Does Workers’ Compensation Pay for Inpatient Treatment?

Workers’ compensation is an important safety net for employees injured on the job. Some online estimates show that there are 4.9 million workers’ compensation claims made each year by both private and government employees, and the typical workers’ comp claim is around $41,000.  

But what about if you’re hospitalized?  

Does workers’ compensation pay for inpatient treatment in Maryland? Keep reading where we answer that question. 

Understanding Workers’ Compensation Coverage 

Workers’ compensation laws vary by state, and Maryland is no exception. Our state’s system is designed to provide medical benefits, wage replacement, and vocational rehabilitation to employees injured while performing their job duties. 

Types of Injuries Covered 

Workers’ compensation typically covers a wide range of injuries and illnesses that occur in the course of employment. Here are some common types of injuries and conditions that are often covered: 

• Accidental Injuries: Injuries resulting from accidents such as slips, falls, or collisions at the workplace are generally covered. This includes fractures, sprains, strains, cuts, bruises, and other traumatic injuries. 
• Repetitive Stress Injuries: Conditions caused by repetitive motions or overuse, such as carpal tunnel syndrome, tendonitis, or bursitis, are often covered if they are deemed work-related. 
• Occupational Illnesses: Workers’ compensation may cover illnesses or diseases that develop as a result of workplace exposure to hazardous substances or conditions. This can include respiratory conditions from exposure to chemicals, asbestosis from asbestos exposure, or skin conditions from contact with toxic materials. 
• Psychological Injuries: Mental health conditions such as anxiety, depression, or post-traumatic stress disorder (PTSD) that result from work-related incidents or conditions may also be covered by workers’ compensation. 
• Occupational Diseases: Diseases that are directly related to a particular occupation or industry, such as hearing loss in a noisy workplace or lung disease in a coal mine, may be eligible for coverage. 
• Aggravation of Pre-existing Conditions: If a work-related incident aggravates a pre-existing injury or condition, workers’ compensation may cover the additional medical treatment and lost wages resulting from the aggravation. 

It’s important to note that coverage may vary depending on the specific laws and regulations of each state, as well as the circumstances of the injury or illness.  

What Is Inpatient Treatment?  

Inpatient treatment refers to medical care provided to patients who require overnight or extended stays in a hospital or other healthcare facility.  

Some common reasons for inpatient treatment can include: 

• Surgery: Inpatient care is often necessary before and after surgical procedures for monitoring and recovery. 
• Serious Injuries: Severe injuries such as fractures, head trauma, or internal injuries may require inpatient care for stabilization and treatment. 
• Acute Illnesses: Conditions like pneumonia, heart attacks, or diabetic complications may necessitate inpatient treatment for intensive medical management. 
• Mental Health Concerns: Inpatient psychiatric care is provided for individuals experiencing severe mental health crises, such as suicidal ideation or psychosis. 
• Chronic Diseases: Managing complex chronic diseases like cancer, kidney failure, or autoimmune disorders may require inpatient care for specialized treatments or monitoring. 
• Infections: Serious infections, including sepsis or severe cellulitis, often require hospitalization for intravenous antibiotics and close monitoring. 
• Organ Failure: Conditions such as liver failure, respiratory failure, or heart failure may require inpatient care for supportive therapies or organ transplant evaluation. 
• Postoperative Care: After major surgeries, patients may need inpatient care for pain management, wound care, and rehabilitation. 
• Complications: Complications arising from medical procedures or pre-existing conditions may require inpatient treatment for timely management and monitoring. 
• Rehabilitation: Inpatient rehabilitation programs help patients recover from injuries or surgeries, regain function, and learn adaptive skills for daily living. 

Patients receiving inpatient treatment typically stay in a hospital room or ward until they are deemed stable enough to be discharged or transferred to a lower level of care, such as outpatient or home-based treatment. 

Coverage for Inpatient Treatment in Maryland 

In Maryland, workers’ compensation generally covers the cost of necessary medical treatment for work-related injuries or illnesses, including inpatient care. This coverage extends to hospital stays, surgeries, rehabilitation services, and other medical expenses directly related to the injury. 

Maryland’s statutes state, “Not all injuries are covered by the Workers’ Compensation Law even if the injury happened “on the job.” In Maryland, in order for an injury to be covered, the harm suffered by the employee must have been caused by an “accidental personal injury arising out of and in the course of employment.”  

This means that workers’ compensation typically does not cover injuries sustained while commuting to and from work, injuries resulting from horseplay or intoxication, or injuries incurred while engaging in activities unrelated to work duties. 

Employers and insurance carriers may require documentation and evidence to support the claim, including medical records, incident reports, and witness statements. 

Navigating the Claims Process 

Filing a workers’ compensation claim for inpatient treatment can be complex, involving paperwork, reporting deadlines, and potential disputes. Injured employees must understand their rights, seek legal guidance if needed, and follow the proper procedures to ensure their claim is processed smoothly. 

While workers’ compensation typically covers inpatient treatment, challenges may arise during the claims process.  

Disputes over the severity or cause of the injury, delays in approval, or issues with medical billing can complicate matters for injured workers seeking benefits. 

Seeking Legal Assistance 

In cases where workers’ compensation claims for inpatient treatment are denied or contested, seeking legal assistance from an experienced attorney specializing in workers’ compensation law can be a game-changer.  

Qualified workers’ compensation attorneys advocate for an injured worker’s rights, navigate the legal process, and help secure the compensation they deserve. We do the same with our clients here at Belsky & Horowitz, LLC. 

In Maryland, workers’ compensation provides coverage for inpatient treatment for work-related injuries or illnesses. Understanding the intricacies of workers’ compensation laws, the claims process, and eligibility criteria is essential for injured employees seeking medical benefits.  

By navigating the system with care and seeking appropriate legal guidance, injured workers can access the care they need and protect their rights under the law.