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Workers' Compensation Blog

I injured myself at work – why did my employer’s insurance deny my claim?

Friday, September 23, 2016

Simply getting injured at work doesn’t guarantee you any benefits or rights under the law, unless you file an accepted claim with the Workers’ Compensation Commission. Many injured workers only file paperwork with their employer or employer’s insurance company without ever realizing that this is NOT the same thing as a workers’ compensation claim. When you proceed in this manner, it is a private transaction between you and your employer’s insurance. Unfortunately, in countless instances, the insurance company will deny medical coverage and disability payments leaving the injured worker on their own without any help and without any options.

Secure Your Rights and Benefits

However, when you file a claim with the Workers’ Compensation Commission, not only do you secure all the rights and benefits guaranteed under the law , but you also secure the right to present your case to a Commissioner who has the authority to order your employer’s insurance to pay for treatment and disability payments, even when they initially denied it. The Workers’ Compensation Commission was established specifically to litigate injured worker claims and to ensure compliance with the workers’ compensation laws of Maryland. Nevertheless, you MUST first file a claim with the Commission in order to secure jurisdiction for your work-injury.

Get Help...Contact Matt

If you have any questions regarding your status under the law, please contact Attorney Matthew Engler for a free consultation.

I was told I have lifetime medical coverage, under workers' compensation, but they are denying my claim!

Friday, September 23, 2016

The Law. Many injured workers remember that towards the end of their case, when they settled, received a lump sum award, or weekly payments for a set period of time for their workers’ compensation claim, they were told that there right to medical treatment was left open for the duration of their life. However, of course, this comes with a caveat; according to the Workers’ Compensation Law of Maryland, injured workers are entitled to medical treatment with no time limitation, unless stipulated otherwise, for the body part that was injured at the time of the accident as long as the requested medical treatment is reasonable and necessary and is casually related to the original accidental injury.

What does this really mean? For continued medical treatment the injured worker must prove that their current need for medical treatment is still related to the original claim. Thus, the insurance company may not approve any treatment without a doctor’s letter stating that the current need for treatment is still related to the original claim. In my practice, clients often call me after two (2) - five (5) years of feeling fine and now have an onset of the same symptoms they felt several years ago from their accidental injury or disabling occupational disease. Injured workers are often frustrated that their employer’s insurance company will not automatically approve a visit or treatment. This is compounded when the injured worker finds out that before treatment is approved, the employer’s insurance company is allowed to send them to the insurance company’s own “independent” medical evaluation, which often times will state that the current need for treatment is no longer related to the claim. When there has been a large gap in time from the last date of treatment until the present need for treatment usually an injured worker must participate in a hearing to request the Commission to order the treatment or visit. Scheduling of these hearings can take several months.

What should I do? First the insurance company needs evidence through medical reports that the new symptoms are related to the original injury. Then the insurer will need to verify that the requested treatment is reasonable and necessary. Finally they will investigate to ensure there was no intervening event or accident that might have caused the onset of new symptoms. The best way to get your treatment as quickly as possible is to visit your doctor and ask them to write a letter that describes what treatment has been recommended, why the treatment is recommended and whether or not it relates back to the original Workers’ Compensation claim make sure all of your providers have your workers’ compensation insurance claim number and send reports and bills directly to the insurance company to ensure time is not lost in updating the workers’ compensation insurance file. In addition, verify that your attorney also has all of the appropriate recent medical reports, thereby supporting the effective and expeditious advocacy on your behalf. If Berman, Sobin, Gross, Feldman & Darby LLC was the law firm you used for the original claim we will continue to fight to get the medical treatment you need.

For More Information, Contact Attorney Julie Mirman 301-740-3306

Ken Berman Expands Law as to PTSD for Fire Fighters

Friday, September 23, 2016

Post Traumatic Stress Disorder is a huge issue among first responders and can quickly develop into a serious and life threatening condition. Studies show that Post Traumatic Stress Disorder can lead to dangerous and suicidal thoughts among those who suffer from it. A study published by the Journal of Affective Disorders in 2015 found that “Fire Fighters report an alarmingly high career prevalence of suicidal thoughts and behaviors.” More than half of those study participants reported encountering suicidal thoughts at one or more points during their career.

PTSD and Workers’ Compensation Claims

For many years, Post Traumatic Stress Disorder was not recognized as a compensable workers’ compensation claim. In the 1980s and 1990s Berman, Sobin, Gross, Feldman & Darby LLP persuaded the Workers’ Compensation Commission to begin to recognize Post Traumatic Stress Disorder as compensable. It was normally limited, however, to instances of specific horrific incidents occurring.

