Why Was My Maryland Workers’ Comp Claim Denied?

The most common reasons for a denial

• “It didn’t happen at work.” The insurer questions whether the injury arose out of and in the course of your employment, often because there were no witnesses or the first medical record does not mention work.
• “It’s a pre-existing condition.” Common with backs, knees and shoulders. An aggravation of an old condition by a work accident can still be compensable.
• Late notice. Maryland requires prompt notice to the employer after an accident. Insurers use a late report to question whether the injury happened on the job.
• Late filing. Filing with the Commission is a separate step with its own deadline. Telling your supervisor is not filing a claim.
• Not an employee. The insurer says you were an independent contractor. The label on your paperwork is not always the answer.
• Treatment disputes. The claim is accepted but a surgery, test or therapy is denied as unnecessary or unrelated.
• Return-to-work disputes. Wage benefits stop because an insurer’s doctor says you can work.
• Intoxication or misconduct. Less common, and on intoxication and drugs the law starts from a presumption in your favor. See whether fault matters in a Maryland comp claim.

Contesting the denial before the Commission

When the insurer contests a claim, it files the issues it disputes and the matter is set for a hearing before a commissioner of the Workers’ Compensation Commission. The hearing is less formal than a trial, but it is where the claim is decided, and the evidence you bring is the evidence that counts.

What usually wins a disputed hearing:

• Medical records that connect the injury to the work event or job duties
• A clear opinion from your treating doctor on cause and on the treatment you need
• Witness statements, incident reports, texts or emails showing when and how you reported the injury
• Pay records for the wage calculation

The insurer will often send you to its own doctor for an independent medical examination. Answer honestly and consistently, and tell your own doctor about that exam.

If the commissioner rules against you

There are two further steps, and both have short deadlines set by statute:

1. A motion for rehearing with the Commission, filed within 15 days after the decision. It can be granted only for an error of law or newly discovered evidence.
2. An appeal to the circuit court, by a petition for judicial review filed within 30 days after the date the Commission mailed its order. If a rehearing motion was filed, the appeal clock starts from the Commission’s ruling on that motion.

Because the windows are short, it is worth speaking to a lawyer as soon as a denial or an unfavorable order arrives.

How to make a denial less likely

1. Report the injury to your employer in writing, promptly, and keep a copy.
2. Tell every medical provider that the injury happened at work, and how.
3. File your claim with the Commission rather than relying on your employer to do it.
4. Keep treating and follow your doctor’s restrictions. Gaps in treatment are used to argue you recovered.
5. Be consistent. Differences between your incident report, your doctor’s notes and your testimony are what insurers look for.

Check for a claim against someone else

While the comp claim is in dispute, look at who else was involved. If another contractor, a property owner, an equipment maker or a negligent driver helped cause the injury, you may have a separate injury claim against them that does not depend on the comp claim. See construction site injury claims for the most common example. Our case review is free, and there is no fee unless we recover money for you.

Common questions