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Defense Wins at the Workers’ Comp Commission

February 2019



Chesapeake Employers’ thorough case preparation, investigation and defense help to keep premium costs fair by limiting unnecessary and excessive awards or claims payments. Here are a few cases in which the Commission and courts ruled in our favor.

The Case of a Jury Supporting the Commission’s Decision         

 

A Chesapeake Employers’ attorney and claims adjuster worked together to successfully defend this claim on appeal in the Circuit Court. 

As a result of a hearing before the Maryland Workers’ Compensation Commission, an award was issued in support of the claimant. But because the award was significantly lower than the claimant’s rating, the claimant appealed the decision and requested a jury trial. Attempts to resolve the appeal were unsuccessful, so the appeal proceeded to trial.

At trial, the claimant’s attorney argued that the Commission’s decision was in error because it unfairly determined that a portion of the disability was not related to the accident, despite the absence of symptoms prior to the accident.

Chesapeake Employers’ attorney argued that the Commission’s award is presumed correct, noting that the Commission has expertise in evaluating workers’ compensation claims, and further argued that, although the claimant had a lengthy period of treatment, the diagnosis made by the treating hospital was merely a strain and contusion.
 
After a 2-day trial, the jury returned a verdict finding the Commission’s decision to be correct. 



The Case of a Lack of Credibility


Chesapeake Employers’ attorney and claims adjuster were successful in defending this claim in which the claimant alleged a back injury in 2017 while at work installing signage along a Maryland highway.

The claimant had minimal medical treatment until early 2018, when the claimant was first seen at a diagnostic and surgical center in Maryland. At that time, the claimant alleged a workers’ compensation-related back injury but gave a different description of how the accident occurred.

Due to the claimant’s conflicting descriptions, Chesapeake Employers conducted a visit to the claimant’s workplace to investigate the facts surrounding the alleged accident. At the visit, the employer advised that the claimant was on “light duty” at the time of the alleged accident and that the work the claimant was performing at that time required no lifting. Another employee stated that the claimant had been previously employed as a jockey and had complained about back pain many times before the alleged accident.  

At the hearing, Chesapeake Employers proffered the testimony of the employer and co-worker. Chesapeake then argued that the Commission should not rely on the opinion of the Independent Medical Examination (IME), which stated the claimant had a workplace-related accident, because the doctor relied solely on information the claimant had provided. The Commission disallowed the claim, but the claimant appealed.

Due to Chesapeake’s diligence and effort, the parties agreed to settle the claim at a substantially reduced cost to the employer.



The Case of Surveillance to Defend against Authorization for Medical Treatment


Chesapeake Employers’ legal and claims staff successfully defended this claimant’s request for additional treatment for pain management.

The claimant testified to experiencing stabbing back pain and that the pain limited the ability to sit. The claimant admitted that, in addition to obtaining care from a treating doctor, the claimant was also under the care of the claimant’s own doctor, who provided a muscle relaxer and recommended the use of a heating pad.

Prior to the hearing, Chesapeake Employers had secured surveillance video clearly showing the claimant was capable of walking freely with no pain. In addition, Chesapeake obtained an IME indicating the claimant was at maximum medical improvement and could return to work full duty. Chesapeake raised further concerns about the lack of specificity involving the request for pain management treatment and advised the Commission of the claimant’s multiple prior claims, some of which involved the back with continued residual symptoms. Chesapeake additionally argued that none of the diagnostic tests indicated the type of pain requiring pain management.

The Commission denied the request for additional pain management treatment and the claimant did not appeal.



The Case of a Claim Defeated Due to Marijuana Intoxication


Our claims and legal departments teamed up once again to successfully defeat this claim.

The claimant, a bus driver, claimed to have injured the left knee while involved in a crash when pulling out from a bus stop. Our claims adjuster alerted our attorney that the claimant had tested positive for marijuana immediately following the accident.

Chesapeake Employers produced the Maryland law citing the illegality of driving under the influence of drugs as well as the employer’s rules for employee conduct, which banned the same. The IME agreed that, based on the markedly elevated concentration of marijuana in the claimant’s system, it was likely the claimant was under the influence of the drug at the time of the accident. The IME concluded that the claimant’s intoxication was a cause of the accident.

At the hearing, Chesapeake Employers raised the issue of impairment, or, in the alternative, willful misconduct, and argued that, per the IME, the drug use was a cause of the accident. The claimant attempted to defeat the defense by testifying to using marijuana 2 days prior to the date of accident. The claimant did admit, however, that it was against the employer’s code of conduct to use marijuana while driving the bus, and that it was unlawful in Maryland to drive under the influence of drugs.

The Commission denied the claim based on willful misconduct and, as a result, no benefits were paid to the claimant.


 

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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