Active and Retired Fire Fighters Who Suffer from PTSD

For decades Ken Berman has represented fire fighters and first responders who have suffered from PTSD. In two recent cases, Mr. Berman convinced the Commission that fire fighters and first responders can suffer from PTSD from every day stresses and strains and that coverage for PTSD should not just be limited to problems arising from one specific event. Mr. Berman argued that the day to day stresses and strains, cumulative in nature, were equally, if not more, harmful and devastating and should be covered under the law. The Commission, based upon the above arguments, along with appropriate testimony and medical records, agreed. In both cases the fire department argued that such day to day traumatic events are “just part of the job” of a public safety employee. Mr. Berman turned that defense on its head and argued that this was precisely the point. If it is a part of the job and intertwined with it then it should be covered.

The two new decisions are important given that studies show that anywhere between 7% and 37% of fire fighters suffer from PTSD and that the likelihood of suffering from PTSD increases with the number of traumatic situations an individual is exposed to.

Getting Help for PTSD

If you believe you are suffering from Post Traumatic Stress Disorder, or know someone that might be, seek immediate help from a qualified medical professional. If you are worried about a co-worker, talk to them about your concerns. Providing a supportive environment built on mutual experiences can prove to be extremely beneficial to your fellow fire fighters. If you have any questions on any of the above or wish to discuss any matter, in a confidential environment, please feel free to contact Berman, Sobin, Gross and Darby at 1-800-827-COMP(2667).

Can Teachers Collect Leave Benefits During Summer Break?

Friday, September 23, 2016

The days are now long, morning frost is a thing of the past, and thousands of Maryland’s educators’ are enjoying their summer breaks. What better way to kick off this year’s few months of relaxation (or switching gears for that summer job) than to brush up on your workers’ compensation knowledge?

Workers' Comp Benefits and Summer Break

This time of year, I always hear from a number of my teacher clients who are wondering how the summer break will affect their workers’ compensation benefits. Generally speaking, under the Workers’ Compensation Act, Maryland workers are entitled to 2/3s of their wages (known legally as temporary total disability or “TTD”) during the recovery period after an injury when they are incapable of working. (Most boards of education offer a 100% wage benefit to their employees for a specified time period. This issue and its implications on workers’ compensation benefits will be discussed in greater detail in a future blog).

Boards of Education however, will often refuse payment of TTD during our educators’ summer vacation - making the argument that the injured teacher is a 10 month employee and would not be paid during the summer months if they had not been injured at work.
The law in Maryland, however, makes clear that the having an actual intention to work or the opportunity to work for that matter, is not a requirement to collect TTD. Maryland’s test is loss of earning capacity, or the inability to work, regardless of whether there would be actual wage loss. Maryland’s highest court has held that both retired workers – who may never work again (no intention of working), and incarcerated employees (no opportunity to work), are both entitled to payment of TTD during the period they would be physically unable to perform their job duties.

In short – teachers are entitled to TTD over the summer if they are still recovering from a work injury and can’t physically perform their job duties, regardless of whether or not there are any job duties available to perform.

Pay Plans and Benefit Coverage

Another important factor to consider under these circumstances is whether an individual takes a 10 month pay or chooses to spread out their pay over 12 months. Boards of Education will often argue that if a teacher is compensated on the 12 month plan, they should not be entitled to TTD benefits during summer because they are already being paid and would then be “double dipping”. However, this could not be further from the truth. Even if the pay is spread over 12 months, teachers are still only being paid for 10 months of work and accordingly, are still entitled to summer TTD. Deferring earned income does not preclude TTD benefits during the summer months.

Bring on the heat.

Facts About Injuries for Fire Fighters and First Responders

Friday, September 23, 2016

Fire fighters get injured at work more than the general population. If that seems logical to those who perform the job, now there are official numbers to back it up. In 2014 there were 63,350 fire fighter injuries which occurred in the line of duty, a decrease of 3.8% from 2013 when there were nearly 65,880 line of duty fire fighter injuries. While this number, thankfully, is the fewest since 1981, and 2013 represented a 5% drop from the number of injuries to fire fighters in 2012, it is still much higher, proportionately, than for any other occupation. This is especially worrisome when one considers that the number of fires has decreased by 57.1% since 1981.

1 Injury Occurs Every 8 Minutes

Thus, while the number of total injuries for fire fighters has gone down slightly over the last two decades, the number of fires since 1981 has decreased at a much greater rate. The number of injuries remain much higher for first responders than anyone else. It amounts to one fire fighter injury occurring every 8 minutes. In fact, according to the Harvard School of Medicine, putting out a fire has a 100 times higher risk of death than working in a non-emergency situation. Although many people assume that burns and smoke inhalation are the cause of most fire fighter fatalities; heart disease (coronary artery disease) is actually the single most frequent cause of duty-related deaths.

