When a worker is injured on the job, they are entitled to seek benefits under workers’ compensation. However, not all claims are straightforward. In some cases, disputes arise between the injured worker and their employer or the insurance company about the nature of the injury, the amount of benefits, or other key issues. This is where the adjudication of a workers’ compensation claim comes into play. The adjudication process ensures that disputes are resolved fairly and by the law.
What is Adjudication?
Adjudication is the legal process through which a judge or a government agency reviews evidence and arguments from both parties. Then they make a formal decision about a dispute. In the context of workers’ compensation, adjudication occurs when there is a disagreement between the parties involved. This includes the injured employee, the employer, or the insurance carrier regarding the workers’ compensation claim.
Common reasons for disputes include:
- Whether the injury or illness is truly work-related
- Extent of the injury and the necessary medical treatment
- Duration or amount of wage replacement benefits
- Disputes over permanent disability ratings
Once a claim is adjudicated, the decision made by the adjudicator is legally binding, meaning both parties must adhere to the outcome.
Adjudication in Maryland Workers’ Compensation Law
In Maryland, workers’ compensation claims are governed by the Maryland Workers’ Compensation Commission (WCC). If a dispute arises regarding a workers’ compensation claim, the case may be referred to the WCC for adjudication. The process ensures that injured workers receive the benefits they are entitled to under Maryland law while also allowing employers and insurers to contest claims they believe to be invalid.
Here’s how the adjudication process works in Maryland:
- Filing a claim: The injured worker or their attorney files a formal workers’ compensation claim with the Maryland Workers’ Compensation Commission if they believe they are entitled to benefits.
- Employer/insurer response: The employer and their insurance carrier will have an opportunity to respond to the claim. They may accept the claim or dispute it, leading to an adjudication process.
- Hearing: If the claim is disputed, a hearing will be scheduled before a WCC commissioner. At the hearing, both the worker and the employer/insurer will present evidence, such as medical records, witness testimony, and expert opinions, to support their case.
- Decision: After reviewing the evidence and hearing arguments, the commissioner will make a decision regarding the claim. The decision will outline whether the worker is entitled to benefits, the amount of benefits, and any additional actions that must be taken by the employer or insurer.
- Appeal: If either party disagrees with the WCC’s decision, they can file an appeal in the Maryland Circuit Court. However, the appeals process can be lengthy and complex, and it’s recommended to have legal representation during this stage.
Important Considerations for Injured Workers
If you’re injured on the job and your claim goes to adjudication, here are a few things to keep in mind:
- Gather documentation: Having thorough documentation of your injury, medical treatment, and its connection to your job is crucial. This includes medical records, doctor’s notes, accident reports, and any other relevant documentation.
- Legal representation: Workers’ compensation laws can be complicated, and disputes can quickly become challenging. Having an experienced workers’ compensation attorney represent you during the adjudication process can help protect your rights. They also ensure you receive the benefits you deserve.
- Timeliness: In Maryland, workers have a limited time to file a workers’ compensation claim. You must notify your employer of your injury as soon as possible and file your claim within two years of the date of injury or diagnosis of the work-related illness.
- Appeals: If your claim is denied during the initial adjudication, don’t lose hope. You have the right to appeal the decision, and many claims are successfully resolved during the appeal process. An attorney can help guide you through this more complex stage of the process.
Seek Professional Legal Guidance
The adjudication of a workers’ compensation claim is an essential for ensuring that injured workers receive the benefits they’re entitled to. It also allows employers and insurers the opportunity to contest claims they believe are not valid. If you are injured on the job in Maryland and your workers’ compensation claim is disputed, the adjudication process will determine the outcome.
Understanding your rights and having strong legal support can make all the difference in securing the compensation you deserve. If you’re facing an adjudication of your claim, contact Shugarman & Mehring to discuss your options and ensure your case is handled properly.