How Do You File a Workers Compensation Claim in Virginia?

 

We Explain Everything You Need to Know About Filing a Workers Compensation Claim in Virginia

 

This article is meant to show you how to file a workers compensation claim in Virginia that gives you the best chance of getting approved for benefits. Though filing a workers compensation claim may seem simple and easy, there are many complex issues that may arise and affect your right to workers’ compensation benefits. We recommend gathering as much information as possible about the workers compensation claims process before filing your workers comp claim since litigation may be required to get the money and medical treatment you deserve. By taking the right steps when you file a workers’ compensation claim, you can prepare yourself for the defenses the employer and its insurance carrier may raise when denying your claim.

 

We recommend contacting a workers compensation attorney who can guide you through all the steps required to file a Virginia workers’ compensation claim. Call, text, or email top-rated attorney Corey Pollard today for help. We’ve filed workers’ comp claims for hundreds of injured employees across Virginia. And we can help you win your case and negotiate a valuable workers compensation settlement.

 

What is a Workers Compensation Claim in Virginia?

 

You’re probably reading this article because you’re not a Virginia workers compensation expert. We get it. Corey Pollard is an experienced workers compensation attorney who has helped hundreds of disabled employees file a workers compensation claim. So we’ll start from the beginning by explaining what is a workers compensation claim in Virginia.

 

Over the course of representing hundreds of injured workers we’ve noticed a trend. Most injured employees want to get the workers compensation benefits they deserve but are worried about “suing” their employer. They don’t want to cause too much trouble for supervisors and bosses that they like and, in many cases, have spent years with.

 

We tell them not to worry. A workers compensation claim is a claim against the employer’s insurance policy, not a personal injury lawsuit. There are key differences between a workers compensation claim and a personal injury action filed in civil court.

 

In a “normal” lawsuit you file a complaint against a negligent party in civil court and ask their insurance company to pay you a monetary amount for damages related to your accident and injury.

 

Virginia workers compensation doesn’t work that way. It is much more complicated. In fact attorneys who don’t regularly practice before the Virginia Workers’ Compensation Commission are often confused by its rules, procedures, and case law.

 

Here’s an example. Back when I represented employers and insurers in workers’ comp claims I remember showing up to a hearing against an attorney who had no experience with Virginia workers comp. Though he regularly represented injury victims in personal injury claims, he had no idea what he was doing at the workers compensation hearing. He asked for benefits that are not available under Virginia workers comp and was scolded by the judge. You don’t want to be in that situation.

 

Let’s break it down:

 

When you file a workers compensation claim you are filing a claim against your employer’s insurance policy. Almost all employers in Virginia are required to carry workers’ compensation insurance for the benefit of their employees.

 

It doesn’t matter what caused your work accident: an unavoidable accident, a third party acting negligently, your own negligence, your employer’s violation of an OSHA safety rule, or a co-worker’s mistake. A workers compensation claim is an insurance claim seeking benefits for a work injury or occupational disease.

 

Filing a workers compensation case in Virginia is not the same as suing your employer. In fact you cannot sue your employer for a job injury or occupational illness, except in rare circumstances. This is why the Virginia General Assembly has passed laws that require almost all employers to purchase workers compensation insurance.

 

If your employer is supposed to have workers compensation insurance but did not purchase it, then you can seek benefits through the Uninsured Employer’s Fund (UEF). The UEF will seek reimbursement from your employer.

 

Workers compensation helps injured workers in that it provides benefits even if the accident was the worker’s fault. It helps employers by allowing them to avoid large jury verdicts that could cripple their business and force them to file for bankruptcy or close.

 

What Can You Receive if You File a Workers Compensation Claim in Virginia?

 

In Virginia workers compensation insurance pays two types of benefits in most cases:

 

  • Medical benefits – you’ll receive medical treatment for the work injuries caused or exacerbated your accident (referred to as a lifetime Award of medical benefits); and,

 

  • Indemnity benefits – these are cash payments for lost wages, permanent disability, and possibly a lump sum settlement to resolve your workers comp claim.