WHERE the Injuries Occur

A look behind the numbers nationwide in 2014 show that forty three percent (43%) of fire fighter injuries occur at or on the fire grounds, while seventeen percent (17%) occur during other on-duty activities. Six percent (6%) arise from responding to or returning from an incident, while eleven percent (11%) happened during training activities. Finally, twenty three percent (23%) occurred at non-fire emergency incidents. The highest rate of injuries (per 100 fire fighters) were, perhaps not surprisingly, among departments that protected populations of one million citizens or more and the fewest were to fire fighters that protected populations of fewer than 25,000.

Exposure To More Than Burns and Scars

In addition to injuries, NFPA estimates that in 2013 (the last calendar year for which reportable numbers exist) there were 7,100 exposures nationwide to infectious disease (such as hepatitis, meningitis, HIV) and 17,400 exposures to hazardous conditions (asbestos, radioactive materials, chemicals, etc.)

Public Safety Workers’ Compensation Claim Rates

The national numbers are mirrored in the State of Maryland. Out of all the workers’ compensation claims filed in the State of Maryland, a disproportionate number have been for public safety employees.

2015 2014 2013
# of Claims 23,711 24,211 23,241
# FF Claims 754 (3.2%) 799 (3.3%) 769 (3.3%)

If you know of fire fighter, first responder, or EMS worker who has been injured on the job have them call me for a confidential consultation.

The First Week After Your Maryland Workers’ Compensation Injury

Monday, September 19, 2016

By Clifford Sobin, Esq.

 

What you do during the first week after being injured on the job will set the tone for the rest of your claim. It is the most important time. You must:

  • Report the injury to your employer.
  • Get medical treatment as soon as possible. Don't let several days pass.
  • Give an accurate history of the injury to your medical provider.
  • Don't speak to the insurance company unless you are sure you are not going to get an attorney (a decision that almost always is a bad one).
  • If you want an attorney, choose one who will guide you, educate you, and that you trust. If the conversation is only about money, consider choosing another attorney.
  • File a Workers' Compensation claim.
  • Choose a doctor for follow up care and obtain authorization to go.
  • Decide if you are going to speak to a nurse assigned by the insurance company to your case.

If you make the wrong decisions, you might make it difficult to win your case. The insurance company may deny your claim. What you say or do in the first days after you are injured matters once you are in front of a Commissioner. Even if the insurance company pays benefits in the beginning, when the inevitable disagreement with the insurance company occurs, you will not be in a position to obtain a speedy hearing in front of the Workers' Compensation Commission if a claim was not previously filed appropriately.

What You Do Matters

You should report your injury to your employer immediately after it occurs and at worst not later than the next day. Never wait until Monday to report an injury that occurred on Friday. If your injury was not witnessed by anybody else, you risk it will be assumed you hurt yourself over the weekend and are now lying.

Always get prompt medical treatment and tell the doctor what happened. If for some reason you did not report the injury to your employer but told the emergency room you were injured on the job earlier that day that will usually be enough to win your case if the insurance company contests it. Furthermore, by getting the treatment immediately:

  • You get the care you need when you need it.
  • You protect yourself from the insurer arguing you had a new injury between your job related injury and the medical treatment you are now receiving.

You should not speak to the insurance company without having hiring, or at least meeting with, an attorney. Workers' compensation is an extremely complex area of law. The insurance adjuster is experienced in finding reasons not to accept a claim. You are not experienced with dealing with insurance adjusters looking for reasons not to pay you. Your desire to be helpful to the adjuster may be hurtful to you. Instead, you should have an attorney control all communications with the insurer.

You should also have the assistance of an attorney when your Workers' Compensation claim form is filed. It matters what is written on the form. It matters even more if you have not reported all the details of your injury to the employer or if your doctor did not write down the correct history of the injury you provided. The average weekly wage you write in the claim form matters as well. It is up to the insurance company to dispute whatever you claim. If you state too low a number because you are not clear on the law, will the insurance company correct it? You already know the answer to that.

Your choice of medical provider can have a significant impact on the future of your claim. Some doctors are better than others. Some injuries require specific medical specialties. Your attorney can guide you through this unfamiliar territory.

Frequently, insurance companies assign nurses to manage the medical aspects of compensation claims. They will attempt to contact you, your doctor and be present at your medical appointments. They are often beneficial in catastrophic cases. However, the value of having them versus the risk they present is an issue, especially with less severe injuries. The insurance company will obtain information through their involvement that they may otherwise never know. Also, nurses often pressure health care providers to do things that you might not welcome. That is why most attorneys place stringent ground rules on their involvement. Furthermore, experienced attorneys have a much greater sense of which nurses can be trusted and which nurses cannot. You should never speak to one without the assistance of counsel.

The bottom line is that the first week after an injury is the scariest and most dangerous time for you. The injury is scary because of the pain it is causing you and your fears of how it will impact your future. It is also dangerous because your actions, non-actions, statements, and non-statements may haunt you throughout the rest of your claim.

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