reglab/statecodes huggingface dataset:
Code of Maryland Regulations › Title 14 - INDEPENDENT AGENCIES › Subtitle 09 - WORKERS' COMPENSATION COMMISSION › Chapter 14.09.06 - Payment of Awards and Assessments and Termination of Benefits › Section 14.09.06.01 - Payment Prior to Filing of Claim

Current through Register Vol. 51, No. 14, July 12, 2024
A. If a covered employee or dependent has not
				filed a claim with the Commission for the death or disability of the covered
				employee, an employer or insurer may not pay, in whole or in part, any
				compensation under Labor and Employment Article, Title 9, Annotated Code of
				Maryland.
B. If a covered employee
				or dependent has not filed a claim with the Commission for the death or
				disability of the covered employee, an employer or insurer may pay or contest
				charges for medical and other services under Labor and Employment Article,
				Title 9, Subtitle 6, Part IX or Part XIII, Annotated Code of
				Maryland.
C. An employer or insurer
				shall pay uncontested medical charges promptly after receipt.
Code of Maryland Regulations › Title 14 - INDEPENDENT AGENCIES › Subtitle 09 - WORKERS' COMPENSATION COMMISSION › Chapter 14.09.06 - Payment of Awards and Assessments and Termination of Benefits › Section 14.09.06.02 - Claims for Medical Expenses; Notice; Penalty

Current through Register Vol. 51, No. 14, July 12, 2024
A. Notice. Within 5 days after receipt of an
				order of the Commission on a claim for payment for medical services, the
				claimant shall serve a copy of the order on the provider of the medical
				services for which payment was granted or denied.
B. Penalty for Late Payment for Treatment or
				Services.
(1) The Commission may assess
				against an employer or insurer a fine not to exceed 20 percent of any fee
				approved but not timely paid pursuant to Labor and Employment Article, 9-664,
				Annotated Code of Maryland.
(2) The
				Commission shall determine the amount of the fine on a case-by-case
				basis.
Code of Maryland Regulations › Title 14 - INDEPENDENT AGENCIES › Subtitle 09 - WORKERS' COMPENSATION COMMISSION › Chapter 14.09.06 - Payment of Awards and Assessments and Termination of Benefits › Section 14.09.06.03 - Payment of Assessments

Current through Register Vol. 51, No. 14, July 12, 2024
A. Time
				for Payment. Assessments payable for the SIF and the UEF shall be paid within
				30 days after the date of the award of compensation or approval of a
				settlement.
B. Assessments shall be
				paid in accordance with Labor and Employment Article, §§
									9-806,
				9-1007, and
				9-1008,
				Annotated Code of Maryland, as ordered by the Commission.
Code of Maryland Regulations › Title 14 - INDEPENDENT AGENCIES › Subtitle 09 - WORKERS' COMPENSATION COMMISSION › Chapter 14.09.06 - Payment of Awards and Assessments and Termination of Benefits › Section 14.09.06.04 - Termination of Temporary Total Disability and Medical Benefits

Current through Register Vol. 51, No. 14, July 12, 2024
A. Termination of
				Monetary Benefits Requiring Notice.
(1) Prior
				to terminating payment of temporary total disability benefits, an insurer shall
				give written notice to the claimant by:
(a)
				Completing the insurer's termination of temporary total disability benefits
				form; and
(b) Sending a copy of the
				form to the claimant, counsel and to the Commission.
Code of Maryland Regulations › Title 14 - INDEPENDENT AGENCIES › Subtitle 09 - WORKERS' COMPENSATION COMMISSION › Chapter 14.09.07 - Vocational Rehabilitation › Section 14.09.07.02 - Application Procedures for Registration

Current through Register Vol. 51, No. 14, July 12, 2024
A. To apply for registration with the
				Commission, an applicant shall submit to the Commission:
(1) An application on the form prescribed by
				the Commission completed in accordance with the directions provided;
(2) Two letters attesting to the applicant's
				moral character;
(3) Appropriate
				documentation that the applicant satisfies the education and experience
				requirements of Labor and Employment Article, § 9-6 A-09, Annotated Code
				of Maryland; and
(4) Payment in the
				amount of the application fee established by the Commission.
Code of Maryland Regulations › Title 14 - INDEPENDENT AGENCIES › Subtitle 09 - WORKERS' COMPENSATION COMMISSION › Chapter 14.09.07 - Vocational Rehabilitation › Section 14.09.07.03 - Hearings on Denial of Application or Request for Waiver

Current through Register Vol. 51, No. 14, July 12, 2024
A. Denial of
				Application.
(1) If the Commission denies an
				application or request for waiver, the Commission shall issue an order advising
				the applicant of the Commission's action.
(2) The applicant may request a hearing by
				submitting the prescribed Commission form to the Director within 30 days after
				the date of the order.
Code of Maryland Regulations › Title 14 - INDEPENDENT AGENCIES › Subtitle 09 - WORKERS' COMPENSATION COMMISSION › Chapter 14.09.07 - Vocational Rehabilitation › Section 14.09.07.04 - General Rules for Vocational Rehabilitation Service Practitioners

Current through Register Vol. 51, No. 14, July 12, 2024
A. A practitioner
				shall consider the best interests of a disabled covered employee in providing
				vocational rehabilitation services. Unrepresented disabled covered employees
				shall be treated in the same manner as represented disabled covered
				employees.
B. A practitioner may
				not misrepresent the practitioner's duties or responsibilities or the workers'
				compensation process to disabled covered employees.
C. The vocational rehabilitation practitioner
				shall exercise independent and professional judgment when performing an
				assessment or developing a vocational rehabilitation plan.
D. At the initial comprehensive assessment, a
				practitioner shall advise the disabled covered employee that:
(1) The practitioner's fees are paid by the
				employer/insurer; and
(2) The
				practitioner is an independent professional and shall render an opinion based
				solely on the facts and evidence in the case.
Code of Maryland Regulations › Title 14 - INDEPENDENT AGENCIES › Subtitle 09 - WORKERS' COMPENSATION COMMISSION › Chapter 14.09.07 - Vocational Rehabilitation › Section 14.09.07.05 - Standards of Practice for Rehabilitation Counselors and Vocational Evaluators

