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<regulation prefix="Regulation" num=".02" citation="COMAR 14.09.02.02" title_num="14" subtitle_num="09" chapter_num="02" heading="Requirements for Filing and Amending Claims.">
  <paragraph num="A.">
    <text>Claim for Benefits.</text>
    <paragraph num="(1)">
      <text>To initiate a claim for benefits, an employee shall file a claim form with the Commission as follows:</text>
      <paragraph num="(a)">
        <text>If represented by counsel, counsel shall file the claim on behalf of the employee electronically through CompHub; or</text>
      </paragraph>
      <paragraph num="(b)">
        <text>If unrepresented by counsel, the employee may file the claim:</text>
        <paragraph num="(i)">
          <text>Electronically through CompHub; or</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>By paper form.</text>
        </paragraph>
      </paragraph>
    </paragraph>
    <paragraph num="(2)">
      <text>The Commission shall reject a claim form that does not contain sufficient information to process the claim, including:</text>
      <paragraph num="(a)">
        <text>The employee's name;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>The employee's address;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>The employee's date of birth;</text>
      </paragraph>
      <paragraph num="(d)">
        <text>The date of the accident or occupational disease;</text>
      </paragraph>
      <paragraph num="(e)">
        <text>The member of the body that was injured;</text>
      </paragraph>
      <paragraph num="(f)">
        <text>A description of how the accidental injury or occupational disease occurred; and</text>
      </paragraph>
      <paragraph num="(g)">
        <text>The employee's employer's name and address.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(3)">
      <text>Parties and attorneys of record shall notify the Commission of any change in their contact information within 30 days of the change. The Commission may rely on the latest information received by it for service of any papers.</text>
    </paragraph>
    <paragraph num="(4)">
      <text>The employee shall sign the claim form certifying that the information submitted on the claim form is accurate.</text>
    </paragraph>
    <paragraph num="(5)">
      <text>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:</text>
      <paragraph num="(a)">
        <text>The member of the body that was injured by an accident or occupational disease, as indicated on the claim form; and</text>
      </paragraph>
      <paragraph num="(b)">
        <text>The description of how the accidental injury or occupational disease occurred, as indicated on the claim form.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(6)">
      <text>Revocation of Authorization.</text>
      <paragraph num="(a)">
        <text>A claimant may revoke an authorization for disclosure of health information in writing.</text>
      </paragraph>
      <paragraph num="(b)">
        <text>The claimant shall serve a copy of the written revocation on all parties in the case.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(7)">
      <text>The Commission shall reject a claim form that does not contain a signed authorization for disclosure of health information.</text>
    </paragraph>
    <paragraph num="(8)">
      <text>Date of Filing When Filed by Paper Form.</text>
      <paragraph num="(a)">
        <text>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.</text>
      </paragraph>
      <paragraph num="(b)">
        <text>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.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(9)">
      <text>Date of Filing When Submitted Electronically.</text>
      <paragraph num="(a)">
        <text>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.</text>
      </paragraph>
      <paragraph num="(b)">
        <text>A claim electronically submitted but not verified by the Commission as provided in §A(9)(b) of this regulation is not considered filed.</text>
      </paragraph>
    </paragraph>
  </paragraph>
  <paragraph num="B.">
    <text>Social Security Number.</text>
    <paragraph num="(1)">
      <text>Voluntary Disclosure of Social Security Number.</text>
      <paragraph num="(a)">
        <text>On the claim form, the Commission shall request the Social Security Number of each claimant for workers' compensation benefits.</text>
      </paragraph>
      <paragraph num="(b)">
        <text>The disclosure of the Social Security Number by the claimant on the claim form is voluntary.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(2)">
      <text>Use of Social Security Number.</text>
      <paragraph num="(a)">
        <text>The Commission may use the Social Security Number for the following purposes:</text>
        <paragraph num="(i)">
          <text>Verifying wage records of a claimant;</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>Verifying the identity of a claimant;</text>
        </paragraph>
        <paragraph num="(iii)">
          <text>Identifying a claimant who has changed his or her name;</text>
        </paragraph>
        <paragraph num="(iv)">
          <text>Verifying medical records necessary to adjudicate workers' compensation claims;</text>
        </paragraph>
        <paragraph num="(v)">
          <text>The administration and enforcement of Maryland's workers' compensation laws;</text>
        </paragraph>
        <paragraph num="(vi)">
          <text>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</text>
        </paragraph>
        <paragraph num="(vii)">
          <text>Assisting in the enforcement of child support orders as required by State and federal laws.</text>
        </paragraph>
      </paragraph>
      <paragraph num="(b)">
        <text>The Commission may not use the social security number for any purpose not authorized under this regulation or by state or federal law.</text>
      </paragraph>
    </paragraph>
  </paragraph>
  <paragraph num="C.">
    <text>Amendment of Claim to Add or Remove a Body Part.</text>
    <paragraph num="(1)">
      <text>A claimant may amend a claim to add or remove a member of the body by filing with the Commission a claim amendment form.</text>
    </paragraph>
    <paragraph num="(2)">
      <text>A claimant shall serve a copy of a claim amendment form on the parties of record.</text>
    </paragraph>
    <paragraph num="(3)">
      <text>The claimant shall sign the claim amendment form certifying that the information submitted on the claim amendment form is accurate.</text>
    </paragraph>
    <paragraph num="(4)">
      <text>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.</text>
    </paragraph>
    <paragraph num="(5)">
      <text>The Commission shall reject a claim amendment form that does not contain a signed authorization for disclosure of health information.</text>
    </paragraph>
  </paragraph>
</regulation>