Workers Comp Process: A Flow Chart for Claim Procedure
Corey R. PollardWorkers’ compensation attorney · Former insurance defense · $100M+ recovered
Why trust this? It’s written by the attorney who argues these cases before the Virginia Workers’ Compensation Commission, not a content team, and reviewed against current Virginia law.
An Overview of the Workers Comp Claim Process
This Article Explains the Procedure for Claiming Workers Compensation
Compared to other types of civil litigation, the workers compensation process has more steps and variability. Even experienced attorneys find it complex and confusing.
The title of this page promises a flow chart. Here is the useful version of one. Tell the stepper below where you are right now, and it will tell you what is happening at that step, what you should be doing about it, whose clock is running, and what comes next.
Although no two claims are alike or follow the same path, the overview of the workers comp process below can help you recover more money, get the medical treatment you need to heal, and negotiate a lump sum settlement.
If you have questions, complete this form or call (804) 251-1620 or (757) 810-5614. You can also review our answers to workers compensation FAQs.
We have obtained results for hundreds of injured workers in Virginia and Maryland. See if we can help you.
Where Are You in the Process Right Now?
Where are you now?
The page below describes the whole process. This tells you about the part of it that is happening to you: what it is, what to do, whose clock is running, and what comes next.
You were here last time.
Every claim Step 1 of 9
Your employer posts the notice
What happens
The process starts before you get hurt. Every business covered by the Virginia Workers’ Compensation Act has to post the notice in Form VWC1 in a conspicuous place, where employees will actually see it.
What you do
Nothing. This one is your employer’s obligation, not yours. It is worth knowing it exists, because it is the state telling you in advance that you have rights.
No clock runs against you at this step.
Every claim Step 2 of 9
You get hurt
What happens
Your work injury, or the day you are told that a diagnosis is an occupational disease, starts the process for your specific case.
What you do
Write down the date, the time, what you were doing, and who saw it. Do it now, while you remember it. You will be asked about it a year from now by someone who is paid to doubt you.
Nothing to file yet. But every other clock on this page is counted from this date.
Every claim Step 3 of 9
You report it to your employer
What happens
You tell your employer that you were hurt at work.
What you do
Report it in writing and keep a copy. A verbal mention to a supervisor who later cannot remember it is not much of a record. I keep a sample letter on this site you can use as a template.
You must report a workplace injury to your employer within 30 days of the accident date. You may forfeit the right to benefits entirely if you do not.
Every claim Step 4 of 9
You get medical treatment
What happens
Treatment does two jobs at once. It heals you, and it builds the record. The Commission usually decides whether you meet the definition of "injury by accident", whether you have a disability from work that qualifies for wage loss payments, and whether you suffered permanent impairment, by reading your medical reports.
What you do
Seek care immediately. Tell every provider that this happened at work, and tell them exactly how. What gets written in the chart in week one tends to decide the case in year two.
The Act sets no number here, so I will not invent one. But the Commission decides your case on the medical record, and a gap in the record is a hole in your case.
Every claim Step 5 of 9
Your employer files the First Report of Injury
What happens
Virginia Code Section 65.2-900 requires every employer, or its insurer or claim administrator, to report your injury to the Workers’ Compensation Commission within ten days. The report has to name the employer, name you, and state the cause of the accident and the nature of the injuries.
What you do
Nothing to file. But find out whether they did it, because an employer’s failure to file this report tolls the statute of limitations for filing your claim. Their mistake can buy you time.
Ten days from the injury, under Virginia Code Section 65.2-900. This is their deadline, not yours.
Every claim Step 6 of 9
The insurer calls you
What happens
Not mandatory, but it almost always happens once they hear about your injury. The adjuster may send you a list of doctors to choose from, ask you to give a recorded statement, and mail you an information packet containing a blank request to release your medical records.
What you do
Speak with an attorney before you do any of those three things. That is not a sales line, it is the advice I give on this page. The panel, the statement and the release are the three places a good claim gets quietly damaged in the first fortnight.
No clock runs on this call. Nothing the adjuster asks for on it has to happen the day they ask.
Every claim Step 7 of 9
The Commission sends a Notification of Injury
What happens
Once the Commission has the employer’s first report, it sends you a letter titled Notification of Injury. It encloses a claim form for you to complete and file, and a copy of the Commission’s Workers’ Compensation Guide for Employees.
What you do
Open it and understand what it is. It is not your claim. It is an envelope containing the form that becomes your claim, once you file it.
No clock on the letter. The clock is on the form inside it. That is the next step, and it is the one that matters most on this page.
Every claim Step 8 of 9
You file your claim with the Commission
What happens
Submitting a claim for benefits to the Commission protects your rights and tolls the statute of limitations. Your claim should state the benefits you are seeking and whether you want the claim referred for a hearing.
