• Your Name
  • Your Phone Number
  • Your Email Address
  • Please Describe What Happened

Medical Benefits

Once an employee has a compensable case as outlined above, the employee has numerous entitlements to benefits.  Medical treatment that the employee may seek may include but are not limited to hospital charges, nursing charges, doctor visits, surgical charges, medications, durable medical supplies, prosthetic devises, physical therapy, mileage reimbursements for travel to medical providers. This is not to say the insurance company will blindly pay for all treatment that is recommended by a doctor. 

In most cases the insurance company will question and possibly deny the medical treatment for one or more of the following reasons:

a.    if they believe that the treatment is not causally related to the workers compensation accident;

b.    there is a new accident or injury;

c.    the claimant has reached maximum medical improvement(in the view of one doctor);

d.    the treatment is expensive or excessive.

Most of the time, the employer will require a statement from the treating doctor which sets out the treatment that is being proposed.  In some cases, the employer/insurer will send the claimant for an independent medical evaluation to determine if they want to pay for the requested medical treatment.  The insurance company has the right to set the claimant up for an independent medical examination.  This is an examination will usually determine whether the insurance company will continue benefits or cut off benefits.  In rare cases, the workers compensation commission will order a medical exam.  Currently, in Maryland there is a schedule of fees that sets out the compensation due to medical providers for services performed.  The medical providers must accept what the fee schedule determines is the correct payment.