Filing a Workers Compensation Claim in Virginia
Do You Want to Know How to File a Workers Comp Claim for Benefits in the Commonwealth of Virginia? Here are Tips for Submitting an Initial Claim that Gets the Insurer’s Attention and Increases the Likelihood of an Accepted Claim or a Reasonable Settlement.
Workers compensation is a no-fault legal system that provides lifetime medical treatment, income replacement, and compensation for permanent partial disability for most work-related injuries and illnesses.
However, as an injured worker, you must file a claim with the Virginia Workers Compensation Commission to protect your right to available benefits. (Read this article if someone told you that filing a workers compensation claim is bad. They are wrong.).
If you do not alert the Commission of your occupational injury or illness by filing a claim within the applicable deadline (a statute of limitations), this failure could stop you from receiving medical care or cash payments at the employer or claim administrator’s expense.
This article explains how to file a claim to protect your legal rights and begin Virginia’s workers’ compensation process.
Indeed, it goes a step further and shows how to complete the workers compensation claim form and what to include to strengthen your case and persuade the employer and their insurer (or claim administrator such as Sedgwick, ESIS, or Gallagher Bassett) to offer an Award Letter or pay a fair settlement without litigation.
After reading this article, you will know the steps for applying for workers compensation benefits and what documents to attach to the claim form to increase the likelihood the insurer will accept your case and set high insurance reserves that drive up the potential workers compensation settlement value.
Keep reading to learn more.
If you want to talk to a top-rated work injury attorney, call our firm at (804) 251-1620 or (757) 810-5614. We have helped hundreds of injured workers get results that provide financial security.
What is a Claim?
A claim is a demand for money, property, or a right provided by law.
What is the Importance of Filing a Workers Compensation Claim?
Virginia courts have said that filing your workers comp claim “sets in motion the machinery to determine whether or not an employee has in fact been injured, the nature of the injury, whether it arose out of and in the course of his employment, whether permanent or temporary, and whether compensable or not. This is the notice which activates the right of the employee to compensation, and which invokes the jurisdiction of the Industrial Commission.”
What Does It Mean to File a Workers Comp Claim in Virginia?
The Virginia Workers Compensation Act and judicial precedent (case law) interpreting the Act require you to notify your employer of an occupational injury in writing within 30 days of the accident. Otherwise, the insurer can raise a notice defense and argue that your delayed reporting of the accident prejudiced its ability to investigate the claim, barring you from receiving benefits.
Virginia does not consider this written notice to the employer or its claim administrator to be filing a workers compensation claim. Telling your employer or its insurer about the occupational injury is insufficient. You must also inform the Commission so it can create a case file for your injury in its system.
However, the Virginia Workers Compensation Act does not define “claim.”
Instead, the Workers Compensation Commission’s Rules and case law say that an injured employee must sign the original claim for benefits and include the information discussed in later sections.
Forms of Filing a Workers Comp Claim
You satisfy the claim filing requirement by filing a legal document (also called a pleading) that includes specific information directly with the Workers Compensation Commission.
You can use multiple forms for your workers comp claim.
Indeed, a formal pleading is not needed. So long as your document tells the Commission of the necessary elements of your claim, it activates your right to compensation.
The two forms for completing a claim are:
- Fill out the template “Claim Form” developed by the Commission.
- Submit a letter
If you do not file this claim with the Workers Compensation Commission or if you file it after the statute of limitations expires, the judge (called a deputy commissioner) may deny your claim. A denied claim means you cannot receive medical coverage or wage loss payments for your work-related injury.
Who Can File a Workers Compensation Claim?
Anyone can file a claim form on behalf of an injured worker, including family members, friends, attorneys, social workers, medical providers, and employers.
But do not rely on others. Instead, file the Virginia workers compensation claim yourself.
As the injured worker, you must ensure the prompt filing of claims for benefits and requests for hearings with the Workers Compensation Commission.
The employer may file a claim on your behalf, but it does not have to. Indeed, its responsibility is limited to reporting the accident or disease to the Commission within ten days or risking a civil fine under Code Section 65.2-902.