Current through Register Vol. 51, No. 14, July 12, 2024
A. Scope.
				This regulation applies only to rehabilitation counselors and vocational
				evaluators.
B. Standards.
(1) Rehabilitation counselors and vocational
				evaluators shall use their professional skills to promote a disabled covered
				employee's active participation in plan development and the rehabilitation
				process within the disabled covered employee's physical and mental
				abilities.
(2) Rehabilitation
				counselors and vocational evaluators shall function within the limits of their
				defined roles, training, and professional competencies.
(3) Rehabilitation counselors and vocational
				evaluators may not engage in any activity which may compromise the health,
				safety, or welfare of the disabled covered employee, and shall avoid continuing
				a consulting or counseling relationship if it is reasonably expected that the
				relationship can be of no benefit to the client.
(4) Rehabilitation counselors and vocational
				evaluators shall demonstrate honesty and objectivity in:
(a) The administration, scoring,
				interpretation, and utilization of assessment instruments;
(b) The writing of reports; and
(c) Charges for professional
				services.
(5)
				Rehabilitation counselors and vocational evaluators may not engage in
				harassment or discrimination of disabled covered employees on the basis of age,
				race, creed, national origin, gender, disability, or religious
				affiliation.
(6) Rehabilitation
				counselors and vocational evaluators may not engage in any act or omission of a
				dishonest, deceitful, or fraudulent nature in the conduct of their professional
				activities.
(7) Rehabilitation
				counselors and vocational evaluators may not allow the pursuit of financial
				gain or other personal benefit to interfere with the exercise of sound
				professional judgment and skills.
(8) Rehabilitation counselors and vocational
				evaluators may not disparage the competency or ethics of other professionals or
				agencies in discussions with their clients.
(9) Rehabilitation counselors and vocational
				evaluators shall perform appropriate and objective vocational evaluations and
				vocational assessments promptly.
(10) Rehabilitation counselors and vocational
				evaluators shall work cooperatively in a multidisciplinary effort to provide
				services leading to suitable gainful employment for an injured
				worker.
Code of Maryland Regulations › Title 14 - INDEPENDENT AGENCIES › Subtitle 09 - WORKERS' COMPENSATION COMMISSION › Chapter 14.09.07 - Vocational Rehabilitation › Section 14.09.07.06 - Complaints Against Practitioners

Current through Register Vol. 51, No. 14, July 12, 2024
A. Complaints.
(1) A complaint concerning a practitioner
				shall be:
(a) In writing;
(b) On the form prescribed by the Commission;
				and
(c) Signed under oath by the
				complainant.
Code of Maryland Regulations › Title 14 - INDEPENDENT AGENCIES › Subtitle 09 - WORKERS' COMPENSATION COMMISSION › Chapter 14.09.07 - Vocational Rehabilitation › Section 14.09.07.07 - Procedures for Hearings on Complaints

Current through Register Vol. 51, No. 14, July 12, 2024
A. Notice of Hearing. The Commission shall
				send written notice of a hearing to all interested parties at least 30 days
				before the hearing. The notice shall state the:
(1) Date, time, and place of the hearing;
				and
(2) Issues or charges involved
				in the proceeding.
Code of Maryland Regulations › Title 14 - INDEPENDENT AGENCIES › Subtitle 09 - WORKERS' COMPENSATION COMMISSION › Chapter 14.09.07 - Vocational Rehabilitation › Section 14.09.07.08 - Application Procedures for Enrollment of Providers

Current through Register Vol. 51, No. 14, July 12, 2024
A. To enroll with the Commission, the
				provider shall submit:
(1) An application on
				the form prescribed by the Commission completed in accordance with the
				directions provided; and
(2) A
				complete listing of all registered practitioners employed by the
				provider.
Code of Maryland Regulations › Title 14 - INDEPENDENT AGENCIES › Subtitle 09 - WORKERS' COMPENSATION COMMISSION › Chapter 14.09.07 - Vocational Rehabilitation › Section 14.09.07.09 - Selection of Practitioner

Current through Register Vol. 51, No. 14, July 12, 2024
A. A
				rehabilitation practitioner shall register with the Commission in accordance
				with Regulation .02 of this chapter.
B. To be eligible for referral under §F
				of this regulation, a provider shall enroll with the Commission in accordance
				with Regulation .08 of this chapter.
C. The Commission website shall provide
				information regarding enrolled providers including the name, address, website
				address, and telephone number of the provider.
D. A disabled covered employee may obtain
				vocational rehabilitation services only in accordance with this
				regulation.
E. Referral by
				Agreement or Order.
(1) The parties shall
				attempt to reach agreement on:
(a) Whether
				vocational rehabilitation services are appropriate in the case; and
(b) The registered practitioner to provide
				the vocational rehabilitation services.
Code of Maryland Regulations › Title 14 - INDEPENDENT AGENCIES › Subtitle 09 - WORKERS' COMPENSATION COMMISSION › Chapter 14.09.07 - Vocational Rehabilitation › Section 14.09.07.10 - Assessment and Reporting

