Virginia Workers’ Compensation Rules: The Commission’s Rules 1–13, Explained

Corey R. PollardWorkers’ compensation attorney · Former insurance defense · $100M+ recovered

One procedural misstep can end a workers’ comp claim before a deputy commissioner looks at the merits. The Virginia Workers’ Compensation Commission publishes the rules that govern every claim it hears, and the insurer’s lawyer knows them cold. This page walks through Rules 1 through 13, one at a time, and tells you what each one means for you. These workers’ compensation rules aren’t suggestions; following them is mandatory to give you the best chance of securing workers’ compensation benefits.

A few years ago, I agreed to coach my son’s youth basketball team. At the first practice, I asked who had played before. No hands went up. When nobody knows the game, you don’t run a motion offense. You start with where to stand, which basket to shoot at, and how to dribble the ball.

Workers’ compensation is like that. Before you can win, you need to know the rules. The insurer does.

Why the Rules Matter

Virginia Code Section 65.2-201 gives the Commission the power to make, interpret, and enforce its own rules. The Commission’s website describes them as mandatory procedures that every party must follow. The appellate courts back that up: the Court of Appeals of Virginia gives the Commission’s interpretation of its own rules great deference and will uphold it unless it is arbitrary and capricious. See Village Avenue Management, LLC v. Schofield, Record No. 1672-23-2 (Va. Ct. App. Oct. 22, 2024) (citations omitted), a case I handled. That’s a high bar.

Insurers still try to challenge the Commission’s interpretations. I had a case where the carrier argued for a reading of a rule that the Commission never intended. We won before the Commission, the Court of Appeals agreed, and the case settled at mediation afterward.

So the rules cut both ways. Ignore them, and you can lose your claim without a hearing. Yes, a violation can cost you your day in court.

• Deadlines don’t forgive. The Commission will not waive a rule because you didn’t know it existed.
• Several rules give the insurer a path to stop your benefits or dismiss your claim with a hearing on the merits.
• Different rules apply at different stages. Knowing one or two won’t cut it; you need to know every rule that applies to the stage you’re in.

Follow the workers’ compensation rules, and you gain leverage to obtain workers’ comp benefits or negotiate a fair settlement. Most of the rules below include a way I’ve used that rule against the employer or the insurance company.

When you finish, the answers to 200+ Virginia workers’ compensation FAQs cover specific injuries, employers, insurers, and procedural situations.

Rule 1 – Prehearing Procedures

Rule 1.1 – What your initial claim must include

Your first claim with the Commission must include the details listed in this rule. If it doesn’t, the Commission can find that what you filed wasn’t a claim at all.

That creates a problem that could defeat your claim before you reach the merits. Suppose you believe you filed a claim, and months later, usually after the insurer argues that your filing didn’t tell them what happened or what you want, the Commission agrees it was insufficient. You can fix it if you’re still inside the two-year statute of limitations. If you’re not, the claim may be time-barred.

Avoid the scenario by using the Commission’s Claim for Benefits form and read how to file a workers’ compensation claim before you send anything.

Rule 1.2 – Change in condition & the 90-Day Rule

Receiving an Award Agreement form, followed by the Commission’s entry of an award letter, is a relief. But it is not the end of the case.

Workers’ comp cases can reopen months, years, and sometimes decades after the injury. In one case, for example, I negotiated a settlement for a cervical spine injury that happened thirty years earlier; the employee needed a revision and extension of a fusion done under the original award.

The usual triggers for reopening or litigation that heats up: the insurer decides your wage-loss benefits should stop, denies that a new problem is a compensable consequence of the original injury, or gets an IME doctor to say that your prescribed surgery isn’t reasonable or necessary.

Rule 1.2 governs how to reopen the claim on a change in condition, and it is where the 90-Day Rule lives: compensation on a change-in-condition claim generally can’t be awarded for any time more than 90 days before you filed the claim. Waiting to file may result in you giving up back pay you are entitled to. File promptly.

Rule 1.3 – File supporting evidence within 90 days

You don’t need all your evidence to file a claim or a change-in-condition application. But you must file some supportive evidence within 90 days of filing, or the insurer can move to dismiss. Usually, you can satisfy this requirement by uploading some of your medical records to the Commission’s file. One doctor’s note can be enough.

I recommend that you file medical reports as you receive them. Or, if you have plenty of time and no financial urgency before the statute of limitations expires, collect the reports first and file the claim second.

Rule 1.4 – Employer’s Application for Hearing

Assume the insurer is looking for ways to stop paying if you receive ongoing temporary total disability benefits. It’s what they do.

When they find what they think is a reason to stop payments, expect to see an Employer’s Application for Hearing.

You’ll find some due process protections in this rule, although not as much as I would like. The insurer must overcome these hurdles before the Commission permits the suspension of payments pending a hearing.