What you do
File it yourself, and confirm the Commission has it. Filling out your employer’s incident report is not the same as filing a claim with the Commission, and reporting the injury to your employer does not stop the clock. List every injured body part: the deadline runs separately against each one. You can narrow later. You cannot expand after two years.
For an injury by accident, two years from the date of the accident, under Virginia Code Section 65.2-601. Occupational disease deadlines vary by disease. Miss it and the Commission loses jurisdiction: the employer does not even have to raise the defence.
Every claim Step 9 of 9
The 30-Day Order goes out, and the claim forks
What happens
Once the Commission has your claim and the medical records substantiating it, it issues a 30-Day Order to the employer and insurer. They must complete and return an Order Response Form within 30 days or risk sanctions. There are three possible answers: they accept the claim and send agreement forms, they say the investigation is ongoing, or they deny it. If they deny it, the Commission dockets your case for a hearing before a deputy commissioner.
What you do
Wait for the answer, and find out which of the three you got. This is the fork in the flow chart. Everything after it depends on which way you went.
They have 30 days to return the Order Response Form or risk the imposition of sanctions. This is their deadline, not yours.
If the insurer accepts Step 1 of 4
They send an Agreement to Pay Benefits
What happens
If the employer or insurer accepts your claim, they should send you a form titled Agreement to Pay Benefits. Once it is signed, the parties send it to the Commission.
What you do
Read every line before you sign. Check that every injured body part is named, and check the average weekly wage written on the form, because your weekly compensation rate is calculated from that wage figure. It is not a flat percentage of it: Virginia sets a minimum and a maximum weekly rate, and both change every July. Work out what the rate on that wage should be before you sign, not after. The award gets built from this form, and the award is what gets enforced.
No deadline is set on this form. That is not a reason to sign it quickly.
If the insurer accepts Step 2 of 4
The Commission enters an Award Order
What happens
The Commission enters an Award of Benefits memorialising what the parties agreed to in the Agreement to Pay Benefits.
What you do
Check that the award says what you think you agreed to: the body parts, the wage, and the type of benefit. The award, not the conversation you had with the adjuster, is the thing that binds them.
No clock runs against you at this step.
If the insurer accepts Step 3 of 4
The benefits start
What happens
You should start receiving the lifetime medical benefits and the wage loss payments in the award within a few weeks of the Commission entering the Award Order.
What you do
If nothing arrives, say so. An award is an order of the Commission, not a promise from an insurer.
A few weeks after the Award Order is entered. That is what I see in practice. It is not a statutory number and I am not going to dress it up as one.
If the insurer accepts Step 4 of 4
The benefits end, one of three ways
What happens
An award does not run forever. It ends when the parties negotiate a settlement, when the Commission enters an opinion in favour of the employer’s application to stop your benefits, or when you sign a Termination of Wage Loss Award based on a full-duty release or a return to work.
What you do
Work out which of the three is happening to you before you sign anything. They are not the same event and they do not have the same consequences. This is the point in the process where most of the money is won or lost, and it is the point at which people call me too late.
No single deadline. Which of the three routes you are on decides which clocks apply to you.
They have applied to stop my benefits
What comes next
That is the end of the flow chart. What happens after it is a negotiation, and negotiations do not go on flow charts.
If the insurer denies or ignores you Step 1 of 9
Discovery starts
What happens
The Rules of the Commission allow the parties extensive pretrial discovery. Interrogatories, requests for documents, requests for admissions of fact and of legal conclusions, accident site inspections, subpoenas and depositions are all available to probe the defences the employer and insurer are running.
What you do
Answer their discovery honestly and on time, and use yours. A denial is a position, not a verdict. Very often it is a position taken before anyone on their side has read your medical records.
Discovery deadlines come from the Commission’s rules and the scheduling in your case, not from a single figure in the Act.
If the insurer denies or ignores you Step 2 of 9
A deputy commissioner takes your case
What happens
Once the employer or insurer denies your claim, or simply ignores it, the Commission refers your claim to a deputy commissioner. That deputy commissioner presides over the pretrial motions and the hearing.
What you do
Nothing to file. This is the Commission moving your case toward trial.
No clock runs against you at this step.
If the insurer denies or ignores you Step 3 of 9
The Notice of Hearing arrives
What happens
Soon after you learn which deputy commissioner has your claim, you should receive a Notice of Hearing. It tells the parties the hearing’s date, time, place and length.
What you do
Calendar it, then work backwards from it. Your evidence has to be finished before that date, not on it.
The date on the notice is now the date that governs everything else in your case.
If the insurer denies or ignores you Step 4 of 9
Mediation is offered
What happens
The judge may recommend that the parties take part in issue mediation, or in full and final mediation, with the Commission’s Alternative Dispute Resolution department. The judge cannot force a party to mediate, but can order the parties to attend an ADR orientation session.