Current through Register Vol. 51, No. 14, July 12, 2024
A.
				Comprehensive Vocational Assessment.
(1) As
				soon as practicable, a practitioner shall meet with the disabled covered
				employee and conduct a comprehensive vocational assessment in compliance with
				Labor and Employment Article, §
										9-670(d),
				Annotated Code of Maryland.
(2) A
				nurse case manager providing telephonic medical case management may conduct an
				initial assessment by telephone.
(3) A comprehensive vocational assessment may
				include evaluation of the disabled covered employee's:
(a) Age;
(b) Education, including information about
				education level, courses or transcripts, licenses, and certifications or
				registrations obtained by the disabled covered employee in the past;
(c) Complete work history, addressing any
				gaps in employment;
(d)
				Transferable skills and experience, whether obtained from prior employment,
				prior courses and training, prior vocational rehabilitation services or plans,
				or non-work related activities such as hobbies and/or volunteer
				experience;
(e) Current physical
				and mental conditions caused by the injury or occupational disease, and the
				effect of those conditions on the disabled covered employee's ability to
				work;
(f) Pre-existing physical and
				mental conditions and the effect of those conditions on the disabled covered
				employee's ability to work;
(g)
				Post-injury physical and mental conditions and the effect of those nonrelated
				conditions on the disabled covered employee's ability to work;
(h) Wage and employment at the time of
				injury;
(i) Barriers to employment,
				including whether the barriers can be removed and what is needed to address the
				barriers;
(j) Current financial
				status; and
(k) Family
				supports/psychosocial aspects.
Code of Maryland Regulations › Title 14 - INDEPENDENT AGENCIES › Subtitle 09 - WORKERS' COMPENSATION COMMISSION › Chapter 14.09.07 - Vocational Rehabilitation › Section 14.09.07.11 - Vocational Rehabilitation Services and Plans

Current through Register Vol. 51, No. 14, July 12, 2024
A. Hierarchy of Vocational Rehabilitation
				Services.
(1) In determining the appropriate
				vocational rehabilitation services reasonably necessary to return a disabled
				covered employee to suitable gainful employment, a practitioner shall consider
				each of the factors specified in Labor and Employment Article, §
										9-673(b),
				Annotated Code of Maryland.
(2) A
				practitioner shall document that each factor has been considered either in the
				vocational rehabilitation plan or in the initial assessment report.
(3) In providing vocational rehabilitation
				services, a practitioner shall attempt to return a disabled covered employee to
				suitable gainful employment in accordance with the following order of
				preference:
(a) Returning the disabled
				covered employee to the same job with the same employer;
(b) Modifying the same job with the same
				employer;
(c) Finding a new job
				with the same employer;
(d) Finding
				a job with a new employer;
(e) On
				the job training;
(f) Formally
				retraining the disabled covered employee for a period of time designed to lead
				to suitable gainful employment; and
(g) Self-employment.
Code of Maryland Regulations › Title 14 - INDEPENDENT AGENCIES › Subtitle 09 - WORKERS' COMPENSATION COMMISSION › Chapter 14.09.07 - Vocational Rehabilitation › Section 14.09.07.12 - Disputes, Noncompliance and Termination

Current through Register Vol. 51, No. 14, July 12, 2024
A. Disputes.
(1) If a dispute or issue arises regarding
				vocational rehabilitation services, the parties shall file electronically a
				vocational rehabilitation dispute form, as prescribed by the
				Commission.
(2) Upon receipt of the
				vocational rehabilitation dispute form, the Duty Commissioner shall contact the
				parties by telephone.
(3) If the
				Duty Commissioner is unable to resolve the dispute, a hearing will be scheduled
				within 5 business days.
(4) The
				Commission may award reasonable attorney fees in disputes arising out of
				vocational rehabilitation issues when deemed necessary given the particular
				facts of a claim.
Code of Maryland Regulations › Title 14 - INDEPENDENT AGENCIES › Subtitle 09 - WORKERS' COMPENSATION COMMISSION › Chapter 14.09.08 - Guide of Medical and Surgical Fees › Section 14.09.08.01 - Definitions

Current through Register Vol. 51, No. 14, July 12, 2024
A. In this chapter,
				the following terms have the meanings indicated.
B. Terms Defined.
(1) Ambulatory surgical center (ASC) means
				any center, service, office facility, or other entity that:
(a) Operates primarily for the purpose of
				providing surgical services to patients requiring a period of postoperative
				observation but not requiring overnight hospitalization; and
(b) Seeks reimbursement from payors as an
				ambulatory surgery center.
Code of Maryland Regulations › Title 14 - INDEPENDENT AGENCIES › Subtitle 09 - WORKERS' COMPENSATION COMMISSION › Chapter 14.09.08 - Guide of Medical and Surgical Fees › Section 14.09.08.02 - Incorporation by Reference

Current through Register Vol. 51, No. 14, July 12, 2024
A. The
				"Official Maryland Workers' Compensation Medical Fee Guide" (1995) is
				incorporated by reference.
B.
				Health Services Cost Review Commission. In accordance with Health-General
				Article, § 19-211, Annotated Code of Maryland, in the case of a
				discrepancy between a rate for a hospital service set by the Health Services
				Cost Review Commission and that set by the Workers' Compensation Commission,
				the rate set by the Health Services Cost Review Commission shall
				prevail.
Code of Maryland Regulations › Title 14 - INDEPENDENT AGENCIES › Subtitle 09 - WORKERS' COMPENSATION COMMISSION › Chapter 14.09.08 - Guide of Medical and Surgical Fees › Section 14.09.08.03 - Calculation of the Maximum Reimbursement Allowable

