Alright, the insurance carrier sent you an Award Agreement Form and you want to hurry up and get the benefits you deserve. But you also want to understand what it is the insurer is proposing.
When it comes to the initial payment of workers comp benefits, there are two types of systems: the direct payment and agreement systems.
Under the direct system, an employer must begin paying benefits as soon as it accepts liability for an on-the-job injury.
Under the agreement system, an employer does not have to pay benefits until there is complete agreement on the types of workers compensation benefits owed and the correct amount, even if it accepts liability for the on-the-job injury.
Virginia workers compensation uses the agreement system. Because of this many employees who are hurt on the job or diagnosed with an occupational disease are forced to fight for every workers compensation benefit they’re owed. Rather than doing the right thing and providing coverage immediately, the employer and its insurance carrier or third party claims administrator (TPA) may deny the claim and force litigation, discovery, and a workers comp hearing.
But this isn’t always the case. Some of you will receive a claim acceptance letter from the insurance company or TPA after you file your workers compensation claim.
The claim acceptance letter should state what benefits the insurer agrees to pay. It should also include a separate document called an Award Agreement Form.
The purpose of this article is to help you understand the Award Agreement Form and what to look for when deciding whether to sign it after your work injury. The Workers Compensation Commission uses the information from the Award Agreement Form to issue your Workers Compensation Award Letter. So it’s important that the Award Agreement Form is both accurate and complete. A mistake on the this form now may cause you to miss out on additional cash or medical benefits in the future.
Keep reading to learn more. If you have any questions about your case, or are looking for a top-rated workers comp lawyer in Virginia, call me for a free consultation: (804) 251-1620 or (757) 810-5614. Come see why hundreds of injured employees have turned to me for help negotiating their workers compensation settlements and getting results.
The Workers Compensation Award Letter, often called an Award Order, is a letter entered by the Commission that states what benefits are granted or denied.
Usually the Award Order is one page long. It states:
There three types of Workers Comp Award Orders in Virginia:
A Medical Only Award Order states that your employer and its workers comp insurance carrier are responsible for the payment of medical treatment that is reasonable, necessary, authorized, and causally related to your on-the-job injury.
This type of Award Order does not provide wage loss payments.
An Open Award is an order that states your employer and its workers compensation insurance carrier must pay you weekly benefits on an ongoing basis.
A Closed Award is an order that states your employer and its workers comp insurer must pay you for a specific period, with a beginning and end date.
An award of permanent partial disability is also considered a Closed Award.
In my opinion the workers comp system is stacked against employees. Employers and insurance carriers have most of the leverage because you cannot receive compensation for pain and suffering related to your work injury and you do not have the right to request a jury trial to decide the total value of your case.
But having a Workers Compensation Award Letter gives you some leverage, which you can use to negotiate a bigger settlement.
An Award Order carries the same weight as a judicial opinion issued by a judge after a hearing or the full Commission or Court of Appeals of Virginia on appeal. It is binding on all parties and is an enforceable contract.
If the Commission has not entered an Award Order then the employer and insurer can deny medical treatment for your work injuries or stop paying wage loss benefits at any time and without notice. This is true even if the claim adjuster told you verbally, by email, or by letter that your claim is accepted and that the insurer will pay benefits.
When you have a Workers Compensation Award Letter, the employer or its insurer cannot stop your benefits unless they file an Employer’s Application for Hearing and the Commission finds probable cause to suspend or terminate benefits, at which time a hearing is scheduled. The Award Order, therefore, gives you some due process.
You can also use the Workers Comp Award Letter to enforce your benefits.
For example if you have an Open Award Order for temporary total disability benefits and your weekly workers comp check is late, your employer or its insurance company may have to pay a 20 percent penalty. This is extra money in your pocket.
Similarly, if the insurance carrier refuses to pay for medical care recommended by the authorized treating physician you chose from the panel of doctors, or someone you were referred to, then you can use your Medical Award to get the treatment covered. And, depending on whether the Commission finds the employer or its insurer acted in bad faith in defending your claim, you may receive additional monetary damages. That is because the Commission has the power to sanction employers and insurers for acting unreasonably.
There are two ways to get a Workers Compensation Award Letter in Virginia – (1) by negotiating an agreement with the employer, insurer, and TPA and signing an Award Agreement Form or Stipulation or (2) by winning at trial. This article focuses on the first method.
The Workers Compensation Commission encourages the parties to try to resolve their differences without litigation. It does this by offering mediation services for free and by allowing you and the employer to reach an agreement about the compensation and benefits you are owed after the injury.