What you do
Go in knowing what your claim is worth. Mediation is a negotiation, and the other side valued your file the week it landed on their desk.
No deadline, and mediation is voluntary. You can be ordered into an orientation session, but not into a mediation.
If the insurer denies or ignores you Step 5 of 9
The hearing is held
What happens
The hearing is workers’ compensation’s version of a trial. You must present evidence to support your claim for benefits. The employer and insurer present evidence supporting their defences.
What you do
You carry the burden of proof. Your medical records, your testimony and your witnesses are the case. There is nothing else in the room.
The record you build at this hearing is, in most cases, the record every appeal above it gets decided on.
If the insurer denies or ignores you Step 6 of 9
The Judicial Opinion arrives
What happens
You will receive the deputy commissioner’s written decision, called a Judicial Opinion, within 30 to 60 days of the hearing.
What you do
Read it the day it arrives. Whatever it says, the appeal clock starts running on it.
Thirty to sixty days after the hearing for the opinion to reach you. That is the Commission’s turnaround, not a deadline you have to meet. Your 30 days to appeal begins when it lands.
If the insurer denies or ignores you Step 7 of 9
Appeal to the Full Commission
What happens
A party has 30 days to appeal the Judicial Opinion to the Full Virginia Workers’ Compensation Commission. Usually the Full Commission decides the case on the evidentiary record developed at the hearing and on written briefs, though it may schedule oral argument.
What you do
Decide quickly. Thirty days is not long, and the record you are appealing on is the record you made at the hearing. You do not get to improve it now.
30 days from the Judicial Opinion. Either party can appeal.
If the insurer denies or ignores you Step 8 of 9
Appeal to the Court of Appeals of Virginia
What happens
A party has thirty days from the publication date of the Full Commission’s opinion to appeal to the Virginia Court of Appeals.
What you do
Note where this clock starts. It runs from the publication date of the opinion, not from the day you happen to read it.
Thirty days from the publication date of the Full Commission’s opinion. Either party can appeal.
If the insurer denies or ignores you Step 9 of 9
Petition the Supreme Court of Virginia
What happens
Either party can file a petition for appeal with the Virginia Supreme Court. It rarely grants petitions in workers’ compensation cases.
What you do
Understand the odds before you spend another year of your life on them.
I do not publish a deadline for this step, so this tool will not show you one. Do not take a date for a Supreme Court petition off a web page. Ask me.
What comes next
That is the end of the flow chart. What happens after it is a negotiation, and negotiations do not go on flow charts.
Do not let a web page be the last word on a date.
The deadlines in here are the ones Virginia actually sets, quoted from my own pages: 30 days to report the injury to your employer, ten days for your employer to file the First Report of Injury, two years to file your claim with the Commission for an injury by accident, 30 days to appeal a Judicial Opinion. Where the Act sets no deadline, this tool says so instead of guessing at one.
But the deadline that applies to you can run from a date other than the one you expect, and some are shorter than the general rule. If a date here looks close, or looks like it has already passed, call me rather than assuming this tool is right about it.
No two claims follow the same path either. Read this as the usual order of events, not as a prediction about yours.
Reading it does not make me your lawyer, and nothing in it is legal advice about your situation. For that, talk to me, or to any lawyer, about your actual case.
Procedural Steps Applicable to All Workers Comp Claims
The steps below apply to all workers compensation claims, regardless of whether the insurer accepts or denies the case.
Employer Provides Notice of Injured Employees’ Rights under the Workers Compensation Act
The workers comp claim process starts before you suffer an occupational injury.
Every business covered by the Virginia Workers Compensation Act must post the notice in Form VWC1 in a conspicuous place where employees will see it. Other states have similar rules for employers.
Occupational Injury or Illness Occurs
Your work-related injury or the communication of a diagnosis of an occupational disease starts the workers comp claim process for your specific case.
Report the Injury to Your Employer
You must report a workplace injury to your employer within 30 days of the accident date. This letter can serve as a template for your injury report.
You may forfeit the right to workers compensation benefits if you do not report the injury within 30 days.
You Receive Medical Treatment
Medical treatment serves several purposes in the workers comp claim process.
First, medical treatment helps you heal and regain as much of your pre-injury functioning as possible.
Second, the Workers Compensation Commission often decides whether you meet the definition of “injury by accident,” have a disability from work that qualifies for wage loss payments, or suffered permanent impairment based on your medical reports.
Therefore, you must seek medical care immediately.
Employer Completes a First Report of Injury (FROI)
Virginia Code Section 65.2-900 requires every employer (or its insurer or claim administrator) to report a workplace injury or death to the Workers Compensation Commission within ten days of the injury or death.