Current through Register Vol. 51, No. 14, July 12, 2024
A. For medical services and treatment
				provided before August 31, 2001, the MRA shall be the fees set forth in the
				Official Maryland Workers' Compensation Medical Fee Guide (1995). For
				anesthesiology services, the MRA is calculated by adding the Time Units and
				Base Units/Basic Value and multiplying that sum by a conversion factor: MRA =
				(Time Units + Base Units) x Conversion Factor.
B. For medical services and treatment
				provided between August 31, 2001, and August 31, 2004, the MRA shall be
				calculated by increasing the fees set forth in the Official Maryland Workers'
				Compensation Medical Fee Guide (1995) by 4 percent.
C. For medical services and treatment
				provided between September 1, 2004, and January 31, 2006, the MRA shall be
				calculated by multiplying the MRR by a percentage multiplier as follows:
(1) The MRR is obtained from the Medicare
				Physician Fee Schedule by utilizing 2004 for the year, Maryland for the state,
				Baltimore and Surrounding Counties for the locality, the applicable CPT code
				and any CPT modifier;
(2) The MRA
				is calculated by multiplying the MRR by 109 percent; and
(3) For anesthesiology services, the MRA is
				calculated by adding the Time Units and Base Units/Basic Value, multiplying
				that sum by the CMS 2004 conversion factor multiplied by 109 percent: MRA =
				(Time Units + Base Units) x CMS 2004 Conversion Factor x 109 percent.
Code of Maryland Regulations › Title 14 - INDEPENDENT AGENCIES › Subtitle 09 - WORKERS' COMPENSATION COMMISSION › Chapter 14.09.08 - Guide of Medical and Surgical Fees › Section 14.09.08.04 - MRA or Fee Not Established

Current through Register Vol. 51, No. 14, July 12, 2024
A. The
				Commission has not established a medical fee schedule for dental services,
				durable medical equipment, and pharmaceuticals.
B. For products and services for which the
				Commission has not established an MRA or medical fee schedule, including dental
				services, durable medical equipment, and pharmaceuticals, the insurance carrier
				shall assign a relative value to the product or service.
C. An insurance carrier may base the assigned
				value on nationally recognized and published relative value studies, or on the
				values assigned for services involving similar work and resources.
D. Upon application of either party, the
				amount of reimbursement is subject to review by the Commission under the
				procedures set forth in Regulation .06 of this chapter.
E. Reimbursement.
(1) Except as provided in §E(2) of this
				regulation, reimbursement shall be the lesser of:
(a) The MRA amount as established by this
				regulation; or
(b) The authorized
				provider's usual and customary charge.
Code of Maryland Regulations › Title 14 - INDEPENDENT AGENCIES › Subtitle 09 - WORKERS' COMPENSATION COMMISSION › Chapter 14.09.08 - Guide of Medical and Surgical Fees › Section 14.09.08.05 - Guidelines for Using Values and Codes

Current through Register Vol. 51, No. 14, July 12, 2024
A. The Maryland Workers' Compensation Act,
				implementing regulations, policies, and guidelines shall take precedence over
				any conflicting provision adopted or utilized by CMS in administering the CMS
				program.
B. For coding, billing,
				reporting, and reimbursement of medical treatment and services, authorized
				providers shall apply the CPT/HCPCS code and CPT modifier in effect on the date
				the treatment or service was provided.
C. The Commission shall post instructions for
				obtaining RVU and GPCI values on its website.
D. RVU and GPCI values shall be obtained
				utilizing the current year, the locality code for Baltimore and Surrounding
				Counties (0090101), the applicable CPT/HCPCS code and any CPT
				modifier.
E. The Commission shall
				post a link to the Medicare Physician Fee Schedule on its website.
F. The Commission shall post a link to the
				ASC payment rate instructions on its website.
G. Notwithstanding CMS payment policies,
				chiropractors may be reimbursed for services provided within the scope of their
				practice act.
H. For procedures
				performed or services rendered after September 1, 2004, a multiple procedure
				discount is not permitted for physical medicine and rehabilitation services
				(CPT codes 97010-97799).
I. After
				September 1, 2004, only one code per session will be reimbursed for CPT codes
				97012-97039.
Code of Maryland Regulations › Title 14 - INDEPENDENT AGENCIES › Subtitle 09 - WORKERS' COMPENSATION COMMISSION › Chapter 14.09.08 - Guide of Medical and Surgical Fees › Section 14.09.08.06 - Reimbursement Procedures

Current through Register Vol. 51, No. 14, July 12, 2024
A. To
				obtain reimbursement under this chapter, an authorized provider shall:
(1) Complete Form CMS-1500 in accordance with
				the written instructions posted on the Commission's website; and
(2) Within the time provided in §H of
				this regulation, submit to the employer or insurer the completed Form CMS-1500,
				which shall include:
(a) An itemized list of
				each service;
(b) The diagnosis
				relative to each service;
(c) The
				medical records related to the service being billed;
(d) The appropriate CPT/HCPCS code with CPT
				modifiers, if any, for each service;
(e) The date of each service;
(f) The specific fee charged for each
				service;
(g) The tax ID number of
				the provider;
(h) The professional
				license number of the provider; and
(i) The National Provider Identifier (NPI) of
				the provider.
Code of Maryland Regulations › Title 14 - INDEPENDENT AGENCIES › Subtitle 09 - WORKERS' COMPENSATION COMMISSION › Chapter 14.09.08 - Guide of Medical and Surgical Fees › Section 14.09.08.07 - Medical Records