Further, we do not recommend asking your supervisor, human resources manager, or safety manager to file a workers comp claim for you. They may include incorrect information on the form, making obtaining benefits more difficult.
For example, we have seen employers file claims with inaccurate accident descriptions that suggest an injury not covered under workers comp laws (such as repetitive motion/cumulative trauma). This erroneous information led the insurer to deny the claim and protracted litigation.
In addition, employers may file claims listing the wrong body parts (or not all of them) or a lower pre-injury average weekly wage, which affects your claim’s value.
How to Fill Out a Workers Compensation Claim Form or Submit a Complete Letter Claim
Regardless of which format you choose, a valid workers comp claim requires basic information about you, your employer, and the accident date. Then it provides specific information about how the accident occurred, what injuries you suffered, and the types of benefits claimed.
Remember to take your time and fill out the form accurately.
Any inconsistencies between this form, your deposition or hearing testimony, your medical records, and incident reports completed by the employer may harm your case.
Here is the information you should include when completing the claim:
- Injured worker’s name and address (double check this so you receive all correspondence from the Commission.
- Employer’s name and address.
- Accident date.
- Injured body parts (include every injury and condition – even preexisting degenerative disc disease – listed in your medical records).
- How the workplace accident happened (include details if the claim appears compensable and the insurance company has made voluntary payments; otherwise, use a generic description on the form if the insurer may argue that a specific employment risk did not cause the injury).
- Benefits sought (lifetime medical, temporary total disability, temporary partial disability, compensation for permanent loss (permanent partial disability), payment or reimbursement of medical bills, mileage, or prescriptions, death benefits, or other relief, such as authorization of surgery). Check any benefit that may apply; you can always reserve specific claims if they are not ripe for adjudication. You must say what specific benefits you want; the Commission has held that an award for medical benefits is the only type of award implicit in a first request for hearing.
- Periods of disability if you claim wage loss benefits. The Commission is not authorized to award benefits you do not ask for. Therefore, you must ask for cash payments for all time missed from work or wage loss.
But your goal should not be a bare-bone, “basic” pleading. Instead, we recommend filling out the claim for benefits and attaching more letters and evidence that persuade the insurer that you have a prima facie compensable injury.
For example, you should file this information and paperwork through WebFile when you file the claim for benefits.
- Gross Weekly Earnings: Tell your pre-tax income from the employer, including overtime pay and bonuses. Attach income tax or earnings statements supporting the number. This figure controls how much you receive in wage loss and disability payments. If the employer disagrees with your number, it must produce a wage chart.
- Injury Location: The injury location governs what judge will hear your case and where the trial will happen. Suppose your injury occurred far from your residence or your employer’s principal place of business. In that case, you may move to transfer the venue to somewhere with a more claimant-friendly judge. (We serve auto accident victims and injured workers in every city, county, and town in Virginia).
- Medical Records: Submit your reports for treatment for the work-related injuries beginning the accident date and continuing. You do not need to obtain office visit notes for health care received in the past.
- Doctor Disability Letters: Asking your doctor to state the relationship between the work accident and the need for medical treatment (causation) and disability (total or light-duty restrictions) before you file a claim for benefits gives you leverage. In addition, a physician’s opinion on future medical expenses or when you will reach maximum medical improvement (MMI) helps increase the settlement value of your case.
- Photographs of the injury or the accident scene: For example, pictures of cuts, vehicle damage, and bruising can persuade the claims adjuster to stipulate compensability and start paying benefits.
An Insider’s Tips to Drafting a Claim that Protects Your Right to All Potential Workers Compensation Benefits
Deciding what periods of disability benefits or type of indemnity payments you can receive is challenging if you are unfamiliar with the workers compensation system.
Therefore, we offer these three tips when writing your letter claim or completing the Commission’s claim form:
- Write this sentence: “I claim and reserve my right to seek all benefits to which I may be entitled under the Virginia Workers Compensation Act.”
- Request both temporary total and temporary partial disability benefits beginning the accident date and continuing. You can always amend the periods if you return to work or do not have medical evidence to support the entire period.
