Workers’ Compensation Law in Virginia – Understanding the Claims Process

 

Attorney Corey Pollard Guides You Through the Virginia Workers Compensation Claims Process Step-by-Step

 

Many injured employees believe that their workplace injury is covered under the Virginia Workers’ Compensation Act if their employer or its insurance carrier accepts their claim and pays workers’ compensation benefits voluntarily. But that isn’t true. You must take additional action to protect your rights under Virginia workers’ compensation law.

 

This article provides an overview of the workers’ compensation claims process in Virginia and explains the flow of a typical case. Though this article is not intended to apply to every case, we hope that it provides some background information on workers’ compensation law so that you can maximize the value of your claim and improve your chance of a financial, physical, and emotional recovery after your workplace accident.

 

Keep reading to learn more. If you have any questions about the workers compensation claims process or Virginia workers’ comp law, or are looking for legal representation, call, text, or email attorney Corey Pollard today. Your consultation is free. And there is no fee unless you get approved for benefits or resolve your claim.

 

Virginia Workers Compensation Claims Process for an Accepted Claim

 

Your Employer’s Compliance with Workers’ Compensation Law

 

The workers’ compensation claims process starts before you are injured at work.

 

Most employers in Virginia are required to carry workers’ compensation insurance. Even if your employer violates workers’ compensation law and fails to purchase coverage when it is supposed to, you may still be entitled to workers’ compensation benefits through the Uninsured Employer’s Fund.

 

Get Necessary Medical Treatment for Your Workplace Injury

 

Timeline: Immediately

 

If you’ve been hurt at work, you should seek medical attention right away. Go to the nearest doctor, urgent care center, or hospital immediately.

 

Though most injuries are noticeable when they happen, some are difficult to detect right away. It may take days, weeks, or even a month before you realize how bad you were hurt on the job. That’s why it’s important to seek medical care after your work accident, even if you think you’ll be fine.

 

When you see the medical provider, make sure you tell him or her that you were injured at work. The medical record generated at your first appointment is an important part of proving your workers comp case. If the note does not mention a work injury, then you will have a difficult time obtaining the benefits you deserve. It doesn’t matter how good your attorney is.

 

The medical provider should contact your employer or the workers compensation insurance company when you tell him or her that you were hurt at work. Under Virginia workers compensation you do not have to pay any co-pays at your appointments and the medical provider cannot bill you for any charges written off by the workers compensation insurance carrier.

 

Give Notice of Your Workplace Injury to Your Employer

 

Timeline: As Soon as Possible and Within 30 Days of Your Injury

 

When you’re hurt in a work-related accident, it is important that you notify your employer immediately. In Virginia you have 30 days from the date of the injury to notify your employer that the accident and injury occurred. The notice should be in writing, though other forms of notice may be accepted by the Commission.

 

Though you have 30 days to report the injury, we recommend reporting it right away. The longer you wait the more difficult it may be to prove a compensable accident and the more likely it is that the employer and its insurance carrier will dispute your claim.

 

Your Doctor Completes Attending Physician’s Statement

 

Timeline: Within 1 Week of Your Injury or As Soon As Possible

 

We recommend asking your treating physician to complete an Attending Physician’s Report as soon as he or she treats you. Your physician should send a copy of the report to your attorney.

 

You may obtain multiple Attending Physician Reports throughout the course of your workers’ compensation claim.

 

File a Claim for Benefits with the Virginia Workers’ Compensation Commission

 

Timeline: As Soon as Possible and Within 2 Years of the Date of Injury

 

Original Claims/Initial Claims

 

Either you or your workers’ compensation attorney can prepare the Claim for Benefits/Request for Hearing form and file it with the Workers’ Compensation Commission (WCC). You must file this form within 2 years of the accident.

 

We recommend filing the Claim for Benefits/Request for Hearing form online, using the Workers’ Compensation Commission’s WebFile system. You should also send the signed claim to the Workers’ Compensation Commission by certified mail.

 

Your Claim for Benefits form should specify the exact benefits you are seeking: temporary total disability; temporary partial disability; permanent total disability; permanent partial disability; lifetime medical; reimbursement of mileage or other out-of-pocket medical expenses; authorization and payment of medical treatment; vocational rehabilitation; or, a change in treating physician.

 

We encourage you to file a claim for workers compensation even if you think your injury was minor and even if you did not miss much time from work.

 

There are two reasons for this:

 

1. Seemingly minor injuries have a way of becoming major injuries if ignored or not treated properly. By establishing that you suffered a work injury early on, you protect yourself financially and medically if things get worse. You’ll wish you had tax free workers comp benefits if your condition worsens.