Current through Register Vol. 51, No. 14, July 12, 2024
A. Medical
				records are the basis for determining whether a particular treatment or service
				is medically necessary and, therefore, reimbursable.
B. Each health care provider is responsible
				for creating and maintaining legible medical records documenting the employee's
				course of treatment.
C. Employee
				medical records shall include the:
(1) History
				of the patient;
(2) Results of a
				physical examination performed in conformity with the standard of practice of
				similar health care providers, with similar training, in the same or similar
				communities;
(3) Progress,
				clinical, or office notes that reflect:
(a)
				Subjective patient complaints;
(b)
				Objective findings of the provider;
(c) Assessment of the presenting
				problem;
(d) Any plan or plans of
				care or recommendations for treatment; and
(e) Updated assessments of patient's medical
				status and response to therapy;
(4) Copies of lab, x-ray, or other diagnostic
				tests, if any, that reflect the current progress of the patient and response to
				therapy; and
(5) Hospital inpatient
				and outpatient records, if any, including:
(a) Operation reports;
(b) Test results;
(c) Consultation reports;
(d) Discharge summaries; and
(e) Other dictated reports.
Code of Maryland Regulations › Title 14 - INDEPENDENT AGENCIES › Subtitle 09 - WORKERS' COMPENSATION COMMISSION › Chapter 14.09.08 - Guide of Medical and Surgical Fees › Section 14.09.08.08 - Deposition Witness Fee

Current through Register Vol. 51, No. 14, July 12, 2024
A. After
				March 24, 2008, the Commission no longer regulates the reimbursement of
				deposition fees through a medical fee schedule.
B. For witness depositions for which a bill
				has been submitted by the authorized provider before March 24, 2008, the
				authorized provider shall be allowed a witness fee if the provider submits a
				bill for the fee using the CPT code for the service.
C. Reimbursement for a deposition is limited
				to the amount published in the "Official Maryland Workers' Compensation Medical
				Fee Guide (1995)" for the appropriate CPT code.
Code of Maryland Regulations › Title 14 - INDEPENDENT AGENCIES › Subtitle 09 - WORKERS' COMPENSATION COMMISSION › Chapter 14.09.09 - Guide for Evaluation of Permanent Disability › Section 14.09.09.01 - Incorporation by Reference

Current through Register Vol. 51, No. 14, July 12, 2024
Guides to the Evaluation of Permanent Impairment (American
				  Medical Association, Fourth Edition, 1993) is incorporated by
				  reference.
Code of Maryland Regulations › Title 14 - INDEPENDENT AGENCIES › Subtitle 09 - WORKERS' COMPENSATION COMMISSION › Chapter 14.09.09 - Guide for Evaluation of Permanent Disability › Section 14.09.09.02 - Filing Issues

Current through Register Vol. 51, No. 14, July 12, 2024
A. A claimant
				alleging permanent disability shall file with the Commission an issues form
				that:
(1) Explicitly claims permanent partial
				or permanent total disability;
(2)
				Identifies the body parts at issue; and
(3) Identifies any alleged psychiatric
				disability.
Code of Maryland Regulations › Title 14 - INDEPENDENT AGENCIES › Subtitle 09 - WORKERS' COMPENSATION COMMISSION › Chapter 14.09.09 - Guide for Evaluation of Permanent Disability › Section 14.09.09.03 - Evaluation of Permanent Impairment

Current through Register Vol. 51, No. 14, July 12, 2024
A. Written Evaluation Required. As evidence
				of permanent impairment, a party shall submit:
(1) A written evaluation of permanent
				impairment prepared by a physician; or
(2) In claims where the issue concerns
				psychiatric impairment, a written evaluation of permanent psychiatric
				impairment prepared by a licensed psychologist or psychiatrist.
Code of Maryland Regulations › Title 14 - INDEPENDENT AGENCIES › Subtitle 09 - WORKERS' COMPENSATION COMMISSION › Chapter 14.09.09 - Guide for Evaluation of Permanent Disability › Section 14.09.09.04 - Stipulation for Permanent Disability

Current through Register Vol. 51, No. 14, July 12, 2024
A. A written stipulation to an award for
				permanent disability shall be filed using the stipulation of parties and award
				of compensation form and contain the following information:
(1) The claimant's average weekly
				wage;
(2) The inclusive dates of
				any temporary total disability;
(3)
				The inclusive dates and rate of any temporary partial disability;
(4) A copy of any medical evaluation relied
				upon;
(5) The percentage of
				claimant's loss of use or industrial loss of use and the benefits weeks
				payable;
(6) Any medical expenses
				claimed;
(7) Any attorney's fees
				sought by claimant's attorney; and
(8) The signatures of all parties if a
				written stipulation is submitted.
Code of Maryland Regulations › Title 14 - INDEPENDENT AGENCIES › Subtitle 09 - WORKERS' COMPENSATION COMMISSION › Chapter 14.09.10 - Settlements and Lump Sum Payments › Section 14.09.10.01 - Lump Sum Payment

Current through Register Vol. 51, No. 14, July 12, 2024
A. A
				claimant seeking a lump sum payment shall file an application with the
				Commission that:
(1) States specifically the
				facts and circumstances that the claimant contends justify the lump sum
				payment; and
(2) Is accompanied by
				any documents upon which the claimant relies in support of the
				application.
Code of Maryland Regulations › Title 14 - INDEPENDENT AGENCIES › Subtitle 09 - WORKERS' COMPENSATION COMMISSION › Chapter 14.09.10 - Settlements and Lump Sum Payments › Section 14.09.10.02 - Agreements for Final Compromise and Settlement

