Is the Employer or Its Insurance Company Trying to Stop Your Virginia Workers' Compensation Benefits?

Things are going smoothly. You have an accepted work comp claim. You are receiving weekly benefits. Your physical recovery is on pace. Then it happens. You receive an Employer’s Application for Hearing to Terminate, Suspend, or Modify your workers’ compensation benefits. What is it? And what can you do about it?

Below we’ll tell you more about what happens after the employer files its application. Make sure that you contact a Virginia workers compensation attorney right away. You have a limited amount of time to respond, and an experienced attorney will help you make a strong argument as to why your benefits should continue.

When Can An Employer File an Application for Hearing?

The employer’s application for hearing is similar to the employee’s change in condition claim. When things change after a claim has been accepted, the employer can file an application to protect its rights and reduce its exposure.

The employer can file an application to stop benefits for any of the following reasons:

  • You returned to your pre-injury work;
  • Your treating physician, or one of the physicians who provided a report for the insurance carrier, releases you to return to your pre-injury work;
  • You are hurt in a supervening accident that causes disability and your physician states that your ongoing disability is unrelated to the industrial accident;
  • You fail to show up to an employer-requested medical examination that was properly scheduled;
  • You refused selective employment (light duty work) within your physical capacity;
  • You refused to cooperation with the vocational rehabilitation counselor assigned to your case; or
  • You refused medical treatment that was reasonable, necessary, and causally related to your industrial accident.

Just because the employer files an application for one or more of the reasons listed above does not mean the employer will win. An experienced Virginia workers compensation lawyer can help you fight back and try to get the application rejected. You have to hurry though. You have a limited amount of time to object to the employer’s application, or else the commission will schedule the application for a hearing.

How Will I Know that the Employer is Trying to Stop My Workers' Compensation Benefits?

An employer’s application for hearing must be in writing and state the specific grounds relied upon and the relief sought. The Virginia Workers’ Compensation Commission provides a form that most employers and insurance companies use. The employer must send you a copy of its application for hearing, along with any supportive documentation filed with the application.

What Must the Employer's Application for Hearing Show?

The employer’s application for hearing based on a change in condition must (i) be in writing; (ii) be signed under oath; (iii) state the basis of the application; and (iv) state the date for which compensation was last paid under an award order. Compensation must be paid through the dates below, or else the Commission will reject the employer’s application and refuse to refer it to the hearing docket:

  • If the application alleges the injured employee returned to work, the employer must pay through the date of the return;
  • If the application alleges the injured employee refused light duty employment or medical examination, the employer must pay through the date of the refusal or 14 days before the filing, whichever is later;
  • If the application alleges the injured employee failed to cooperate with vocational rehabilitation, the employer must pay through the date the application is filed;
  • If the employer files multiple applications for hearing, compensation must be paid through the date required by the first application; and,
  • If the employer alleges multiple grounds for termination of the aware, payment is determined by the allegation that allows the earliest termination date.

An employer’s change in condition claim is subject to a statute of limitations. The Commission will reject an employer’s application for hearing unless it is filed within two years from the date compensation was last paid pursuant to an award.

What Happens After an Employer's Application for Hearing?

When the employer files an application for hearing, the Commission will review it for technical compliance. If the application is compliant, the injured employee has 15 days from the date the application was filed to present evidence in opposition. After the deadline for a statement in opposition has passed, the Commission will make a decision on the application for hearing.

The employer may suspend benefits while a decision on its application is pending. This can be a difficult time for injured employees because they are no longer receiving checks and are uncertain over what will happen with their case.

If the Commission decides to reject the application, it will send the parties a letter stating the reason for rejection and telling the employer to reinstate benefits. If the Commission finds probable cause to support the employer’s allegations, it will accept the application and refer it to the hearing docket.

Either party can challenge the Commission’s decision to accept or reject the employer’s application for hearing. Rule 1.6 gives the parties 30 days from the date of the initial decision to request review. The letter requesting review of the decision must be specific and contain all supportive documentation you have because oral argument is not allowed. The opposing party has ten days from the date of the request for review to file a response. After reviewing the written statements, the full Commission will issue a written decision.

Fight Back Against the Employer's Application for Hearing

You don’t have to accept the employer’s decision to stop your benefits. But you must fight for what is yours.

We want to help you keep your benefits. Call us anytime at 804-251-1620 or 757-810-5614, or complete the form on the right side of the screen.