 

You should file a Virginia workers compensation claim against your employer’s insurance policy if you are hurt on the job. It doesn’t matter what type of accident (slip and fall, car accident, electrocution, etc.) or occupational disease (heart disease, lung disease, cancer, carpal tunnel syndrome, etc.), you should still file a workers compensation claim in Virginia. Then contact a skilled Richmond workers compensation attorney or workers compensation lawyer in Virginia Beach who can represent you no matter where you’re located in the state.

 

What Information Should You Include When Filing a Workers Compensation Claim in Virginia?

 

There are specific steps you must follow to file a Virginia workers compensation claim. Failure to follow these steps can keep you from getting the benefits, medical care, and settlement you deserve.

 

The Virginia Workers’ Compensation Commission’s Rules require you to put your claim for benefits in writing and to sign your name. Your workers comp claim should include the following:

  • Your name, address, and telephone number.

 

  • Your employer’s name, address, and telephone number.

 

  • The date of your work-related accident.

 

  • A brief description of the accident. Do not make this too detailed. If you were injured in a car wreck, write “motor vehicle accident.” If you slipped on liquid and fell, write “slip and fall.”

 

  • If you are claiming an occupational disease, and not an injury, write the date a doctor told you the occupational disease is related to your employment.

 

  • All body parts injured. Do not leave any out. Err on the side of listing too many and being too specific. If you leave out a body part and your claim is litigated or you do not file a supplemental claim for workers comp, then you may waive a claim for that body part.

 

  • Your pre-injury average weekly wage.

 

The Virginia Workers’ Compensation Commission provides a Claim for Benefits form. The form has two sections: Part A and Part B. Part A asks for the information discussed above. Part B asks you to specify which benefits you are seeking.

 

Even if you are not seeking benefits at this time, we recommend completing Part A of the Claim for Benefits. Why? Because you protect your legal rights to benefits when you complete and file Part A of the Virginia workers comp claim form within the applicable statute of limitations. This is what’s known as an Assertion of Rights.

 

You do not have to use the commission’s Claim for Benefits form. If you write, sign, and file with the commission a letter that contains the details discussed above, the commission will consider that a valid workers’ comp claim.

 

We recommend contacting an attorney before filing your Virginia workers compensation claim. We’ve seen insurance companies use information provided on the claim for benefits form to fight claims.

 

For example, let’s say you are a construction worker who has to lift five heavy bags of concrete. On the third bag you feel a sharp pull and immediate pain. If you file a claim that states you hurt your back while “lifting bags.” the insurer will argue that you suffered a repetitive motion injury that should not be covered under the Virginia Workers’ Compensation Act. As your attorney we will take care of filing all workers compensation claims on your behalf so that you do not give the insurance company additional ammunition to dispute your claim.

 

What Documents Should You Include When You File a Virginia Workers Compensation Claim?

 

You do not have to file additional documents such as medical records with your workers’ compensation claim. But you should.

 

The commission will not schedule your workers comp claim for a hearing before a deputy commissioner until you file medical evidence to support your claim. By not filing medical records with your claim, you are delaying the process. Delay helps the insurance company, not the injured employee.

 

There is another reason to include medical records and reports with your claim for Virginia work comp. It lets the insurance company know you are serious about protecting your rights and getting all the types of workers compensation benefits to which you’re entitled. Though we understand you want to file your claim as soon as possible, it often makes more sense to wait until you get medical records and an opinion statement from your authorized treating physician.

 

Also, not filing medical records and reports with your work injury claim may lead to the employer filing a motion to dismiss your claim. Rule 1.3 of the Rules of the Virginia Workers’ Compensation Commission is titled “Dismissal Upon Failure to File Supporting Evidence.” Under the rule your claim may be dismissed if you do not file supporting evidence within 90 days after your claim for benefits is filed. So the clock starts ticking when you file a claim.