Current through Register Vol. 51, No. 14, July 12, 2024
A. General Requirements. An agreement for
				final compromise and settlement of a claim that is submitted to the Commission
				for approval as required by Labor and Employment Article, §
									9-722, Annotated
				Code of Maryland, shall be submitted electronically and contain the following:
(1) The total amount of settlement
				proposed;
(2) An application or
				petition for approval of attorney's fees, medical evaluation fees, and costs as
				provided in COMAR
				14.09.04.02;
(3) The inclusive dates of any temporary
				total disability;
(4) The date on
				which the payments under the agreement are to begin;
(5) If any compensation was previously
				awarded or paid, a statement indicating whether the settlement includes, is in
				addition to, or is in place of all or part of that compensation;
(6) A statement indicating the rate of
				payment and whether all or part of the settlement is to be paid in a lump
				sum;
(7) The claimant's average
				weekly wage;
(8) The claimant's
				date of birth and age in years and months;
(9) The total amount of all indemnity
				benefits paid to claimant;
(10) The
				gross total of all future payments to be paid pursuant to an annuity (not
				present value);
(11) If the insurer
				makes an assignment of any of its obligations to a third party, the settlement
				agreement shall contain affirmative language confirming that the
				employer/insurer shall resume its obligation for all remaining payments in the
				event of default by the third party;
(12) The date of disablement by accidental
				injury or occupational disease; and
(13) A completed copy of the settlement
				worksheet form, available on the Commission website, attached to the
				settlement.
Code of Maryland Regulations › Title 14 - INDEPENDENT AGENCIES › Subtitle 09 - WORKERS' COMPENSATION COMMISSION › Chapter 14.09.10 - Settlements and Lump Sum Payments › Section 14.09.10.03 - Assessments on Third Party and Structured Settlements

Current through Register Vol. 51, No. 14, July 12, 2024
A. Third-Party Settlements. In a final
				compromise and settlement involving third-party liability under Labor and
				Employment Article, Title 9, Subtitle 9, Annotated Code of Maryland, the
				assessments for SIF and UEF shall be computed on the amount of compensation
				paid or to be paid by the employer or insurer for which the employer or insurer
				may not be reimbursed from the third-party settlement.
B. Structured Settlements.
(1) In case of a structured settlement of a
				claim, the assessments for SIF and UEF shall be computed on the premium payable
				by the employer or insurer for any annuity policy purchased on behalf of the
				employee.
(2) If the parties fail
				to disclose to the Commission the amount of premium payable by the employer or
				insurer, then the assessments shall be computed on the total amount of money
				guaranteed to be paid under the settlement agreement.
Code of Maryland Regulations › Title 14 - INDEPENDENT AGENCIES › Subtitle 09 - WORKERS' COMPENSATION COMMISSION › Chapter 14.09.11 - Judicial Review Procedures › Section 14.09.11.01 - Petition for Judicial Review

Current through Register Vol. 51, No. 14, July 12, 2024
A. A
				party seeking judicial review of a decision of the Commission shall file a
				petition for judicial review in the circuit court within 30 days after the date
				the Commission's order was mailed in accordance with Labor and Employment
				Article, §
									9-737, Annotated
				Code of Maryland, and the Maryland Rules, 7-201, et seq.
B. A party filing a petition for judicial
				review shall serve a copy of the petition on the Commission in accordance with
				Labor and Employment Article, §
									9-737, Annotated
				Code of Maryland, and Maryland Rule 7-202(d).
C. A party seeking judicial review of a
				decision granting or denying attorney's fees shall serve a copy of the petition
				for judicial review on the Assistant Attorney General assigned to represent the
				Commission at the Commission's principal office in Baltimore City. The judicial
				review shall be on the record of the Commission in accordance with Maryland
				Rule 7-206.1(b).
Code of Maryland Regulations › Title 14 - INDEPENDENT AGENCIES › Subtitle 09 - WORKERS' COMPENSATION COMMISSION › Chapter 14.09.11 - Judicial Review Procedures › Section 14.09.11.02 - Transcript of Proceedings

Current through Register Vol. 51, No. 14, July 12, 2024
A.
				Unless the parties agree that a transcript is not necessary for review, or the
				court so orders, the first petitioner shall request and pay for a copy of the
				transcript of the proceedings before the Commission in accordance with Maryland
				Rule 7-206.
B. The first petitioner
				shall file a written request that the transcript be prepared containing:
(1) The Commission case number;
(2) The date and place of the Commission
				hearing;
(3) The circuit court case
				number if known;
(4) The name of
				the first petitioner; and
(5) An
				acknowledgement that the first petitioner shall pay the cost of
				transcription.
Code of Maryland Regulations › Title 14 - INDEPENDENT AGENCIES › Subtitle 09 - WORKERS' COMPENSATION COMMISSION › Chapter 14.09.11 - Judicial Review Procedures › Section 14.09.11.03 - Circuit Court Proceedings

Current through Register Vol. 51, No. 14, July 12, 2024
A.
				Following the disposition of a petition for judicial review by trial or motion,
				the prevailing party shall notify the Commission of the circuit court
				disposition within 30 days after disposition.
B. A Cover Sheet for Action on Claims on
				Appeal shall be used to notify the Commission of the circuit court disposition
				and shall be accompanied by a copy of the verdict or signed order and
				memorandum, if any.
C. If a hearing
				is required, the prevailing party shall file an issues form with the cover
				sheet.
D. If a party appeals the
				circuit court disposition, the party shall notify the Commission using a Cover
				Sheet for Action on Claims on Appeal accompanied by a copy of the notice of
				appeal.
Code of Maryland Regulations › Title 14 - INDEPENDENT AGENCIES › Subtitle 09 - WORKERS' COMPENSATION COMMISSION › Chapter 14.09.11 - Judicial Review Procedures › Section 14.09.11.04 - Appellate Proceedings

Current through Register Vol. 51, No. 14, July 12, 2024
A.
				Following the disposition of a case on appeal to the appellate courts, the
				prevailing party shall notify the Commission of the appellate court
				disposition.
B. A Cover Sheet for
				Action on Claims on Appeal shall be used to notify the Commission of the
				appellate court disposition and shall be accompanied by:
(1) The appellate court opinion and order;
				and
(2) The appellate court
				mandate.
Code of Maryland Regulations › Title 14 - INDEPENDENT AGENCIES › Subtitle 09 - WORKERS' COMPENSATION COMMISSION › Chapter 14.09.11 - Judicial Review Procedures › Section 14.09.11.05 - Supplemental Order Subject to Review on the Pending Appeal

