Consider this fact pattern. A bus driver injures their knee and ankle while stepping off the bus. Their Maryland workers’ compensation claim is approved, along with a finding of permanent partial disability of the injured leg. Five years later, the driver requests coverage within the same claim for follow-up medical treatment for ongoing knee pain. Is coverage appropriate?

This is precisely the case the Court of Special Appeals considered in its Sept. 4, 2020, opinion in Montgomery County v. Jackson, which agreed with the Circuit Court and Workers’ Compensation Commission (WCC or Commission) holding that the link between Timothy Jackson’s original 2011 injury and the later pain and treatment in 2016 was a reasonable inference and did not require an expert medical witness to establish the causal relationship.

Montgomery County, the employer, argued that there had to be expert medical testimony to establish the link because of the complexity of the medical issue and the “significant passage of time.”

Maryland workers’ compensation law

The court explains the applicable legal concepts:

• An employer’s liability for a work injury continues if the condition worsens.
• The Commission decides if the worsening condition is “reasonably attributable solely” to the original injury and this decision carries significant weight.
• The Commission’s decision need only be based on the “minimum evidence necessary to support an award” and the proof must only be “beyond speculation and conjecture.”
• A medical expert to establish the link will almost always be necessary if there has been a significant passage of time, but there is no automatic requirement for expert testimony (oral or written), depending on the circumstances of each case.

Causal link straightforward

In Jackson’s claim, the court recognized a reasonable inference of causal connection between the old injury and the new pain that did not require a medical expert. A previous fall that permanently injured a knee could reasonably cause later pain in that knee, especially since Jackson testified that he had not had further injury to the knee after the 2011 work accident. In addition, the original injury was not linked to any pre-existing conditions. In short, the medical issue was straightforward.

Finally, in a close case, any “ambiguity or ‘tie’ goes to the claimant” because Maryland workers’ compensation law is “remedial social legislation” meant to protect employees and their families.

Consult an attorney as soon as possible after your work injury, before you file your workers’ compensation claim or any time after a denial to discuss potential review or appeal. A lawyer can step in and represent you at any stage. In addition, should your covered condition later flare-up such as in the Jackson case, an attorney can assist with the appropriate filings.