in a very small percentage of cases. Therefore, whenever you are injured on the job it is vital to ensure that a claim has been filed timely. When in doubt, the easiest way to do that is to contact us. There is no fee for us to check.

By Clifford B. Sobin, Esq.

Three Problems Caused By Maryland’s Medical Fee Guide For Workers’ Compensation Claims

Monday, June 20, 2011

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:

    • payments being yanked from the medical provider by the health insurer; or
    • 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.

By Clifford B. Sobin, Esq.

Maryland Workers' Compensation – Ten Rules For Speaking To Doctors

Monday, June 13, 2011

Anybody that has watched TV for more than fifteen minutes can recite the Miranda warnings from all the cop shows; I bet you know them … “You have the right to remain silent, anything you say can and will be used against you …” you get the picture. But, what does that have to do with a Workers Compensation (or personal injury) claim? Everything!

Injured folks are constantly talking to doctors and nurses who make notes and then place those notes into your records or on your chart. Sometimes, they even quote what you say. I recently litigated a cancer case where the other side actually brought up that a my client, suffering from leukemia due to a workplace toxic exposure, told a doctor that he was doing “fine” when the doctor asked him how he was!

Everything you say to medical care provider (doctor, nurse, PA, everybody) has the potential of ending up in charts that will be read and scrutinized by lawyers at a later date. Who can forget the antics that Elaine, from the TV show Seinfeld, went through to see her own medical chart and then how she was blackballed by other doctors for looking at it; maybe funny on TV, but very serious in the world of personal injury and workers compensation.

Sometimes, what is just as important as what you say is what you don’t say. If you fall at work and break your leg, but fail to mention that you hit your head, or shoulder when you fell, it gives the other side the chance to argue that you did not actually hurt that body part in the accident.

Here are some rules of thumb for when you speak to all medical providers:

  1. Everything you say might be placed in the medical record so speak carefully
  2. Never lie or exaggerate, but don’t hesitate to tell them that something hurts and the more specific you are the better
  3. Doctors rarely will purposely misdiagnose or change a diagnosis just because they work for one side or the other; however, the employer/insurer’s medical opinion may tilt heavily towards the person paying the bills. Keep this in mind.
  4. Be very friendly to the office staff and doctors. If you are sincere, friendly and honest to everybody they will spend more time with you and listen more carefully to what you are saying.
  5. Some of the tests and questions the doctors send your way are designed to see if you are being truthful. They know a lot more about how things are connected in your body than you and I do, but if you are being completely truthful it is less of a problem.
  6. Not all doctors have good bedside manner or want to engage in small talk, such is life
  7. Write down specific problems, complaints and questions, before you go to the appointment and take them with you. It saves everybody time and you don’t forget to bring up important points
  8. Mention problems with other body parts and let them see if they are related. For example, neck, back and shoulder injuries often result in other body parts having symptoms. These may or may not be related, let the doctors decide
  9. Tell them about any medications you take, even if embarrassing. Not telling them could actually hurt or kill you due to a drug interaction
  10. 10. And finally, never, ever, ever tell them you are “fine” … unless you really are … if you were fine you wouldn’t be talking to a doctor, now would you?

By Ken Berman

Maryland Workers’ Compensation Dependency Benefits – The 2011 Legislation

Tuesday, May 17, 2011

As of October 1, 2011, Maryland’s manner of compensating dependents of employees who die due to injuries or diseases sustained as a result of their job has changed! The new law will immediately impact all employees and their dependents other than employees of municipal corporations or counties that have a right to claim their:

  1. Heart Disease
  2. Hypertension
  3. Lung Disease
  4. Lymes Disease; or
  5. Cancer

is presumed to be caused by the job. These presumptions are given to all fire fighters and police officers, some deputy sheriffs and correctional officers, and some employees of the Maryland- National Capital Park and Planning Commission. The excluded employees may be included at a later date if the county or municipal corporation they work for “opt in” to the new statute.

The changes eliminate the distinction that has existed for decades between partially and fully independent individuals. The distinction created windfalls for some and despair for others. Until the new law, a dependent whose spouse was killed in a tragic occupational injury would usually receive benefits:

  1. If she was found fully dependent for life (with some exceptions) at the rate of 2/3 the deceased’s average weekly wage, not to exceed the State average weekly wage, for the rest of her life; or
  2. If she was found partially dependent (with some exceptions) at the rate of 2/3 the deceased’s average weekly wage, not to exceed the State average weekly wage, but only until $75,000.00 is paid out.

It was, and still is for those that remain impacted by it, a terribly unfair law. If the deceased’s spouse was working a part time job at the time of the job related death, the spouse would receive only $75,000 compared to potentially over a million dollars for the spouse who was not working. There was no in between!

Rather than focusing on the amount each individual receives, the new law focuses on the amount of the payment. The intent is that dependency payments reflect the amount of support the decedent provided.

To achieve the new “fairness” the Act introduces the new concept of “family income”. Family income is the total of the average weekly wage (hereinafter referred to as AWW) of the deceased, combined with the AWW of all of the dependents. The AWW of the deceased is based on the deceased’s AWW at the time of the accidental injury of disablement from occupational disease.

Once the family income is calculated, the deceased’s AWW is:

  1. divided by the family income and reduced to a percentage;
  2. the percentage is multiplied by the maximum death benefit which is equivalent to two-thirds of the decedents AWW not to exceed the State AWW;
  3. the total represents the maximum cumulative amount that is paid to all dependents; and
  4. the only exception to this rule is if the decedent’s AWW was $100.00 or less, then the weekly dependency benefit shall be equal to the AWW without any reduction based on the percentage calculation discussed above.

The following example brings clarity to the arcane discussion above. Assume:

  1. Decedent’s AWW = $1200.00
  2. Dependent 1 AWW = $200.00
  3. Dependent 2 AWW = $100.00


  1. Total family income is $1500.00 ($1200 +$200 +$100)
  2. Maximum death benefit is $800 (2/3 of decedent AWW of $1200)
  3. Percentage of Decedent’s income to family income is calculated as follows: decedent’s AWW-1200/ family income-1500 = 2/3 or .667 percent
  4. Amount payable to all dependents collectively is $533.34 calculated by multiplying .667 (percentage of decedent’s income to family income) * $800 (maximum death benefit)

The payments are made for a maximum of twelve years retroactive to the date of the death of the decedent unless one of the following occurs:

  1. the dependent’s dependency ceases;
  2. The dependent is a spouse that remarries, in which case the spouse’s benefits cease two years after the marriage;
  3. The dependent(s) are not children of the deceased or the deceased’s spouse, in which case the maximum total payment to that class of dependents is $65,000.00, modified by annual State AWW adjustments beginning January 1, 2012;
  4. The date the deceased would have reached the age of seventy years old if the deceased had not died, in which case dependency benefits cease unless dependency benefits have been paid for less than five years in which case benefits continue until five years of dependency benefits have been paid; or
  5. A child reaches the age of eighteen unless the child continues to attend school on a full-time basis at a school that offers an educational or accredited vocational training program accredited or approved by the State Department of Education, in which case the child can continue to receive dependency benefits until the age of twenty-three; or
  6. A dependent child or spouse remains incapable of self-support (due to mental or physical disabilities that pre-existed the decedent’s death) after their benefits would otherwise be ended, they will continue to receive benefits until their disability ends.

The Workers’ Compensation Commission determines the amount of benefit each dependent receives

The Workers’ Compensation Commission is granted broad discretion to apportion the amount of benefit each dependent receives when there is more than one dependent. The only guidance provided by the statute is that the determination must be “just and equitable”.

By Clifford B. Sobin, Esq.

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