Md. Code Regs. 14.09.09.04 - Stipulation for Permanent Disability
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.
B. If the claimant is not represented by an
attorney, the stipulation shall be accompanied by the following:
(1) All medical information in the possession
of other parties; and
(2) A
statement signed by the claimant acknowledging that the claimant understands
that the stipulation does not foreclose the claimant's future right to benefits
under the Workers' Compensation Law, including the right to reopen and the
right to continuing medical treatment.
C. The stipulation is not binding on the
Commission unless approved by the Commission.
Notes
Regulations .04, adopted effective 41:4 Md. R. 305, eff.
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