Current through Register Vol. 51, No. 14, July 12, 2024
A. If the Commission exercises its continuing
				jurisdiction under Labor and Employment Article, §
									9-742, Annotated
				Code of Maryland, to pass a supplemental order deciding an issue, the first
				petitioner/appellant shall file within 5 days of entry of the supplemental
				order:
(1) A copy of the supplemental order
				with the circuit or appellate court in which judicial review/appeal is pending;
				and
(2) A written certification
				with the Commission that the first petitioner/appellant has filed the copy of
				the supplemental order with the circuit or appellate court.
Code of Maryland Regulations › Title 14 - INDEPENDENT AGENCIES › Subtitle 09 - WORKERS' COMPENSATION COMMISSION › Chapter 14.09.12 - Responsibilities of Insurers › Section 14.09.12.01 - Definitions

Current through Register Vol. 51, No. 14, July 12, 2024
A. In this chapter,
				the following term has the meaning indicated.
B. Terms Defined.
(1) "Competent Individual" means an
				individual who has sufficient skill, knowledge, and experience to handle and
				adjust disputed claims and who has authority to resolve claims without having
				to routinely contact an out-of-State representative of the insurer.
(2) "Commission designee" means the National
				Council on Compensation Insurance or any other entity that the Commission, from
				time to time, may designate as its representative to receive notices required
				by this regulation.
(3) "Insurance
				policy" means a policy or binder for workers' compensation insurance under
				Labor and Employment Article, Title 9, Annotated Code of Maryland.
Code of Maryland Regulations › Title 14 - INDEPENDENT AGENCIES › Subtitle 09 - WORKERS' COMPENSATION COMMISSION › Chapter 14.09.12 - Responsibilities of Insurers › Section 14.09.12.02 - Notices of Insurance, Cancellation, Reinstatement, and Election of Coverage

Current through Register Vol. 51, No. 14, July 12, 2024
A. Notice
				of Insurance. When an insurance policy is issued or renewed, the insurer
				issuing or renewing it shall file a notice of insurance with the Commission
				designee within 45 days after the effective date of the policy.
B. Notice of Cancellation.
(1) Required Filing. When an insurance policy
				is cancelled by the insurer or by the insured, the insurer shall file a notice
				of cancellation with the Commission designee.
(2) Time for Filing.
(a) Cancellation by Insurer.
(i) If the insurer cancels the insurance
				policy for nonpayment of premium, the notice of cancellation shall be filed at
				least 10 days before the effective date of the cancellation, in compliance with
				Insurance Article, §
												19-406(f),
				Annotated Code of Maryland.
(ii) If
				the insurer cancels the insurance policy for any other reason, the notice of
				cancellation shall be filed at least 45 days before the effective date of the
				cancellation, in compliance with Insurance Article, §
												19-406(a),
				Annotated Code of Maryland.
(b) Cancellation by Insured. When the
				cancellation is initiated by the insured, the notice of cancellation shall be
				filed by the insurer within 15 days after the effective date of the
				cancellation.
Code of Maryland Regulations › Title 14 - INDEPENDENT AGENCIES › Subtitle 09 - WORKERS' COMPENSATION COMMISSION › Chapter 14.09.12 - Responsibilities of Insurers › Section 14.09.12.03 - Handling and Adjusting Disputed Claims

Current through Register Vol. 51, No. 14, July 12, 2024
A. An insurer that provides workers'
				compensation insurance in Maryland shall have in the State competent
				individuals who:
(1) Handle and adjust each
				disputed workers' compensation claim for the insurer;
(2) Have authority to resolve claims without
				having to routinely contact an out-of-State representative of the insurer;
				and
(3) Possess the knowledge and
				experience to handle and adjust each disputed claim.
Code of Maryland Regulations › Title 14 - INDEPENDENT AGENCIES › Subtitle 09 - WORKERS' COMPENSATION COMMISSION › Chapter 14.09.12 - Responsibilities of Insurers › Section 14.09.12.04 - Failure to Comply

Current through Register Vol. 51, No. 14, July 12, 2024
A. Fine.
(1) An insurer found in violation of
				Regulation .03 of this chapter may be fined up to $1,000 per offense.
(2) Each day a violation is continued after
				the first fine is a separate offense.
Code of Maryland Regulations › Title 14 - INDEPENDENT AGENCIES › Subtitle 09 - WORKERS' COMPENSATION COMMISSION › Chapter 14.09.12 - Responsibilities of Insurers › Section 14.09.12.05 - Hearing Procedure

Current through Register Vol. 51, No. 14, July 12, 2024
A. Notice
				of Agency Action.
(1) If the Commission has
				reasonable cause to believe that an insurer has violated Regulation .03 of this
				chapter, the Commission shall give reasonable notice of the alleged violation
				and the action the Commission proposes to take.
(2) The notice shall state:
(a) The facts that are asserted;
(b) If the facts cannot be stated in detail
				when the notice is given, the issues that are involved;
(c) The potential penalty that could be
				imposed;
(d) That the recipient has
				a right to request a hearing;
(e)
				That any request for a hearing shall be in writing and received by the
				Commission within 20 days of the date of the notice; and
(f) That if a hearing is not requested within
				the time allowed, the Commission shall render its decision on the basis of its
				own investigation.
Code of Maryland Regulations › Title 14 - INDEPENDENT AGENCIES › Subtitle 09 - WORKERS' COMPENSATION COMMISSION › Chapter 14.09.12 - Responsibilities of Insurers › Section 14.09.12.06 - Penalty for Failure to Submit Required Case Payment Report

