Recent 2012 Chesapeake Employers Success Cases at the Maryland Workers' Compensation Commission

Chesapeake Employers = Vigilant Guardian

Our Legal and Claims professionals work hand-in hand to successfully litigate numerous hearing cases in front of the Maryland Workers’ Compensation Commission (WCC). our thorough case preparation and defense help to keep premium costs fair by limiting unnecessary and excessive awards/claim payments. Here are summaries of recent hearing cases in which the WCC ruled in favor of policyholders and Chesapeake Employers.

A Blast from the Past

In this case, our legal and claims team successfully proved that the claimant’s left foot and ankle issues were not causally related to the accidental injury. The claimant’s past medical history was used to prove that the left foot and ankle issues were from previous problems and not from the accident.

Smile! You’re on Camera

Claims and legal professionals paired up with our Special Investigations Unit (SIU) in order to build a case for denying authorization for knee surgery and terminating temporary total disability benefits for a claimant who they suspected had fully recovered. After obtaining video of the claimant working on the side fixing cars, the video was sent to our Independent Medical Examination (IME) doctor for addendum. The video was shown at the Commission and the claimant was found to be at maximum medical improvement.  

Shouldering the Load

The issues in this case were whether or not shoulder surgery and temporary total disability benefits for a claimant were necessary. Legal and claims professionals teamed up with our IME doctor and convinced the Commissioner that the claimant’s request for additional surgery was radical, especially after the claimant’s initial surgery was not successful and the original treating doctor had released the claimant for full-duty work. The Commissioner agreed and denied the claimant additional treatment.

Taking a Step Down

The claimant in this case alleged that a defective step on a truck caused the claimant to injure their hand. Our attorney and SIU prepared their defense and after testimony from witnesses stating that the injured hand was a result of an altercation and not a faulty step on the truck, the Commissioner disallowed the claim.

Know Your Benefits

Another IWIF legal and claims team defended a claim where the claimant working as an EMT was seeking second tier public safety benefits. At the Commission it was noted by the IWIF team, that EMT’s are not paramedics under Labor and Employment and are therefore not entitled to public safety second tier benefits.

Blood Pressure Rises

In this case, the claimant needed arthroscopic surgery on their right knee. After the preoperative testing, doctors informed the claimant that the claimant needed to lower their blood pressure before surgery. IWIF agreed to pay for the medication needed to control the claimant’s blood pressure until the surgery. Once the claimant’s blood pressure was under control our position was that the Cardiologist and hypertension treatment would be the claimant’s responsibility. The IWIF legal and claims professionals built their case and the Commissioner agreed that the claimant must pay for any future blood pressure treatment.

Employer’s TIP:

Remember, prompt and thorough investigation of the claim starts with you. Report injuries immediately. The more information Chesapeake Employers has to prepare for a possible hearing, the stronger our case. Please work with your claims adjuster by staying involved throughout the claims process.

Quick Comp Terms Defined:

Causally Related - The connection between the claimant’s injury or illness and the work-related accident or disease.

Compensable Injury – An injury caused by an accident arising from the employment and in the course of the employee’s work. The employee is entitled to receive compensation.

Maximum Medical Improvement (MMI) – The point at which the condition of an injured person is stabilized. No further recovery or improvement is expected, even with additional medical intervention.

Temporary Total Disability (TTD) A condition where an injured party is expected to recover, but is unable to work at all during the recovery period. Compensation is paid at 2/3 the average weekly wage, not to exceed the state maximum or go below minimum.

Temporary Partial Disability (TPD) – A condition where an injured party's capacity to work is temporarily impaired, but he or she is able to continue working in a reduced manner and is expected to make a full recovery. Compensation is paid at 50% of the difference between the average weekly wage and the present wage earning capacity not to exceed one-half of the state’s average weekly wage (TTD rate).

Permanent Partial Disability - A condition where the injured party's earning capacity is impaired for life, but he/she is able to work at any gainful employment for his/her remaining lifetime. Maximum permanency rates vary by weeks/length of the award and the affected body part(s).

Workers’ Compensation Hearing - The claims process may involve a workers’ compensation hearing, i.e., when an injury claim is contested by the employer/insurer or when a worker is permanently disabled, it will be scheduled for a hearing before a Workers’ Compensation Commissioner.
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Chesapeake Employers' Insurance Company •  Formerly the Injured Workers' Insurance Fund • 8722 Loch Raven Blvd. • Towson, MD 21286   410-494-2000  1-800-264-4943   Privacy Policy and Data Security