- Check that you seek permanent partial disability for loss of use of the injured body parts, then write that you reserve this claim in the template form’s “Other” section.
This advice has stood up to insurance company challenges in past cases.
Instructions for How and Where to File the Virginia Workers Comp Claim
You have five options to file a workers compensation claim in Virginia:
1. By WebFile (Online): The fastest way to file your claim is electronically using WebFile, the Workers Compensation Commission’s electronic filing system. WebFile is an online portal that allows you to file claims, upload evidence, and review all letters generated by or sent to the Commission by any party. However, you must know your Jurisdiction Claim Number (JCN) and Personal Identification Number (PIN) to use this electronic portal.
2. In-person (hand delivery): The second method is to fill out the Claim for Benefits Form and deliver it to one of the Workers Compensation Commission’s offices (Richmond, Bristol, Fairfax, Harrisonburg, Manassas, Roanoke, or Virginia Beach). Remember to bring a photo ID (driver’s license).
3. By mail: You can mail a workers comp claim to the Commission’s headquarters at 333 E Franklin St, Richmond, VA 23219, or one of the Commission’s regional offices.
If you choose this method for filing a work comp claim, send it by certified mail return receipt requested.
The Commission considers any claim sent by certified mail as filed when mailed. Otherwise, the Commission will only consider your workers compensation claim filed once received. A delay may create problems if the Commission receives the claim form after the statute of limitations expires.
4. By fax: A fourth choice is to fax the workers compensation claim to (804) 367-6124. However, I recommend avoiding this method because it depends on someone else noticing your fax and noting the pleading.
5. By counsel: A fifth way is to ask your workers comp lawyer to file your claim. We review and file all the paperwork for our clients with the Commission.
Do I Need a Lawyer to File a Claim for Workers Compensation in Virginia?
No.
The law allows you to file a workers comp claim without an attorney.
However, it is always a good idea to speak with an attorney before filing a legal document, such as a claim form, because a mistake on the form can dictate the outcome of your case.
Moreover, certain circumstances strongly suggest the need for a lawyer’s experience and knowledge before filing a claim. Their expertise can be invaluable in navigating complex legal processes.
For example, we recommend hiring a lawyer to fill out the claim if one or more of the following situations has occurred:
- Your employer refuses to provide its workers compensation insurance information.
- The insurer demands that you provide a recorded statement before paying benefits.
- The insurer denies your claim.
- Your doctors are hesitant to provide medical work restrictions even though you feel incapable of returning to work.
- You have a third-party civil action arising from the workplace injury. For example, you may have both types of cases if you suffer injuries in a car accident while on the job.
- You have past work injuries or automobile accident claims. Insurers usually contest cases with these facts.
What Happens After I File a Claim Form with the Virginia Workers Compensation Commission?
After you file a workers comp claim with the Commission, the Commission will do one of two things.
First, you will be asked to submit medical evidence if you did not follow the advice in this article and attach those reports to your claim for benefits.
Second, the Commission will order the claim administrator to respond to your claim and tell the Commission if it accepts the claim, denies it, or needs further investigation. Therefore, this letter is like the defendant’s answer in a civil action for personal injuries.
Depending on the insurer’s response, you may need to ask the Commission to docket your claim for benefits for a workers comp hearing where you can present evidence.
We Help Injured Employees File Virginia Workers Compensation Claims that Get Results
Filing a workers comp claim that describes a compensable injury by accident or occupational disease and includes documents showing legal and medical causation and disability will expand the scope of pretrial discovery and scare the insurance adjuster into making a reasonable settlement offer.
In addition, submitting a claim that shows you know the procedural rules and what you must do to satisfy your burden of proof allows you to demand a better settlement.
Contact our work injury law firm to start on the path to financial, physical, and mental healing. We have helped thousands of injured employees file their claims for workers compensation and navigate the system to a fair resolution.
And we want to do the same for you.
We have offices in Richmond, Newport News, Baltimore, Hagerstown, and Cambridge, allowing us to serve injured workers across the Commonwealth of Virginia. Contact us today.
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