 

2. Medical bills are expensive. Make the workers compensation insurance company act responsibly and pay for medical treatment related to your employment.

 

Change in Condition Application for Additional Missed Workdays

 

Timeline: Any Time After Your Claim is Accepted as Compensable

 

You must claim all body parts injured due to your work accident within two (2) years of the date of the accident. You may have additional time if you are seeking a lifetime Award of medical benefits for a compensable consequence injury.

 

Change in Condition Application for Additional Body Parts Injured

 

Timeline: Any Time After Your Claim is Accepted as Compensable

 

If your initial award for benefits has ended, either because you returned to work or because your attending physician released you to full duty, you must file a new claim for benefits covering each additional day or period missed from work. Additional compensation will not be awarded more than 90 days before the filing of these claims, so you must act quickly and file a new claim whenever you miss more time from work.

 

First Report of Injury

 

Timeline: Within One Week of the Employer Receiving Notice of Your Work Injury

 

When an employer receives notice of a work injury, it should report the injury to its insurance company. Either the employer or its insurance carrier should then complete a First Report of Injury that is filed with the Workers’ Compensation Commission.

 

Notification of Rights

 

Timeline: Within 1 Week of the First Report of Injury Being Filed with the Commission

 

The Workers’ Compensation Commission will send you an informational pamphlet after it receives the First Report of Injury from your employer and insurer. The pamphlet explains your rights and responsibilities following a workplace injury.

 

Insurance Company Sends You a Written Statement of Your Rights

 

Timeline: Within 21 Days After the Insurance Company Receives Notice of Your Accident

 

Your employer’s insurance company should provide you with a letter and a statement of your rights under the Workers’ Compensation Act within 21 days after it receives notice of the work injury. This doesn’t always happen though, so you must be proactive to protect your rights.

 

Insurer Offers an Award Agreement Form

 

Timeline: Varies

 

If the insurance carrier accepts your claim, it should send you an Award Agreement form. Make sure that the information on the form is complete and accurate, then sign and file it with the Workers’ Compensation Commission.

 

Notice of Award Order

 

Timeline: Within 1 Week of Submission of the Award Agreement Form to the Commission

 

The Workers’ Compensation Commission will enter an Award Order upon receipt of the agreement form. The Award Order protects your rights as an injured worker. Do not stop pursuing your rights until an Award Order is entered that covers all the benefits sought.

 

Payment of Benefits

 

Timeline: After the Commission Enters the Award Order

 

The employer’s insurance company should begin making wage loss payments after the Award Order is entered, though sometimes you will receive payment prior to entry of the Award Order.

 

Agreement to Stop Weekly Workers’ Compensation Payments

 

Timeline: Varies

 

The parties should sign a Termination of Wage Loss Award when they agree that weekly benefits should be stopped or reduced. Do not sign this form without consulting with a workers’ comp lawyer. If additional wage loss or injury is incurred after you sign this form, you should file an additional Claim for Benefits, which is discussed above.

 

Reaching Maximum Medical Improvement and Obtaining Permanent Partial Disability Benefits

 

Timeline: Varies Depending on the Nature of the Injury

 

After you reach maximum medical improvement for your work-related injuries, your attorney will work with your treating physician and other medical providers to obtain a permanent impairment rating. This rating helps determine the amount of permanent partial disability benefits you’re entitled to.

 

If the employer and insurer disagree with your proposed permanent impairment, they may seek a hearing on the issue.

 

Negotiating a Full and Final Workers’ Compensation Settlement

 

Timeline: Varies Depending on Several Factors

 

At any time the parties can agree to resolve the claim through a full and final workers’ compensation settlement. The WCC must approve the settlement before it becomes final.

 

Virginia Workers Compensation Claims Process for a Disputed Claim (Hearing Process)

 

Accepted and disputed workers’ compensation claims share many of the steps. Keep reading to learn more about Virginia workers’ compensation law when the insurance company disputes your entitlement to benefits and a hearing is necessary.

 

You File a Request for Hearing

 

Timeline: When You File a Claim for Benefits

 

When filing a Claim for Benefits, you are permitted to request a workers’ compensation hearing before a deputy commissioner.

 

If you have filed a claim but did not request a hearing, write to the Commission and ask that your claim be docketed for hearing.