 

Where to File Your Workers Compensation Claim: Use the Virginia Workers Compensation Commission’s WebFile System

 

You have several options to file a claim for benefits with the Workers’ Compensation Commission in Virginia.

 

You can file your claim electronically using the commission’s WebFile system. Before filing electronically you should register for a WebFile account.

 

WebFile is the commission’s electronic portal. It came on line in 2010 when the commission began transitioning to a paperless system. Injured employees, attorneys, and claims administrators can access their case files through WebFile.

 

WebFile allows users to do a number of things. You can:

 

  • File claims for benefits, change in condition applications, motions, and other pleadings

 

  • File medical records, reports, and questionnaires

 

  • File discovery answers and job search efforts

 

  • View all documents that have been filed in your case, either by you, the insurance company, or the Commission

 

WebFile contains a number of other features. It has many “web forms” available, which it pre-populates with information about your claim. So if you want to file a change in condition application, you do not have to re-enter the caption of your case, file number, date of injury, or contact information for you or the employer.

 

You can view or file documents through WebFile around the clock. It is available 24 hours per day, 365 days per year, as long as it not going through a technical upgrade. So long as you file the document by midnight, it will be considered as filed on that day. You do not have to worry about going to the post office.

 

We recommend that all of our clients ask the commission for access to WebFile. We want you to follow along and stay informed on how your case is progressing as we battle for your benefits. Not only can an injured employee view all Virginia workers compensation claims for benefits filed, they can also see documents filed by the insurer and entered by the commission.

 

You can also file your claim for Virginia workers compensation by mail or in-person. The commission is headquartered at 333 E. Franklin St., Richmond, VA 23220. Or you can fax the claim for benefits form to (804) 367-6124. We recommend avoiding fax. If you cannot file your claim in person, then send it by certified mail return receipt requested.

 

Another option is to have your workers compensation lawyer file the initial claim for benefits and all other change in condition applications. We take care of all the paperwork when you hire us to help you with your work accident claim.

 

What Happens When You File a Virginia Workers Compensation Claim?

 

When you file a workers comp claim the commission gains jurisdiction over your case. Your claim puts into motion a series of events to determine whether you suffered an injury by accident or occupational illness that arose out of and in the course of your employment and what benefits you’re entitled to.

 

You must file your claim within the applicable statute of limitations or you may forfeit your rights to benefits or a lump sum workers compensation settlement.

 

If you requested a workers compensation hearing to determine your entitlement to temporary total disability, permanent partial disability, permanent total disability, death benefits, or lifetime medical benefits then your claim will be referred to the hearing docket and scheduled for trial. The commission decides which judge will hear your case.

 

Filing a workers compensation claim in Virginia does two other things as well.

 

It stays debt collection activities by medical providers for treatment related to your accident until the case is resolved. So if you get calls or letters from debt collection agencies because of unpaid medical bills, make sure you let your attorney and the commission know so that they can take action.

 

Second, filing a workers compensation claim prevents medical providers from balance billing you for supplies and services related to the work accident.

 

Answers to Common Questions about Filing Virginia Workers Compensation Claims

 

Do I need my employer's permission to file a workers' comp claim?

No. You do not need your employer’s permission to file for Virginia workers’ comp. If your employer is giving you a hard time about reporting a work-related accident, make sure you document your efforts to get the necessary information. And make sure you report and give notice of your accident!

 

Unfortunately it is common for employers to pressure injured employees not to file for work comp. Many companies have safety incentive programs that reward employees for consecutive days without injury. Or they may not want to have to deal with more paperwork. This puts internal peer pressure on the injured worker to not file. It does not, however, help out the injured worker when he or she needs medical care and payment for lost wages. Ignore the peer pressure.

 

Most employers will go the extra mile to help their injured employees get the benefits they need. But some will ignore your request for work comp information. Remember to do what is necessary to protect yourself. We recommend contacting a Virginia workers compensation lawyer to protect your legal rights.

Do the employer or its insurance carrier have to file a workers' compensation claim for me?