You can sometimes defeat an application by comparing the payment dates on the application to the pay stubs showing when you last received a wage loss check. If the insurer didn’t pay through the date the rule required, the Commission will reject the application.

Rule 1.5 – Employer Response & Your 15-Day Window

The Commission can order the employer to say if it accepts your claim or to explain why not. Use this explanation to build your case.

Next, the Commission gives you just 15 days to submit evidence opposing an application to stop or reduce your benefits. Staying on top of the available evidence throughout your claim is the only way to submit a solid response this quickly.

Finally, the Commission tells the parties it will explain why it accepted or rejected an application. Sometimes, the explanations help you know how to attack docketing on appeal. But other times the explanation is vague and unhelpful.

Rule 1.6 – Requesting a Review

If the Commission docketed the employer’s application, you have a limited period to challenge that decision with a formal request for review.

On the other hand, if you successfully defeated the employer’s application, this rule confirms that the insurer must pay out penalties and interest.

Rule 1.7 – Settlement Papers

Unlike car accident settlements that can settle with a one-page relief, settling workers’ compensation claims take longer. And more paperwork.

No settlement is final without the Commission’s approval. And you must submit several different documents before the Commission will even review the proposed deal.

Rule 1.8 – Discovery Rules

The discovery process lets parties obtain information from one another and others who have relevant documents. Discovery sounds dry, and often is dry, but it’s where you win claims and build your case’s value.

Multiple subparts cover the different discovery tools: subpoenas, depositions, interrogatories, requests for production of documents, requests for admissions, and the production of wage information. They also explain how to get a protective order or when the Commission will sanction a party for ignoring or abusing discovery.

Here’s something I’ve learned from experience: Insurance defense attorneys love to use the discovery tools to hassle claimants and their attorneys. They’ll request every piece of paper you’ve ever signed, then they’ll allege you haven’t produced everything or answered completely. But you have the same ability to conduct extensive discovery. Use it.

These tools can compel the employer and insurer to disclose all relevant information. And you just may find that they would rather make a reasonable settlement offer than go through the time and expense of extensive discovery. Discovery is expensive and time-consuming, and defendants in workers’ comp claims usually have way more paperwork to produce than claimants do.

Rule 1.9 – Issue Mediation

The Commission has one of the best alternative dispute resolution (ADR) programs in the country. Its goal is to help the parties resolve problems without a formal hearing, and this rule tells what disputes are most likely to benefit.

I’ll be honest. I don’t like issue mediation because many disputes are “all or nothing.” How do you split the difference on whether the insurer has to pay for a total knee replacement?

But I do like full and final settlement mediation, though. And many of my clients have benefited from it.

Rule 1.10 – Willful Misconduct Defense

Although you can get workers’ compensation benefits if your negligence caused the injury, you can’t get them if you were hurt because you intentionally harmed yourself, attacked someone, were drunk or high, or willfully violated a safety rule that you knew about.

In recent years, insurers have increasingly raised this defense, often in cases where it is unwarranted or just plain dumb. It’s often a sign they don’t have a strong defense to the claim. For example, a major hospital claimed that its injured nurse had violated a safety rule because she did not use proper ergonomics when lifting a patient. But no rule would have helped because the psychiatric patient bucked violently mid-transfer, and the insurer dropped this defense shortly before trial.

If they intend to raise this defense, insurers must give written notice to the Commission at least 15 days before the hearing. And vague descriptions won’t cut it. You have the right to know the specific ac the insurer relies on.

So, keep an eye on the calendar and the specific notice. Sometimes insurers blow it by raising the defense too late or being too generic in their description.

Rule 1.11 – Prehearing Statements

Many deputy commissioners require you to fill out this form with the details of the claim, defenses, and witnesses. It is a “cheat sheet” for the judge to reference during the hearing.

Rule 1.12 – Sanctions

The Commission may impose a fine or order the payment of the other party’s attorney’s if it find you in contempt of the workers’ compensation rules.

Rule 1.13 – Meet-and-Confer

The commission requires attorneys to certify they attempted to resolve a dispute before filing a motion.

Rule 2 – Hearing Procedures

Rule 2.1 – Decisions on the Record

You don’t always need an in-person trial. Like a motion for summary judgment in state and federal courts, the Commission’s “on-the-record” hearings allows you to submit your claim “on the briefs.”

Some attorneys rave about decisions on the record because they can save time. But I avoid them, and opt for my clients to tell their story in person. ‘

I’ve lost count of how many times I’ve read this section before a workers’ compensation hearing. It explains the how to admit testimony and documents into evidence at trial.

Rule 2.2(B)(3) is the most important part because it tells you exactly how to submit medical evidence, which is often critical to winning, at the hearing.

Rule 2.3 – Expedited Hearings

The gaps without pay while you wait for a hearing challenge every one.

