Maryland Workers’ Comp: Fix Delays in Medical Approval

Why medical approvals get delayed in workers’ comp cases

Workers’ compensation care typically requires coordination among multiple parties (provider, insurer/claims administrator, employer contacts, and sometimes nurse case managers). Delays commonly happen when:

• The insurer says it needs more documentation (updated office note, imaging report, work status, etc.).
• The request is for higher-cost or specialized care (specialty referral, MRI, procedure, DME) that the insurer routes for additional review.
• Paperwork is incomplete or misrouted (wrong adjuster, outdated fax/email, missing claim identifiers).
• Billing/coding confusion makes it unclear what service is being requested.
• There’s a dispute about relatedness to the work injury or medical necessity.

Not every delay is a formal denial, but a prolonged “pending review” can still block care and prolong recovery.

Step 1: Confirm what is actually being requested and by whom

Identify the exact treatment item that is stuck (MRI, pain management referral, surgery authorization, PT, medication, follow-up). Then confirm:

• Who submitted the request (doctor’s office, referral coordinator, PT clinic)?
• Where it was sent (adjuster name, email/fax, mailing address)?
• What documentation was included (office note, imaging, medical necessity letter)?
• What exactly is being requested (specific service, frequency/duration; codes if your provider has them)?

Many delays are solvable once the request is resent to the correct contact with the right identifiers (claim number, date of injury, and body part).

Step 2: Build a clean paper trail (it matters if there’s a dispute)

When approval is delayed, documentation helps keep everyone accountable and reduces “we never got it” problems. Maintain a simple log:

• Dates you called or emailed
• Names/titles of people you spoke with
• What you were told (e.g., “need updated note,” “in review,” “not related”)
• What your provider’s office did (submission date, what was sent, and any confirmation)

Also ask your provider for copies of key records supporting the request (recent office note, imaging report, medical necessity letter).

Step 3: Ask for the reason: missing info vs. review vs. denial

In practice, most delays fall into one of these categories:

• Missing information: the insurer wants specific records or a clearer request.
• Medical review: the insurer is evaluating medical necessity/relatedness.
• Denial/dispute: the insurer refuses (or effectively refuses) to authorize because it disputes causation, necessity, or believes the condition is unrelated/pre-existing.

Your next move depends on which bucket you’re in. Missing information can often be fixed quickly. Review/denial issues usually require stronger medical support and, sometimes, a more formal escalation path.

Step 4: Coordinate with your treating doctor to tighten the medical support

If approval is stalling, ask your provider to submit (or resubmit) a concise, specific explanation that addresses what adjusters and reviewers tend to look for:

• Diagnosis and how it ties to the work injury
• Objective findings (exam findings, imaging results)
• Prior conservative care and response
• Specific treatment plan (what care, how often, how long)
• Functional impact (work limits and daily activity limits)
• Consequences of delay (risk of worsening, chronic symptoms, loss of function)

A clearer medical narrative can reduce back-and-forth and help the insurer make (or confirm) a decision faster.

Step 5: Use the adjuster’s internal escalation channels

Before filing anything formal, internal escalation can sometimes break a logjam:

• Request a supervisor review if the adjuster is unresponsive.
• If a nurse case manager is involved, ask for a joint call with the provider’s scheduler.
• Ask if there is a preferred scheduling pathway or network requirement for the service (and how to comply without delaying care).

Keep your message factual: what was ordered, when it was submitted, and what is needed to get the patient scheduled.

Step 6: If treatment is urgent, make the urgency explicit

If your condition is worsening or the care is time-sensitive, ask your provider to document urgency in the chart and (when appropriate) provide a short letter explaining the medical risk of delay. Send it to the adjuster and confirm receipt.

If you have emergency symptoms, seek emergency care. Administrative delays should not prevent you from obtaining appropriate emergency medical attention.

Step 7: When delays function as a denial, consider formal options through the WCC

If informal follow-ups aren’t working and the delay is effectively blocking medically necessary care, you may need to consider formal dispute resolution through the Maryland Workers’ Compensation Commission. Maryland law generally requires the employer/insurer to provide medical treatment for a covered claim, and the Commission is the forum that resolves many treatment disputes. See, generally, Md. Code, Labor & Employment § 9-660 and WCC procedure resources (Md. Code, Labor & Employment § 9-660; WCC FAQs; WCC forms).

Formal escalation is especially common in disputes over relatedness, diagnostic testing, surgery/procedures, or extended therapy.

If you want help evaluating whether your situation is an administrative delay or a dispute that may warrant Commission involvement, contact us.

Common mistakes that make medical delays worse

• Assuming the provider “handled it” without confirming submission and receipt
• Not updating the adjuster after the doctor changes the plan
• Letting weeks pass without a documented follow-up
• Treating “pending review” as a final answer
• Missing claim identifiers (claim number, date of injury, correct adjuster contact)

FAQ

How long should medical authorization take in Maryland workers’ comp?

Timelines vary by insurer and the type of care requested. If a request sits in “pending” status without clear next steps, treat it as a problem to manage: confirm receipt, ask what is needed, and get the reason in writing.

What if the adjuster says they never received the request?

Ask your provider’s office for proof of submission (fax confirmation, email sent record, portal confirmation) and resend the request with the claim number, date of injury, and body part clearly stated.

What if the insurer says the treatment is not related to my work injury?

That is usually a dispute about relatedness/causation. Ask your treating provider to document how the requested care connects to the work injury with objective findings and functional impact, and consider whether a formal dispute through the WCC is appropriate.

Can I ask the Maryland Workers’ Compensation Commission to intervene?

In many situations, the WCC is the forum for resolving treatment disputes when informal efforts fail. You can review Commission resources here: https://www.wcc.state.md.us/Pages/FAQs.aspx and forms here: https://www.wcc.state.md.us/Pages/forms.aspx.

Next step

If your Maryland workers’ comp medical care is stuck in authorization limbo, we can help you identify what is missing, build the medical support, and escalate appropriately. Request a consultation.

Maryland-specific legal disclaimer

This article is for general informational purposes only and is not legal advice. Maryland workers’ compensation rights, medical treatment obligations, and dispute procedures depend on the facts of each claim, and deadlines and required filings can apply. For advice about your specific Maryland claim, consult a qualified Maryland workers’ compensation attorney.