CODE of MARYLAND REGULATIONS .us

CODE of MARYLAND REGULATIONS

Title 14 INDEPENDENT AGENCIES Subtitle 09 WORKERS' COMPENSATION COMMISSION

Effective March 3, 2014 (41:4 Md. R. 304)

This is an UNOFFICIAL version of the regulations.

The Code of Maryland Regulations is available at dsd.state.md.us as a free service of the Office of the Secretary of State, Division of State Documents. The full text of regulations is available and searchable. Note, however, that the printed COMAR continues to be the only official and enforceable version of COMAR. The Maryland Register is also available at dsd.state.md.us. For additional information, visit sos.state.md.us, Division of State Documents, or call at (410) 974-2486 or 1 (800) 633-9657.

Table of Contents

Title 14 INDEPENDENT AGENCIES..................................................................................................................................1 Subtitle 09 WORKERS' COMPENSATION COMMISSION ............................................................................................1

Chapter 01 General Administrative ...............................................................................................................................1 .01 Definitions.......................................................................................................................................................1 .02 Commission Forms..........................................................................................................................................3 .03 Service of Papers.............................................................................................................................................3 .04 Filing Forms and Documents with the Commission........................................................................................3 .05 Hours of Business............................................................................................................................................4 .06 Waiver of Strict Compliance. ..........................................................................................................................4 .07 Powers and Duties of Commissioners.............................................................................................................4 .08 Referral for Fraud............................................................................................................................................4 .09 Web-Enabled File Management System. ........................................................................................................5 .10 Notices Concerning Claims -- Posting by Employer. ......................................................................................6 (To be deleted)......................................................................................................................................................6 (To be deleted)......................................................................................................................................................6

Chapter 02 Requirements for Filing and Amending Claims...........................................................................................7 .01 Definitions.......................................................................................................................................................7 (To be deleted)......................................................................................................................................................7 .02 Requirements for Filing and Amending Claims...............................................................................................7 .03 Amendment of Claim to Add an Additional Party, Including the Subsequent Injury Fund and Uninsured Employers' Fund. ..................................................................................................................................................9 .04 Death and Funeral Benefits. ...........................................................................................................................9 .05 Foreign Documents. ......................................................................................................................................12 .06 Claim for Unpaid Compensation of Deceased Claimant. ..............................................................................13 .07 Notice to Employer/Insurer of Claim. ...........................................................................................................13

Chapter 03 Hearing Procedures...................................................................................................................................15 .01 Definitions.....................................................................................................................................................15 .02 Filing and Withdrawing Issues. .....................................................................................................................15 .03 Hearing Notices.............................................................................................................................................16 .04 Interpreters and Other Accommodations.....................................................................................................16 .05 Subpoenas.....................................................................................................................................................17 .06 Average Weekly Wage. .................................................................................................................................19 .07 Disclosure of Medical Information................................................................................................................19 .08 Medical Examinations. ..................................................................................................................................20 .09 Hearing Exhibits and Witnesses. ...................................................................................................................21

