What is considered a medical service covered by the Maryland Workers Compensation Statute?

Md. Labor and Employment Code Ann. § 9-660 (Lexis 2009)

9-660. Provision of medical services and treatment
(a) In general. — In addition to the compensation provided under this subtitle, if a covered employee has suffered an accidental personal injury, compensable hernia, or occupational disease the employer or its insurer promptly shall provide to the covered employee, as the Commission may require:
(1) medical, surgical, or other attendance or treatment;
(2) hospital and nursing services;
(3) medicine;
(4) crutches and other apparatus; and
(5) artificial arms, feet, hands, and legs and other prosthetic appliances.

Case law

Ambiguity of whether a medical service or treatment falls within the statute is resolved in favor of the claimant. Breitenbach v. N. B. Handy Co., 366 Md. 467 (2001).

 

Harris v. Janco Enter., 53 Md. App. 674, 677 (1983) interpreted § 9-660 “as dealing with medical services necessary or desirable to treat the effects of the injury.”

Courts, applying Harris, have employed to find incidental, “not intrinsically medical” items compensable under WC Act:

  • “Access for necessities”
  • “Essentials of everyday life”
  • An item which “conveys a medical benefit”

But not:

  • Ones which would purportedly improve quality of life
  • Would be employed for convenience

Non-compensable items:

Specially equipped vans—

  • R&T Constr. Co. v. Judge, 323 Md. 514, 531, 594 A.2d 99 (1991): Court favored broad interpretation of “medical services” despite cited case law from other jurisdictions which adopted a narrower reading. Quadriplegic claimant received additional compensation for increased electric costs from respirator (to operate reasonably necessary medical equipment), but was denied a specially equipped van and other requested home modifications which were deemed not medically necessary because claimant already had a full-time attendant. Claimant’s doctor testified as to the medical need to provideaccess to the bathroom. The testimony also indicated that claimant could not navigate the narrow doorways to his home.
  • KEY: To the extent the modifications to claimant’s house were necessary to provide access to the bathroom or to get in and out of the house, the court found these were reimbursable. However, the proposed modifications that provided quality of life, but not medical necessity, were not reimbursable.
  • Language for denial of home modifications:“[*531]  We further recognize that a body of professional and public opinion supports “mainstreaming,” to the fullest extent possible, for severely disabled persons. We remain mindful that the act is to receive a liberal construction. Nevertheless, HN8in the area of modifications to a residence, the concept of medical treatment under § 37(a) must be limited to access for Here the purpose of the possible improvements goes beyond the necessities already being provided, and seeks to give Judge a sense of increased independence and self-worth. Under the circumstances here that goal is beyond the process of construction of § 37(a). Were we to depart from the standard of access to necessaries that may [***28]  be implied in medical treatment, there would be no statutory standard to guide the Commission in determining the extent of an insurer’s obligation to make alterations to a claimant’s residence. Consequently, on the issue of modifications to the Judges’ home, the Commission reached the legally correct result.
  • Language and case law support for denial of van (*532): “The rationale for our holding concerning further modifications to the residence furnishes the answer to the issue involving a specially equipped van. The insurer currently transports Judge by van approximately once a week to Judge’s physician. Measured by a standard of necessity, that weekly transport is the out-of-doors mobility equivalent of wheelchair access into, and within essential parts of, a home by one who is not as severely limited as is Judge. Increased mobility will certainly improve the quality of Judge’s life, HN9but a specially equipped van is not an “other prosthetic appliance[,]” as the Court of Special Appeals held.

Compensable items:

Home security system (perhaps)—

  • Simmons v. Comfort Suites Hotel, COA (2008): Home alarm detector determined as a matter of law to fall within the meaning of “medical services” under WC Act for its purported medical benefit. Court below to decide if system necessary for this particular claimant.
  • Simmons Court interpreting Judge: “We agree that the case stands for the proposition that the term medical treatment should not be construed narrowly.”


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