New Laws Affecting Workers Comp this Year
In 2016 the Virginia General Assembly passed several bills that were signed into law by Governor McAuliffe and affect the rights of employees, employers, and insurance companies under Virginia workers compensation. Below is a summary of each of these laws and how they could impact all injured workers in Virginia.
Chapter 358 (HB 44)
This law establishes presumptions that an accident arose out of and in the course of the employment if the employee:
- Dies with no evidence that he or she regained consciousness after the accident;
- Dies at the scene of the accident or nearby; or,
- Is found dead where he is reasonably expected to be as an employee.
In the past a claim for workers compensation benefits could be denied if the injured employee passed away without providing evidence to support his or her claim. This law expands the death presumption under the Virginia Workers’ Compensation Act. If an injured employee dies at the scene of the accident or at a location near where he or she should have been to complete his or her job duties then there is a presumption that the death is work-related.
Further, an employee who is knocked unconscious and never regains consciousness is entitled to the death presumption in workers’ compensation even if he or she does not die in the accident or at the scene of the accident. For example a car accident victim who suffers a brain injury and goes into a coma is entitled to the death presumption if he or she never regains consciousness.
The employer and the insurer can rebut the presumption with a preponderance of evidence to the contrary.
Chapters 279 and 290
These laws direct the Virginia Workers’ Compensation Commission to adopt a fee schedule that sets the maximum liability of the employer for medical services provided pursuant to the Virginia Workers’ Compensation Act in the absence of a contract.
In other words these laws direct the Commission to set a fee schedule for medical services by 2018.
Right now the employer and insurer pay your doctors and medical providers pursuant to contracts negotiated between the insurance company and the medical provider. That won’t change under this law.
But some insurance companies and medical providers do not have contracts with each other. So when an injured employee treats with a medical provider who is not under contract, there is often a dispute between the insurance company and the medical provider over the appropriate fee for services. If the insurer and medical provider can’t reach an agreement then the medical provider may file a claim against the insurance company.
These medical provider claims use Commission resources and increase the time it takes for injured workers to resolve their claims. Instead of focusing on claims from injured workers, the Commission is having to spend a lot of time resolving claims between insurance companies and medical providers.
With the establishment of a medical fee schedule the Commission hopes to reduce the amount of time spent on medical provider claims. In the absence of a contract the insurance company will need to pay the medical provider, and the medical provider will have to accept, the fee set forth for the service in the fee schedule.
This will have an indirect impact on injured workers in Virginia. If the fee schedule is not fair and reasonable, some doctors may decide to refuse to take workers’ comp patients. This would make it more difficult to receive medical care after a workplace accident and injury.
Have a question about your work injury claim? Call, text, or e-mail Richmond workers compensation lawyer Corey Pollard for a free, no obligation consultation.