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.10 Consequence of Nonappearance by Claimant..............................................................................................22 .11 Request for Emergency Hearing. ..................................................................................................................22 .12 Request for Continuance. .............................................................................................................................23 .13 Motion for Modification. ..............................................................................................................................23 .14 Motion for Rehearing....................................................................................................................................23 .15 Miscellaneous Forms. ...................................................................................................................................24 Chapter 04 Legal Representation and Fees .................................................................................................................25 .01 Legal Representation. ...................................................................................................................................25 .02 Attorney's Fee and Medical Evaluation Fee -- Application or Petition for Approval. ..................................26 .03 Schedule of Attorney's Fees..........................................................................................................................27 .04 Attorneys' Fees for Multiple Counsel. ..........................................................................................................29 Chapter 05 Uninsured Employers' Fund Claims ..........................................................................................................31 .01 Notification and Response of Uninsured Employer and Claimant................................................................31 .02 Review of Claim Contested by Uninsured Employer. ...................................................................................31 .03 Review of Uncontested Claims. ....................................................................................................................31 .04 Notification and Payment of the Award. ......................................................................................................32 .05 Request for Payment by the Fund. ...............................................................................................................32 .06 Response of UEF and Impleader of Other Employer or Insurer....................................................................32 .07 Notification and Response of Impleaded Employer or Insurer.....................................................................32 .08 Review of Disputed Claim. ............................................................................................................................32 Chapter 06 Payment of Awards and Assessments and Termination of Benefits ........................................................33 .01 Payment Prior to Filing of Claim. ..................................................................................................................33 .02 Claims for Medical Expenses; Notice; Penalty. .............................................................................................33 .03 Payment of Assessments. .............................................................................................................................33 .04 Termination of Temporary Total Disability and Medical Benefits. ...............................................................33 Chapter 07 Vocational Rehabilitation Practitioners ....................................................................................................35 .01 Definitions.....................................................................................................................................................35 .02 Application Procedures for Registration. ......................................................................................................36 .03 Hearings on Denial of Application or Request for Waiver. ...........................................................................37 .04 General Rules for Vocational Rehabilitation Service Practitioners. ..............................................................38 .05 Standards of Practice for Rehabilitation Counselors and Vocational Evaluators..........................................38 .06 Complaints Against Practitioners. .................................................................................................................39 .07 Procedures for Hearings on Complaints. ......................................................................................................40 .08 Application Procedures for Enrollment of Providers. ...................................................................................41 .09 Selection of Practitioner. ..............................................................................................................................41 .10 Assessment and Reporting............................................................................................................................42 .11 Vocational Rehabilitation Services and Plans. ..............................................................................................44

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.12 Disputes, Noncompliance and Termination..................................................................................................46 Chapter 08 Guide of Medical and Surgical Fees ..........................................................................................................47

.01 Definitions.....................................................................................................................................................47 .02 Incorporation by Reference. .........................................................................................................................48 .03 Calculation of the Maximum Reimbursement Allowable. ............................................................................48 .04 MRA or Fee Not Established. ........................................................................................................................50 .05 Guidelines for Using Values and Codes.........................................................................................................50 .06 Reimbursement Procedures. ........................................................................................................................51 .07 Medical Records............................................................................................................................................52 .08 Deposition Witness Fee. ...............................................................................................................................53 Chapter 09 Guide for Evaluation of Permanent Disability...........................................................................................54 .01 Incorporation by Reference. .........................................................................................................................54 .02 Filing Issues. ..................................................................................................................................................54 .03 Evaluation of Permanent Impairment. .........................................................................................................54 .04 Stipulation for Permanent Disability.............................................................................................................55 Chapter 10 Settlements and Lump Sum Payments .....................................................................................................56 .01 Lump Sum Payment. .....................................................................................................................................56 .02 Agreements for Final Compromise and Settlement. ....................................................................................56 .03 Assessments on Third Party and Structured Settlements.............................................................................58 Chapter 11 Judicial Review Procedures.......................................................................................................................59 .01 Petition for Judicial Review. ..........................................................................................................................59 .02 Transcript of Proceedings. ............................................................................................................................59 .03 Circuit Court Proceedings. ............................................................................................................................59 .04 Appellate Proceedings. .................................................................................................................................60 .05 Record of Subsequent Proceeding Where Case on Appeal. .........................................................................60 Chapter 12 Responsibilities of Insurers .......................................................................................................................61 .01 Definitions.....................................................................................................................................................61 .02 Notices of Insurance, Cancellation, Reinstatement, and Election of Coverage. ...........................................61 .03 Handling and Adjusting Disputed Claims. .....................................................................................................62 .04 Failure to Comply. .........................................................................................................................................63 .05 Hearing Procedure. .......................................................................................................................................63 .06 Penalty for Failure to Submit Required Case Payment Report. ....................................................................64 .07 Appeal. ..........................................................................................................................................................64 Chapter 13 Individual Employer Self-Insurer...............................................................................................................65 .01 Definitions.....................................................................................................................................................65 .02 Application. ...................................................................................................................................................65 .03 Revocation of Self-Insured Status. ................................................................................................................66