If you reach an agreement with your employer (or its insurance carrier or TPA), then one of the parties must file with the Commission a signed memorandum of agreement. Either party can prepare the agreement. Or you can use the template Award Agreement Form provided by the Commission.
A deputy commissioner, which is what we call judges in workers comp, will review the proposed memorandum of agreement or Award Agreement Form and decide whether to approve it. If it is approved then the Commission will enter a Workers Compensation Award Letter.
No.
Many injured workers call me after receiving a proposed Award Agreement Form from the insurance company, worried that by signing the document they will close their case before reaching maximum medical improvement (MMI). But a Workers Compensation Award Letter is not the same as a full and final settlement that cashes out future medical treatment.
The Award Order resolves your pending dispute. It does not close your case or prevent you from filing a change in condition application or claim for compensable consequence injuries if you have permanent impairment, require additional medical attention, such as a spinal fusion or total joint replacement, or have a change in your employment or disability status.
It is common to have several Award Orders entered in one case, especially if you suffered a catastrophic injury such as a head injury resulting in post-concussive syndrome, amputation injury, burn injury, back injury resulting in a herniated disc, or a spinal cord injury affecting the neck.
Usually not.
If the Award Agreement Form resolves all pending disputes and the Commission approves it and enters an Award Letter, then you will not need a hearing on that claim.
There are some situations, however, where you will need to go to trial even though the Commission approved the Award Agreement. For example, if you suffered injuries to your shoulder and back in a work-related motor vehicle crash, but the insurance carrier will only agree to pay for treatment for the shoulder, then you may need to go to trial to have the back injury added to the Award Order.
Alright, the insurance carrier sent you an Award Agreement Form and you want to hurry up and get the benefits you deserve. But you also want to understand what it is the insurer is proposing.
Remember this. Though you are gaining some rights when you sign an Award Agreement Form, you may be giving up others if the document is inaccurate or incomplete. And if the insurer is offering a memorandum of agreement to pay compensation, then it believes you have a strong case. As such, do not feel pressured to sign the Award Agreement immediately.
In my experience the two areas that insurance carriers are likely to include wrong information on an Award Agreement Form are:
The Award Agreement Form should also include:
If any of the information is incorrect or incomplete, then consider hiring an attorney.
In Virginia either party can withdraw its offer to settle the workers comp claim or to resolve the pending dispute by a memorandum of agreement.
This is true even if the Commission entered an Award Order, as long as you file a motion to set aside the Award Letter within 30 days of the date it was entered.
If you wait too long to file the motion to set aside, then the Commission will likely refuse to vacate the Award Order.
You have two options if both you and the claim adjuster have signed an Award Agreement Form, but the adjuster refuses to file a copy with the Commission so that you can receive a Workers Compensation Award Letter.
First you can file with the Commission a motion for sanctions against the employer and insurer.
The Workers Compensation Act states:
An employer or insurance carrier which fails to file a memorandum of such agreement with the Commission within fourteen calendar days of the date of its complete written execution as indicated thereon may be subject to a fine not to exceed $1,000 and to any other appropriate sanctions of the Commission.
Rule 4.1 of the Rules of the Workers Compensation Commission also requires the employer to file promptly all agreements as to payment of compensation with the Commission.
The Commission has the power to punish employers and insurers for failing to file an executed Award Agreement Form quickly because a main purpose of workers comp is to provide benefits to injured workers quickly. Having the ability to sanction this delay tactic, which is often used by claim adjusters to see if a doctor releases you to return to work or your employer can accommodate light duty work so that you have the burden of proof, cuts down on its use.
Second you can ask the Commission to refer your Claim for Benefits for an in-person evidentiary hearing.
I recommend using both options to help your case.
Usually the entry of an Award Letter after you sign an Agreement Form is just the start.
An approved workers compensation claim is often followed by several important events, including a functional capacity evaluation (FCE), depositions, interrogatories, discovery requests, a questionable offer of light duty, vocational rehabilitation, and an Independent Medical Evaluation (IME).
By hiring an attorney to negotiate and review your Award Letter, you put yourself in the best position possible to overcome these obstacles.
Call me today for a free strategy session: (804) 251-1620 or (757) 810-5614. I represent injured employees throughout Virginia, including those in Richmond, Chesterfield, Henrico, Fredericksburg, Bristol, Roanoke, Harrisonburg, Winchester, Fairfax, Manassas, Newport News, Williamsburg, Hampton, Norfolk, and Virginia Beach.