You Are Responsible for Filing a Workers Compensation Claim in Virginia. The Insurance Company Does Not Have to Do It for You.

 

The Virginia Workers’ Compensation Commission has regulations that insurance companies, self-insured employers, and professional organizations must follow. If they do not then the Commission can levy a fine against the organization.

 

Some of the Commission’s regulations address the insurance companies’ obligation to file claims reports with the Commission. The specific regulations that address this obligation are 16 VAC 30-91-10 and 16 VAC 30-91-20.

 

This article explains those regulations and why you cannot count on your employer or its insurance company to file a Virginia workers compensation claim for you. If you have any questions about your legal rights following a job injury or are looking for help negotiating a lump sum workers comp settlement, contact workers compensation attorney Corey Pollard for a free consultation.

 

Insurance Company Procedures for Filing Claims Reports with the Commission

 

When an insurance company receives notice of a work accident or the filing of a workers compensation claim, it must file a claim report with the Commission electronically. A claims report is filed electronically when the insurance company files the report with the Commission through the Electronic Data Interchange (EDI), which is an internet portal set up by the Commission for the submission of claims reports.

 

No matter the type of work accident or injury, or how severe or minor the injury, the insurance company must file a First Report of Injury (FROI) with the Commission. A FROI is the initial claims report. This form provides information regarding how the employee’s accident and injury was reported to the insurance company and should include a listing of all body parts injured and a description of how the accident happened.

 

The insurance company must also file a Subsequent Report of Injury (SROI) for every claim that does not involve a minor injury. An injury is considered a minor injury unless it meets one of the following criteria established by the Commission:

 

  • The injury led to more than 7 days of missed time from work
  • The injury required medical expenses of more than $1,000
  • The injury is accepted as compensable
  • The injury results in death
  • The injury results in permanent disability, scarring, or disfigurement

 

If the work injury is not a minor injury then the insurance company must file SROI reports for the following events: denials of initial claims; denials of change in condition claims; wage loss payments, either temporary total disability or temporary partial disability; medical payments for surgeries and other treatment covered under an award of lifetime medical benefits; and suspension of benefits based on the filing of an employer’s application for hearing.

 

Does the Insurance Company’s Claims Report as a Workers Compensation Claim in Virginia?

 

Usually the insurance company will file a claims report with the Commission within 1 to 2 weeks of the date of your accident. I always review the claims report when preparing a case for litigation and a workers comp hearing. It’s usually the first or second document filed in your case.

 

The claims report tells the Commission that the employer and its insurance company have notice of your work accident. But the claims report does not count as an official workers compensation claim because it is not signed by you, does not state what workers compensation benefits you are seeking, and leaves out other important information about your work accident and injuries, including where the accident happened and where and how it took place.

 

No matter what your employer tells you and what documents its insurance company files with the Commission, you should always be proactive in protecting your legal rights after a work accident. You cannot count on your employer or its insurer to look out for your best interests, no matter how long you have worked for the same person or company. It is often the insurance company that makes decisions on whether to accept or deny your claim.

 

We recommend contacting an experienced workers compensation attorney like Corey Pollard before filing your claim for benefits so that you can make sure it contains accurate information and supportive documentation.

 

Have a question about your work injury or claim for benefits? Call, text, or email us today for a free consultation. We help injured workers and their families across Virginia, including those in Richmond, Newport News, Norfolk, and Virginia Beach.