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.04 Voluntary Withdrawal From The Self-Insurance Program. ...........................................................................67 .05 Revoked and Terminated Self-Insurers.........................................................................................................67 .06 Security. ........................................................................................................................................................67 .07 Excess Insurance. ..........................................................................................................................................69 .08 Reporting Requirements. ..............................................................................................................................69 .09 Proceedings...................................................................................................................................................70 .10 Examinations.................................................................................................................................................70 .11 Access To Workers' Compensation Records of Self-Insurer. ........................................................................70 .12 Confidentiality of Information. .....................................................................................................................70 Chapter 14 Governmental Group Self-Insurance ........................................................................................................71 .01 Definitions.....................................................................................................................................................71 .01-1 Application.................................................................................................................................................72 .02 Approval and Review. ...................................................................................................................................73 .03 Members Admission and Termination..........................................................................................................73 .04 Reports to the Commission...........................................................................................................................74 .05 Trustee Responsibilities. ...............................................................................................................................74 .06 Funds, Advance Premium Discounts, Surplus Distribution, Deficits. ............................................................76 .07 Excess Insurance. ..........................................................................................................................................77 .08 Investments Authorized................................................................................................................................78 .09 Reporting Requirements and Corrective Action Plans..................................................................................79 .10 Request for Hearing Before the Commission................................................................................................80 .11 Appeals to Circuit Court. ...............................................................................................................................80 Chapter 15 Open Meetings..........................................................................................................................................81 .01 Scope.............................................................................................................................................................81 .02 Definitions.....................................................................................................................................................81 .03 Public Attendance. ........................................................................................................................................81 .04 Prohibited Conduct or Activity......................................................................................................................81 .05 Recording, Photographing, and Broadcasting of Open Meetings.................................................................81 .06 Recordings, Photographs, Videotapes -- Not Part of Record.......................................................................82 Chapter 16 Public Information Act Requests...............................................................................................................83 .01 Scope.............................................................................................................................................................83 .02 Policy.............................................................................................................................................................83 .03 Definitions.....................................................................................................................................................83 .04 Chairman as Official Custodian. ....................................................................................................................83 .05 Request for Public Records. ..........................................................................................................................84 .06 Necessity for Written Request. .....................................................................................................................84 .07 Contents of Written Request. .......................................................................................................................84

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.08 Addressee. ....................................................................................................................................................84 .09 Response to Request. ...................................................................................................................................84 .10 Notice to Person Potentially Affected by Disclosure. ...................................................................................85 .11 Public Record Temporarily Unavailable. .......................................................................................................85 .12 Public Record Destroyed or Lost. ..................................................................................................................85 .13 Review of Denial. ..........................................................................................................................................85 .14 Disclosure Against Public Interest.................................................................................................................85 .15 Fees. ..............................................................................................................................................................86 .16 Time and Place of Inspection. .......................................................................................................................87

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Title 14 INDEPENDENT AGENCIES Subtitle 09 WORKERS' COMPENSATION COMMISSION

Chapter 01 General Administrative Authority: Health-General Article, ?4-303; Labor and Employment Article, ??9-307, 9-309, 9-310.2, 9314, 9-404, 9-405, 9-410, 9-602, 9-603, 9-610.1, 9-625, 9-635, 9-689, 9-701, 9-709, 9-710, 9-711, 9-721, 9731, 9-736, 9-739, and 9-6A-07; Insurance Article, ??19-405 and 19-406; State Government Article, ?10-