Some of you may be able to shorten the gap by asking for an expedited hearing. This request must include proof of financial hardship.

But don’t expect the insurer to agree to an expedited hearing. They see your hardship as an opportunity to negotiate a low settlement amount.

Rule 2.4 – Video Hearings

WebEx video hearings became popular during the COVID-19 pandemic. They’ve dropped off some, but have hung around.

Personally, I’d rather not have a video hearing unless my client faces great inconvenience traveling to the trial.

If you have a video hearing, read how to submit or object to evidence beforehand, as well as the technical requirements for your laptop or computer.

Rule 3 – Post-hearing Procedures

Rule 3.1 – Appeal Deadlines

Seek review of a Commission decision within 30 days. State the specific findings of fact and conclusions of law that were wrong. Conclusory statements won’t cut it.

Rule 3.2 – Written Statements

Written arguments decide most appeals; you won’t have another hearing. So, focus on the brief.

Rule 3.3 – No New Evidence

You have to put on the best evidence you have at trial. If you don’t have it at the time you request review, the Commission won’t consider it here.

Rule 3.4 – Oral Argument Requests

Oral argument happens, but it’s rare. I’ve only had one case where the Commission ordered oral argument, and neither party had even asked for it.

Rule 4 – Filing Documents

Rule 4.1 – Filing Agreements

No agreement to pay compensation is official unless it’s in writing.

More importantly for injured workers, this rule says that insurers must file any agreements to pay that you sign within 14 days of receiving it, or reject the agreement in writing.

Don’t rely on handshake deals or telephone promises. Demand the forms.

Rule 4.2 – Medical Records

This is one of my favorite Virginia Workers’ Compensation Rules because it helps you get evidence for free (or at a minimal cost). Under this rule, parties must share medical reports as they receive them, and health care providers must send you their records if you ask for them. Usually insurance defense attorneys subpoena your reports from doctors, then send you copies.

Rule 5 – Cost of Medical Services

I’ve seen doctors try to bill injured employees when the insurer refused to pay the full amount. It happens more than it should.

They can’t do this if you have an award of medical benefits. Remind the doctor or debt collector of this rule if you get harassing calls or letters.

Rule 6 – Attorney’s Fees Under § 65.2-714

These rules don’t affect you directly. They cover attorney’s fees owed by medical providers who benefited from your claim.

It’s mainly relevant for attorneys collecting fees from healthcare providers. Skip it unless you’re curious.

Rule 7 – Employer Responsibilities

Employers must give proof of insurance coverage to the Commission and post notice of their compliance with the law in places where employees can see it.

Check whether your employer has posted the required workers’ compensation notices if the insurer argues that you waited too long to report your injury or filed a claim after the statute of limitations had passed. Otherwise, this rule will not affect your case.

Rule 8 – Self-Insurance

Large employers can self-insure, but they must meet specific requirements and file financial documents with the Commission. These papers remain confidential.

If your employer self-insures, they still have to provide the same benefits as employers who purchase insurance. Don’t let them tell you otherwise. I’ve seen self-insured employers try to claim they have different rules. They don’t.

Rule 9 – Payment of Compensation

Rule 9.1 – Waiting Period

Virginia has a seven-day waiting period. You must miss seven days of work before the insurer has to pay wage loss benefits.

What’s helpful is that dayys when you can’t earn full wages count toward the waiting period. So if your medical work restrictions limit you to part-time work, and your employer accommodates that restriction, you can use that day toward the waiting period.

Rule 9.2 – Direct Payment

Benefits go directly to you, while awarded attorney’s fees go straight to your lawyer.

Rules 10–13 – Special Tables & Occupational Disease Claims

These rules apply to specific occupational illnesses. You won’t need to know them if you had a workplace injury, rather than a work-related exposure that led to disease.

Rule 10 – X-Ray Evidence for Black Lung (Rules 10.1 to 10.3)

The Commission sets procedures for Pulmonary Committee reviews and the number of X-ray readings allowed.

Rule 11 – Pneumoconiosis Table

This rule provides a table to convert radiographic evidence into a severity rating (stage) for the disease.

Rule 12 – Hearing Loss Table

This table calculates hearing loss percentages.

Rule 13 – Vision Loss Table

This table sets compensation for vision loss using Snellen Chart readings.

What Now? Know the Rules!

You may not think of yourself as a “rule follower,” but you must follow the Virginia Workers’ Compensation Rules — and all related workers’ compensation procedures in Virginia — if you want to win your case.

You can spend the time to learn the framework of these rules.

Or you can call my law firm to see if we will accept representation.

Contact us today to discuss your claim and how we can use the rules to protect your benefits.

About the authorCorey Pollard is a Virginia workers’ compensation and Social Security Disability attorney in Richmond. Best Lawyers in America® (2020–2026), $100M+ recovered, and a former insurance defense lawyer — which is the part that matters.