Current through Register Vol. 51, No. 14, July 12, 2024
A. The Commission
				may assess against an insurer a fine not to exceed $1,000 for any unexcused
				failure to file a case payment report as required under Labor and Employment
				Article, §
									9-313(b),
				Annotated Code of Maryland.
B.
				Schedule of Assessments. The schedule of assessments established by the
				Commission is as follows:
Date
Amount Not To Exceed
Type Action
41st day
$100
Initial Notice
51st day
250
2nd Notice
61st day
500
3rd Notice
91st day
1,000
Final Notice
120th day
1,000
Referral to Central Collection Unit and Insurance
						  Commissioner
C.
				In calculating the imposition of an assessment on an insurer, each failure to
				submit a required report or the submission of an inaccurate or incomplete
				report is considered a separate violation subject to assessment.
Code of Maryland Regulations › Title 14 - INDEPENDENT AGENCIES › Subtitle 09 - WORKERS' COMPENSATION COMMISSION › Chapter 14.09.12 - Responsibilities of Insurers › Section 14.09.12.07 - Appeal

Current through Register Vol. 51, No. 14, July 12, 2024
An appeal from a decision made under this chapter shall be
				  made in accordance with Maryland Rule 7-206.1(b).
Code of Maryland Regulations › Title 14 - INDEPENDENT AGENCIES › Subtitle 09 - WORKERS' COMPENSATION COMMISSION › Chapter 14.09.12 - Responsibilities of Insurers › Section 14.09.12.08 - Report of Payroll

Current through Register Vol. 51, No. 14, July 12, 2024
A. In
				accordance with Labor and Employment Article, §
									9-316(g),
				Annotated Code of Maryland, each insurer shall file an annual report of insured
				payroll to the Commission electronically and as directed by the
				Commission.
B. Any unexcused
				failure to file an accurate annual report of insured payroll to the Commission
				as required under Labor and Employment Article, §
									9-316(g),
				Annotated Code of Maryland, may result in an inaccurate assessment, delays in
				any refund due as a result of inaccurate reporting, or both.
Code of Maryland Regulations › Title 14 - INDEPENDENT AGENCIES › Subtitle 09 - WORKERS' COMPENSATION COMMISSION › Chapter 14.09.13 - Individual Employer Self-Insurer › Section 14.09.13.01 - Definitions

Current through Register Vol. 51, No. 14, July 12, 2024
A. In this chapter,
				the following terms have the meanings indicated.
B. Terms Defined.
(1) "Acceptable financial indicators" means
				indicators consistent with comparable industry financial health and performance
				criteria as reported in rating services such as RMA Annual Financial Statement
				Studies or equivalent recognized indices.
(2) "Act" means the Maryland Workers'
				Compensation Act, Labor and Employment Article, Title 9, Annotated Code of
				Maryland.
(3) "Actuarial report"
				means a report written by an actuary who is a member of the Casualty Actuarial
				Society or the American Academy of Actuaries.
(4) "Affiliate" means a member of a group of
				companies with common ownership but not the company having a direct ownership
				interest.
(5) "Commission" means
				the Maryland State Workers' Compensation Commission.
(6) "Investment grade securities" means
				federal or state bonds accepted by the circuit courts for investment of trust
				money.
(7) "Irrevocable trust,
				custodian, safekeeping, or book entry account" means a depository account of
				monies and investment grade securities held by a Federal Deposit Insurance
				Corporation bank that agrees to hold amounts ordered by the Commission for a
				self-insurer that can only be withdrawn by the Commission, or if a trust exists
				pursuant to the terms of the trust document.
(8) Self-Insurer.
(a) "Self-insurer" means an employer which
				has been granted the privilege to self-insure its liability and to maintain
				direct responsibility for the payment of this liability under the Act including
				any approved subsidiary of the self-insurer.
(b) "Self-insurer" does not include a parent
				company or affiliate that has guaranteed the payment of the self-insurer's
				liability.
(9) "State"
				means the State of Maryland.
(10)
				"Third-party administrator" means a company that handles and adjusts workers'
				compensation claims under contract to a self-insurer.
Code of Maryland Regulations › Title 14 - INDEPENDENT AGENCIES › Subtitle 09 - WORKERS' COMPENSATION COMMISSION › Chapter 14.09.13 - Individual Employer Self-Insurer › Section 14.09.13.02 - Application

Current through Register Vol. 51, No. 14, July 12, 2024
A. Requirements.
(1) An initial application for individual
				self-insurance shall be submitted to the Commission on forms prescribed by the
				Commission and shall include all required information and documentation
				required by the Commission. A corporation shall submit a resolution of its
				board of directors authorizing and directing the corporation to apply to become
				self-insured.
(2) A nonrefundable
				fee in the amount established by the Commission shall accompany the
				application.
(3) The required
				information on the application shall be fully completed and particularly set
				forth under oath by the employer or an individual acting on the employer's
				behalf. The affidavit shall be made upon personal knowledge of the matters set
				forth in the application. The Commission may require the applicant to
				supplement or explain any of the matters set forth or to provide additional
				information that the Commission considers necessary.
(4) If a third-party administrator is used or
				intended to be used, the applicant shall provide a copy of the contract between
				the parties demonstrating that the third-party administrator agrees to do the
				following:
(a) Have in the State competent
				individuals who possess the knowledge and experience to handle and adjust each
				disputed claim in an efficient manner; and
(b) Handle and adjust each disputed workers'
				compensation claim on behalf of the self-insurer in accordance with Maryland
				law.
(5) Upon receipt of
				a complete application and all required information and documentation, the
				Commission shall act upon the application for self-insurance within 60
				days.