Neither your employer or its insurance company are required to file a workers compensation claim on your behalf. And in our opinion, you should not ask the employer or insurer to file a claim for you.

 

Why? Because the employer and insurer’s description of the accident and injuries on the Claim for Benefits form may not be correct or complete. Or worse, it may describe an injury that is not compensable under the Virginia Workers’ Compensation Act. The employer’s insurance carrier may then turn around and use the language of the Claim for Benefits form to argue that you should be denied benefits.

 

No matter what your employer or the insurance claims adjuster tell you and what documents the 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.

What does the insurance company have to file after I report my workplace injury?

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 partial 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.


Is the insurance company's claims report considered a workers' compensation claim?

Usually the insurance company will file a claims report with the Workers’ Compensation 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.


Will my employer fire me if I file a workers' compensation claim?

We cannot predict what your employer will do. But if they fire you because you filed a claim then they are breaking the law. It is illegal for your employer to retaliate against you because you filed a workers’ compensation claim or testified as a witness at a workers’ compensation hearing.

 

Even though it is illegal to retaliate against you, your employer may try to pressure you into not filing a claim and using your private health insurance after a work injury. Some employers are direct and in your face about it. They may ask you to not file a claim.

 

Other employers are more subtle and will start to suggest they won’t have any work available for you if do not get released to full duty soon. Don’t give in to the pressure. You and your employer do not have the same interests. You must look out for your best interests!

Why should I file a workers' comp claim if I suffered a minor injury?

We see it time and time again. An employee gets hurt on the job and thinks he or she suffered a minor injury. Unfortunately the minor injury leads to major problems a few weeks or months later.

 

Or maybe the employer and insurer do not take the work-related injury seriously. What would ordinarily be a small, medical only claim with no time lost from work turns into a claim for long periods of lost time because the insurer did not provide adequate medical care to the injured employee – or stops providing medical care when there is a referral to a specialist.. This is exactly how minor work injuries turn into big workers comp claims. So file a claim to protect yourself.

Why file a workers' compensation claim if the employer and its insurance company are paying for my medical treatment?

Paying for treatment or wage loss voluntarily does not mean the insurance company and your employer are accepting your claim. We see it happen often – the insurance company pays for medical treatment and sends temporary total disability benefits for a few weeks or months, then decides to deny the claim and stops making payments. By filing a claim for benefits you can reduce the delay while your claim is litigated. Don’t be lulled into a false sense of security.

Will I have to go to court if I file a workers' compensation claim?

Whether you have to go to court after filing a workers compensation claim depends on whether the insurance company accepts or denies your claim.

 

If you and the insurance company are unable to resolve the issues, then the Workers’ Compensation will schedule your claim for a hearing in court before a deputy commissioner.

 

If the insurance company accepts your claim, or if you negotiate a workers’ compensation settlement or stipulation, then you will not have to go to a hearing in court to prove that you suffered a compensable injury.

 

You may, however, have to go to a hearing at a later date if the insurance company denies your entitlement to ongoing wage replacement benefits or medical treatment as your recovery progresses.

Does filing a workers compensation claim start the Social Security Disability or Long Term Disability process?

No. Though claims for workers’ comp, long term disability, and Social Security Disability (SSDI and SSI) are often related, they have separate procedural steps.

 

In addition to representing clients in workplace accident claims, we are also experienced SSD lawyers and long term disability attorneys who can help you get every single penny you’re owed for your injuries from all available sources.

Call an Attorney Before You File a Workers Compensation Claim in Virginia

Call, text, or e-mail Corey Pollard if you have a question following your work-related accident. It can be anything from, “How do I file a workers compensation claim in Virginia?” to “What doctor should I see?” You can also check out our answers to workers’ compensation questions.

 

We help injured workers across the state prosecute well-developed workers compensation claims so that they can obtain top-dollar Virginia workers compensation settlements. And if you’re unable to return to work, our Social Security Disability lawyer will help you get all the benefits you deserve under every possible program.

 

Don’t wait! Contact our Virginia workers compensation claims lawyer today for a free strategy session.