Top Reasons Workers’ Compensation Claims Get Denied in Maryland

Workers’ compensation serves as a safety net for employees who suffer work-related injuries or illnesses. In Maryland, as in other states, workers’ compensation provides financial and medical benefits to eligible workers, helping them recover and return to work. However, despite its intended purpose, claims can sometimes be denied, leaving injured workers facing uncertainty and financial strain. It’s why working with a Maryland workers’ compensation lawyer from the start of your claim is a wise decision; having an attorney on your side can reduce the risk of denial – and ensures that you have an advocate who can help you appeal.

Here are some common reasons why a workers’ compensation claim may be denied:

1. Failure to report the injury promptly

One of the most common reasons for workers’ compensation claim denials in Maryland is the failure to report the injury promptly. Maryland law requires injured workers to report their workplace injuries to their employer within a specified timeframe, typically within 10 days of the incident. Failure to report the injury within this time can raise questions about the validity of the claim and may lead to denial by the workers’ compensation insurer.

2. Lack of medical evidence

Another reason for denial is the absence of sufficient medical evidence to support the claim. In Maryland, injured workers must provide medical documentation substantiating the nature and extent of their injuries. This documentation may include medical records, diagnostic tests, treatment plans, and physician evaluations. Insufficient or inconsistent medical evidence can give rise to doubts regarding the legitimacy of the claim, leading to denial by the insurer.

3. Pre-existing conditions

Workers’ compensation claims may also be denied if the insurer determines that the injury is attributable to a pre-existing condition rather than a workplace accident or exposure. In Maryland, pre-existing conditions don’t necessarily make you ineligible for workers’ compensation benefits. However, you must demonstrate that the workplace injury aggravated or exacerbated your pre-existing condition, resulting in disability or impairment beyond what existed before the workplace incident.

4. Disputes regarding causation

Disputes regarding the cause of the injury can also lead to claim denials. Insurers may argue that the injury was not directly caused by a workplace accident or occupational exposure, but rather by unrelated factors or pre-existing conditions. Proving causation is often a complex and contentious issue, requiring careful documentation and medical opinions to establish the connection between the injury and the employment.

5. Failure to follow medical treatment recommendations

Injured workers are generally required to follow medical treatment recommendations prescribed by their healthcare providers as part of their workers’ compensation claims. Failure to adhere to all recommendations, such as attending medical appointments, undergoing diagnostic tests, or participating in rehabilitative therapy, can be cited as grounds for claim denial. Insurers may argue that your non-compliance with medical treatment contributed to the severity or duration of the injury, warranting their denial of benefits.

6. Disputes regarding the course of employment

Workers’ compensation benefits are available only for injuries that arise out of and in the course of employment. Disputes may arise regarding whether the injury occurred within the scope of employment or while you were engaged in work-related activities.

7. Failure to meet requirements

Maryland’s workers’ compensation system is governed by requirements and regulations that set eligibility criteria, procedural deadlines, and rights and obligations for both employers and employees. Failure to meet these statutory requirements, such as filing deadlines or notice requirements, can result in claim denials. Injured workers should familiarize themselves with the relevant laws and adhere to the prescribed procedures to avoid potential pitfalls. At Plaxen Adler Muncy, P.A., our Maryland workers’ compensation attorneys can help ensure your documents are filed properly and promptly.

8. Employer disputes or objections

In some cases, employers may dispute the validity or extent of a workers’ compensation claim, leading to delays or denials of benefits. Employers may challenge the employee’s account of the incident, question the severity of the injury, or raise concerns about the employee’s eligibility for benefits. Resolving disputes between employers and employees may require mediation, arbitration, or adjudication by the Maryland Workers’ Compensation Commission. Our Maryland workers’ compensation lawyers can help with this.

How can your Maryland workers’ compensation attorneys help?

When facing a denied workers’ compensation claim, enlist the support of a skilled Maryland workers’ compensation attorney to help navigate the legal process. At Plaxen Adler Muncy, P.A., our worker’s compensation lawyers possess a deep understanding of the intricacies of workers’ compensation laws and regulations, enabling us to assess the grounds for denial, identify any errors or omissions during the claims process, and formulate a strategic plan to challenge the decision before the Workers’ Compensation Commission.

Our workers’ compensation attorneys also leverage our acumen and resources to gather relevant evidence, such as medical records and witness testimonies, to strengthen your case and present compelling arguments during hearings or negotiations with insurance companies. Additionally, we offer guidance and advocacy throughout the process, working to ensure that your rights are protected and that you receive the compensation you rightfully deserve for your work-related injuries or illness.

At Plaxen Adler Muncy, P.A., our Maryland workers’ compensation lawyers are on your side. If you are facing a denial of benefits, get in touch with us as soon as possible so we can start preparing your appeal. You don’t have time to waste – get in touch with us today. To schedule a free consultation with an experienced lawyer, call our offices or fill out our contact form today. We serve clients from a variety of offices throughout Maryland.