1103; Annotated Code of Maryland

14.09.01.01 .01 Definitions. A. In this subtitle, the following terms have the meanings indicated. B. Terms Defined. (1) "Affidavit" means a written statement the contents of which are affirmed under the penalties of perjury to be true. (2) "Certified mail" means mail deposited with the United States Postal Service, postage prepaid and return receipt requested. (3) "Claimant" means a person filing a workers' compensation claim and includes: (a) A covered employee; (b) A dependent of a deceased covered employee; or (c) An individual authorized to act on behalf of a dependent of a deceased covered employee. (4) "Commission" means either the Workers' Compensation Commission or its designee. (5) "Disputed workers' compensation claim" means a: (a) Newly filed claim from the date it is filed until the employer or insurer commences paying the claim or until the consideration date has expired; (b) New claim in which issues have been filed; (c) Pending claim in which one or more issues have been filed; or (d) Claim that is pending on appeal. (6) "Final award" means the award of compensation determined by the Commission after exhaustion of all applicable appeals, regardless of whether the award is increased or decreased as a result of any appeal. (7) "Formal set-aside allocation" means a document reflecting a comprehensive analysis and projection of future injury-related medical needs and associated costs. (8) "Healthcare provider delegate" means administrative or support staff designated by a health care provider to have access to basic claim information for the purpose of obtaining settlement, claim and hearing status information. (9) "Individual" means a human being. (10) "Insurer" means: (a) A stock corporation or mutual association that is authorized under the Insurance Article, Annotated Code of Maryland, to provide workers' compensation insurance in the State; (b) The Chesapeake Employers' Insurance Company authorized under Insurance Article, Title 24, Subtitle 3, Annotated Code of Maryland; (c) A governmental self-insurance group that meets the requirements of Labor and Employment Article, ?9-404, Annotated Code of Maryland;

Chapter 01 General Administrative

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(d) A self-insurance group of private employers that meets the requirements of Insurance Article, ??25-301--25308, Annotated Code of Maryland; or

(e) An individual employer that self-insures in accordance with Labor and Employment Article, ?9-405, Annotated Code of Maryland.

(11) "Insurer delegate" means administrative or support staff, designated by an insurer, to have access to all claim documents in all claims in which the insurer is a party for the purpose of filing documents and managing claims.

(12) "Non-compromise case" means a case in which the employer/insurer has not contested liability or in which the Commission has found liability and in which the settlement compensates the claimant for anticipated future medical expenses.

(13) "Person" means:

(a) An individual;

(b) A general or limited partnership;

(c) A joint stock company;

(d) An unincorporated association or society;

(e) A municipal or other corporation;

(f) An incorporated association;

(g) A limited liability partnership;

(h) A limited liability company;

(i) The State, its agencies or political subdivisions; or

(j) A governmental entity.

(14) "Proxy" means administrative or support staff, designated by an attorney, to have access to all claim documents in all claims in which the attorney has entered the attorney's appearance for the purpose of filing documents and managing claims.

(15) "Role" means the functionality and type of account for which a user is authorized in the WFMS system and includes attorney, attorney proxy, employer, insurer, healthcare provider, insurer delegate and healthcare provider delegate.

(16) "State average weekly wage" means the State average weekly wage in effect on the date of the accident or date of disablement.

(17) "Subpoena" means a written order directed to a person and requiring attendance at a particular time and place to take the action specified.

(18) "Subsequent Injury Fund" or "SIF" means the statutorily created entity, funded by assessments on workers' compensation awards and settlements, that may be a party to a claim and which pays benefits attributable to a compensable injury to previously injured body parts.

(19) "Undisputed workers' compensation claim" means a claim in which all issues have been:

(a) Withdrawn;

(b) Resolved by a decision of the commission that is not appealed; or

(c) Resolved on appeal.

(20) "Uninsured Employers' Fund" or "UEF" means the statutorily created entity, funded by assessments on workers' compensation awards and settlements, that may be a party to a claim and which pays workers compensation awards made against an uninsured employer.

(21) "Web-Enabled File Management System" or "WFMS" means the Commission's subscriber-based web-enabled electronic file management system designed to facilitate the filing and adjudication of workers' compensation claims.

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