Md. Code Regs. 14.09.02.02 - Requirements for Filing and Amending Claims
A. Claim for Benefits.
(1) To initiate a claim for benefits, an
employee shall file a claim form with the Commission as follows:
(a) If represented by counsel, counsel shall
file the claim on behalf of the employee electronically through CompHub;
or
(b) If unrepresented by counsel,
the employee may file the claim:
(i)
Electronically through CompHub; or
(ii) By paper form.
(2) he Commission shall reject a
claim form that does not contain sufficient information to process the claim,
including:
(a) The employee's name;
(b) The employee's address;
(c) The employee's date of birth;
(d) The date of the accident or occupational
disease;
(e) The member of the body
that was injured;
(f) A description
of how the accidental injury or occupational disease occurred; and
(g) The employee's employer's name and
address.
(3) Parties and
attorneys of record shall notify the Commission of any change in their contact
information within 30 days of the change. The Commission may rely on the latest
information received by it for service of any papers.
(4) The employee shall sign the claim form
certifying that the information submitted on the claim form is
accurate.
(5) When completing the
claim form, the claimant shall sign an authorization for disclosure of health
information for the release to the claimant 's attorney, the claimant 's
employer, the employer's insurer, the Subsequent Injury Fund , the Uninsured
Employers' Fund , or any agent thereof, the claimant 's medical information that
is relevant to:
(a) The member of the body
that was injured by an accident or occupational disease, as indicated on the
claim form; and
(b) The description
of how the accidental injury or occupational disease occurred, as indicated on
the claim form.
(6)
Revocation of Authorization.
(a) A claimant
may revoke an authorization for disclosure of health information in
writing.
(b) The claimant shall
serve a copy of the written revocation on all parties in the case.
(7) The Commission shall reject a
claim form that does not contain a signed authorization for disclosure of
health information .
(8) Date of
Filing When Filed by Paper Form.
(a) Except
as provided in §A(9) of this regulation, a claim is considered filed on
the date that a completed and signed claim form, including the signed
authorization for disclosure of health information , is received by the
Commission in person or by mail addressed to the Commission's principal office
in Baltimore City.
(b) For any
claim form that has not been rejected as incomplete under §A(2) of this
regulation, the Commission's date of receipt is determined by the date stamp
affixed on the claim form.
(9) Date of Filing When Submitted
Electronically.
(a) For any claim form that
has not been rejected under §A(2) of this regulation, the date of receipt
is determined by the date stamp affixed on the electronically submitted claim
form, provided that the signed claim form, including the signed authorization
for disclosure of health information , is verified by the Commission.
(b) A claim electronically submitted but not
verified by the Commission as provided in §A(9)(b) of this regulation is
not considered filed.
B. Social Security Number.
(1) Voluntary Disclosure of Social Security
Number.
(a) On the claim form, the Commission
shall request the Social Security Number of each claimant for workers'
compensation benefits.
(b) The
disclosure of the Social Security Number by the claimant on the claim form is
voluntary.
(2) Use of
Social Security Number.
(a) The Commission may
use the Social Security Number for the following purposes:
(i) Verifying wage records of a
claimant ;
(ii) Verifying the
identity of a claimant ;
(iii)
Identifying a claimant who has changed his or her name;
(iv) Verifying medical records necessary to
adjudicate workers' compensation claims;
(v) The administration and enforcement of
Maryland's workers' compensation laws;
(vi) The collection of any debts owed as a
result of the claimant 's failure to pay child support under Title 10 of the
Family Law Article; and
(vii)
Assisting in the enforcement of child support orders as required by State and
federal laws.
(b) The
Commission may not use the social security number for any purpose not
authorized under this regulation or by state or federal law.
C. Amendment of Claim to
Add or Remove a Body Part.
(1) A claimant may
amend a claim to add or remove a member of the body by filing with the
Commission a claim amendment form.
(2) A claimant shall serve a copy of a claim
amendment form on the parties of record.
(3) The claimant shall sign the claim
amendment form certifying that the information submitted on the claim amendment
form is accurate.
(4) When
completing the claim amendment form, the claimant shall sign an authorization
for disclosure of health information authorizing the claimant 's health care
providers to disclose to the claimant 's attorney, the claimant 's employer, the
employer's insurer, the Subsequent Injury Fund , the Uninsured Employers' Fund ,
or any agent thereof, the claimant 's medical information that is relevant to
the member of the body identified by the claim amendment form.
(5) The Commission shall reject a claim
amendment form that does not contain a signed authorization for disclosure of
health information .
Notes
State regulations are updated quarterly; we currently have two versions available. Below is a comparison between our most recent version and the prior quarterly release. More comparison features will be added as we have more versions to compare.
No prior version found.