 

Virginia Workers’ Compensation Commission Issues a 20-Day Order

 

Timeline: Within 3 Days of Filing Your Claim

 

Once the WCC receives your Claim for Benefits form and supportive medical records, it will issue a 20-Day Order to the employer and its workers’ compensation insurance carrier. The 20-Day Order ask the employer and its insurer to indicate their response to your claim (i.e. whether the claim is accepted and agreement forms will be sent or whether the claim is denied). You will receive a copy of the 20-Day Order, but you do not need to complete it.

 

Workers’ Compensation Mediation Session

 

Timeline: Varies

 

If both parties are represented by counsel, they may contact the Mediation scheduler and ask for Commission-facilitated mediation. If mediation is not successful then the case is returned to the hearing docket for trial.

 

Your Case is Assigned to a Workers’ Compensation Judge

 

If the employer responds to the 20-Day Order by stating that your claim is being denied or only accepted partially, then the Workers’ Compensation Commission will refer your claim to the hearing docket and assign it to a judge.

 

Workers’ Compensation Hearing Scheduled

 

Once your claim is assigned to a deputy commissioner, the Commission will notify the parties in writing as to the date, time, place, and length of hearing. You may request additional time for hearing.

 

Parties Conduct Discovery

 

We recommend conducting discovery during the period between filing of your claim and the workers’ compensation hearing.

 

Discovery includes issuing interrogatories, requests for production of documents, and requests for admissions, visiting the accident scene, talking with expert witnesses to obtain supportive reports, and deposing witnesses. This information is necessary to determine what issues are in dispute and to give you the best chance possible of winning your workers comp claim.

 

During this period your attorney will file any motions necessary to increase your chance of success. Most motions focus on discovery and evidentiary issues.

 

Pre-Hearing Statement Order

 

Timeline: 7 Days Prior to Hearing

 

Many deputy commissioners with the Workers’ Compensation Commission require the parties to complete a joint Pre-Hearing Statement Order at least 7 days prior to the scheduled hearing date.

 

The Pre-Hearing Statement Order asks the parties to identify the following:

 

  • Nature of the claim (theory of case, date of injury, body parts injured, occupational disease claimed, etc)

 

  • Benefits sought

 

  • Defenses raised

 

  • Average weekly wage alleged

 

  • Facts stipulated to

 

  • Witnesses that will be called to testify

 

  • Whether post-hearing evidence is necessary

 

Failure to file a Pre-Hearing Statement Order may lead to sanctions, including the exclusion of evidence or dismissal of your claim.

 

Workers’ Compensation Hearing

 

Timeline: Roughly 120 Days After You File Your Claim for Benefits

 

At the hearing you must present evidence to support your claim for benefits. The employer and its insurance carrier will have the opportunity to present evidence against your claim.

 

You have the burden of proving your case. You should bring letters, reports, records, and statements that support every aspect of your case.

 

Workers’ Compensation Judicial Opinion Issued

 

Timeline: One Week to Ten Weeks After the Workers Compensation Hearing

 

The deputy commissioner who presides over your hearing will not issue a decision at the hearing. The parties must wait to receive the deputy commissioner’s written opinion. A copy will be filed by the Commission via WebFile and sent by regular mail.

 

Appealing the Deputy Commissioner’s Opinion to the Full Commission

 

Timeline: One Day to 30 Days After the Judicial Opinion is Issued

 

Both parties have 30 days from the date of the deputy commissioner’s written decision to file an appeal with the full Workers’ Compensation Commission.

 

Filing Position Statements with the Full Commission

 

Timeline: 2 Weeks to 6 Weeks After the Appeal is Filed

 

After a party appeals the deputy commissioner’s written decision, the full Commission will issue a schedule for written position statements. You must file your position statement by the stated deadline.

 

Your Attorney for the Virginia Workers Compensation Claims Process

 

As you can see, Virginia workers’ comp law is complex and there are many steps involved in the workers’ compensation claims process. The overview above does not include everything. It is just the start.

 

Understanding the workers’ comp claims process is necessary to winning your case and negotiating a top-dollar workers’ compensation settlement. But figuring out the workers’ comp process is complicated and obtaining all the benefits and wage loss payments you’re owed is much more difficult than most people thing. Many injured workers are denied benefits because they do not seek legal representation.

 

Workers’ comp attorney Corey Pollard has helped hundreds of injured workers throughout the state, including in Richmond, Newport News, Norfolk, Fairfax, and Virginia Beach with their workers compensation claims. We have the resources, skill, and experience to help you navigate the workers’ comp claims process and give you the best chance of a full recovery under Virginia workers’ compensation law.

 

Call, text, or email us today so that we can help you with the workers compensation claims process. There is no fee unless we obtain benefits or compensation on your behalf.