Sec. 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) The 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) If the information set forth in §A(2) of this regulation is unavailable or does not exist the claimant shall:

(a) Enter all zeros (0) in the spaces provided for the information; and

(b) Attach a signed statement certifying that the information is unavailable or does not exist.

(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.