Below you will find a list of common terms and concepts that will arise in the majority of Maryland workers’ compensation claims. I write this so that the general public might gain a better understanding of what to expect if they are dealing with an injury at work in Maryland.
An accidental personal injury is: Any injury that arises out of an in the course of employment; or an injury caused by a willful or negligent act of a third person against the covered Employee in the course of the employment of the covered employee; or a disease or infection that arises from an accidental injury that arose out of and was in the course the covered Employee.
An occupational disease is: A disease contracted by the covered Employee that causes disablement; and occurs as a result of and in the course of Employment; and causes the Employee to be disabled; and is due to the nature of the employment in which the hazards of the disease exist; or the disease symptoms are consistent with those symptoms that are known to result from exposure to biological, chemical, or physical agents that are attributable to the type of the Employee’s employment. (Note: if you think you are disabled from working in Maryland as a result of an occupational disease call an attorney immediately as these claims can become very complex and often hinge on technical medical opinions)
Causal Relationship is proof that the requested benefit is more likely than not because of the compensable accidental injury or occupational disease.
AGGRAVATION OF PRE-EXISTING CONDITION
Aggravation of a Pre-Existing medical condition because of an accidental injury that arose out of and occurred in the course of the Employee’s employment is compensable.
An Idiopathic Condition is a medical condition or trait that is personal to the Employee that exists separate and apart from the Employee’s employment. If an Employee sustains an accidental injury or occupational disease that is solely due to the Employee’s idiopathic condition, then the accidental injury or occupational disease is not compensable.
However, if the Employee’s idiopathic condition was A. aggravated or triggered by the Employee’s employment; or B. The Employee’s employment contributed to the hazard created by the idiopathic condition, then the accidental injury or occupational disease is compensable despite the existence of an idiopathic condition.
An independent contractor is a person who contracts to perform certain work for another person, entity, governmental unit or quasi public corporation according to his or her means or methods, free from control of the Employer in all details connected to the work except as to the product or result of the work. If the Employer does not possess the skills that the Employee does, it is more likely than not that the Employee is an Independent Contractor.
AVERAGE WEEKLY WAGE:
The average weekly wage of a covered Employee is determined by adding the wages earned by the Employee for the fourteen weeks prior to the date the Employee sustained a compensable work injury or date of disablement for an occupational disease then dividing by fourteen. Wages include actual pay earned, tips, the reasonable value of housing, lodging, meals, rent, and other similar advantages. Average weekly wage does not include fringe benefits such as Employer contributions to pension plans. If, as a result of an Employee’s experience or age, the wages of the covered employee can be Employee can be expected to increase, this increase may be taken into account in calculating the average weekly wage.
A covered Employee is not entitled to compensation or benefits if the injuries were caused solely by the Employee’s intoxication. If the Employee’s intoxication was a primary cause of the accidental injury then the Employee is entitled only to medical benefits. Compensation shall not be denied to an Employee if the covered Employee was taking a controlled dangerous substance as prescribed by a physician and its use was not abusive or excessive. There is a presumption that the use of the controlled dangerous substance or the intoxication of the covered Employee was neither the sole nor the primary cause of the injuries of the Employee. To overcome this presumption the Employer must produce substantial evidence to the contrary.
A hernia is compensable if: The hernia did not exist before the work injury; or is a result of an accidental injury; a preexisting hernia became so aggravated, incarcerated or strangulated that an immediate operation was needed.
SUBSEQUENT INJURY FUND:
The Subsequent Injury Fund was created by statute to compensate certain permanently impaired employees who have injuries or diseases prior to the Employee’s accidental injury or occupational disease. The Subsequent Injury Fund is not funded by the State of Maryland. The Fund may be responsible for a portion of the permanent disability payments to the Employee if a prior injury, disease, or congenital condition is likely, or likely to be anytime in the future, a hindrance or obstacle to the ability of the empployee to find or maintain any form of employment.
SUSCEPTIBILITY TO INJURY:
An Employer is responsible for all benefits arising from an otherwise compensable injury or disease even if the Employee was particularly susceptible to the injury or disease that is the subject of the Employee’s claim. It is not relevant that an injury or disease would have been less serious to another similarly situated Employee.
VOCATIONAL REHABILITATION BENEFITS:
Every Employee who sustains a compensable injury or disease who is unable to perform work for which the Employee was previously qualified, is entitled to vocational rehabilitation benefits. The inability to perform work for which the Employee was previously qualified need not be permanent. A temporary inability of the Employee to do so is sufficient.
EMPLOYEE’S RIGHT TO NECESSARY, REASONABLE, AND CAUSALLY RELATED MEDICAL TREATMENT:
Every Employee who sustains a compensable work injury or disease is entitled to medical treatment that is necessary, reasonable, and related to the injury or disease. The Employee has the right to choose medical providers. The Employee does NOT have to use medical providers suggested by the Employer.
TEMPORARY TOTAL DISABILITY:
Temporary total disability is generally defined as the inability to work, because of a compensable injury or occupational disease, while recuperating from the injury or disease. Temporary total disability is not complete helplessness. It is the “healing period.”
PERMANENT PARTIAL DISABILITY:
A medical condition or the effects of a medical condition that continue even though the Employee reached maximum medical improvement.
MAXIMUM MEDICAL IMPROVEMENT:
An Employee has reached maximum medical improvement when any additional medical treatment for the Employee’s compensable work injury or disease will not meaningfully improve the Employee’s physical or mental condition beyond its current state. The Employee may require additional medical treatment now or in the future, but the nature of any additional medical treatment is intended to assist the Employee with maintaining the Employee’s current condition instead of improving the Employee’s medical condition beyond its current state.