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What are some defenses to my workers' compensation claims?

Maryland employers are required to maintain workers' compensation insurance coverage for their employees. Workers' compensation insurers operate like any other insurance company. They make money by not paying out claims. Attorneys working for those insurance companies have the task of trying to exclude you from your workers' compensation benefits by denying your claim on several grounds.

Under Maryland law, there is a presumption that if you were injured at work then the employer's workers' compensation coverage should pay for the treatment of your injuries. However, the insurance company can deny your claims if you assumed a hazard that is not normally associated with your job. You can also be denied if you suffered an injury at work because you engaged in some form of willful misconduct or horseplay.

An example of horseplay might be a pair of warehouse workers injured while racing their fork lifts through aisles of merchandise. Another example might be construction workers injured while tossing their hammers at a metal spike during a game of horseshoes.

Willful misconduct is a little bit more difficult to define. Generally, the employer must have established rules and regulations regarding the activity that caused the injury and the employee must have disregarded those policies. Perhaps a good example of this is a requirement to wear hardhats at an industrial site. An employer might argue that a worker who consistently refused to wear a hardhat should not be compensated after suffering a head injury.

There's also an intoxication defense that some insurance companies may attempt to use. Employees' claims may be completely barred if it is discovered that they were intoxicated at the time of the accident, with the theory being that the only reason that the worker suffered an injury was because of his or her level of intoxication. This might also be used to show an employee's willful misconduct if the company had a standing no drug policy and the employee was high on drugs at the time of the accident.

The important thing to remember is that Maryland allows injured workers to retain lawyers to represent them in any denial of their workers' comp claims. Your workers' compensation attorney can evaluate the facts of your case, prepare a legal response and present your appeal to the workers' compensation appeals board on your behalf.

Source: Maryland Law.org, "§ gle-9-506 A covered employee or a dependent of a covered employee is not entitled to compensation or benefits" accessed Feb. 19, 2015

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