This first accident report must include the following information:
- The employer’s legal name, federal employer identification number (FEIN), type of business, address, and insurance policy number
- The injured employee’s name, phone number, mailing address, occupation, date of birth, and sex
- The accident’s cause and the nature of the injuries
An employer’s failure to file this required accident report tolls the statute of limitations for filing a claim.
The Insurer Contacts You
Although not mandatory, the insurer will likely call you once notified of your occupational injury or illness.
The workers comp claim adjuster may send you a list of doctors to choose from, ask you to give a recorded statement, and send an information packet containing a blank request to release medical records.
I recommend speaking with an attorney before doing any of these things.
Commission Sends a Notification of Rights
Once the Workers Compensation Commission receives the first injury report from the employer or claim administrator, the Commission will send you a letter entitled Notification of Injury.
This notice will enclose a claim form for you to complete and file, as well as a copy of the Commission’s Workers Compensation Guide for Employees.
You File a Claim
Submitting a claim for benefits to the Commission protects your rights and tolls the statute of limitations.
Your claim should state the benefits sought and whether you want the claim referred for a workers compensation hearing.
This is the step people skip, and it is the one that decides whether the claim survives. Filling out your employer’s incident report is not the same as filing a claim with the Commission, and reporting the injury to your employer does not stop the clock. For an injury by accident you have two years from the date of the accident to file with the Commission. Miss it and the Commission loses jurisdiction. Occupational disease deadlines vary by disease. List every injured body part in the claim, because the deadline applies separately to each injury: you can narrow later, but you cannot expand after two years. See every workers comp filing deadline in Virginia, and what pauses them.
Commission Sends a 30-Day Order Claim Filed to the Employer/Insurer
Once the Commission receives your claim and medical records substantiating it, the Commission will issue a 30-Day Order to the employer/insurer.
The employer/insurer must complete and return an Order Response Form to the Virginia Workers Compensation Commission within 30 days or risk the imposition of sanctions.
Potential responses to the 30-Day Order include the following:
- The insurer accepts the claim as compensable and attaches signed agreement forms or indicates the type of agreement form the employer/insurer will mail to the Commission.
- The investigation is ongoing, identifying the information needed.
- The employer/insurer denies the claim.
If the employer or insurer denies the claim, the Commission will docket it for a hearing before a deputy commissioner.
Want to know what your claim is actually worth?
Send me the basics: what happened, your wage, and where treatment stands. I’ll tell you what the insurer has already reserved for your case.
Process for Accepted Workers Comp Claims
The steps in this section apply when the employer/insurer agrees that you suffered an occupational injury or illness and should receive the benefits you claim.
Employer/Insurer Sends an Agreement to Pay Benefits Form to You
If the employer or insurer accepts your claim, they should send you a form entitled Agreement to Pay Benefits.
Once signed, the parties send this form to the Workers Compensation Commission.
Commission Enters an Award Order
The Commission will enter an Award of Benefits memorializing the parties’ agreement as detailed in the Agreement to Pay Benefits.
Payment of Benefits
You should start receiving the lifetime medical benefits and wage loss payments awarded within a few weeks of the Commission’s entry of the Award Order.
Lifetime Medical or Weekly Income Benefits End by Agreement, Opinion, or Settlement
The awarded benefits will continue until the parties negotiate a workers comp settlement, the Commission enters an opinion in favor of the employer’s application to stop benefits, or you sign a Termination of Wage Loss Award based on a full duty release or a return to work.
Workers Comp Claim Process When the Insurer Denies Your Claim
Accepted and denied workers comp claims share many of the same steps.
These extra steps apply when the employer/insurer denies your entitlement to benefits and says you cannot meet your burden of proof.
Pretrial Discovery Starts
The Rules of the Workers Compensation Commission in Virginia allow the parties to engage in extensive pretrial discovery.
You may use interrogatories, requests for documents, requests for admissions of facts and legal conclusions, accident site inspections, subpoenas, and depositions to probe the employer/insurer’s defenses.
Commission Assigns Your Claim to a Deputy Commission
Once the employer/insurer denies or ignores your claim, the Commission will refer your claim to a deputy commissioner.
This deputy commissioner will preside over pretrial motions and the workers compensation hearing.
Notice of Hearing Received
You should receive a Notice of Hearing soon after receiving notice of the deputy commissioner assigned to your claim.
This letter tells the parties the hearing’s date, time, place, and length.
Alternative Dispute Resolution (ADR) Offered
The judge may recommend the parties participate in issue mediation or full and final mediation with the Commission’s Alternative Dispute Resolution (ADR) Department.
Although the judge cannot force a party to participate in mediation, they can order the parties to participate in an ADR orientation session.
Hearing Held
At the hearing, which is workers compensation’s version of a trial, you must present evidence to support your claim for benefits.
The employer/insurer can likewise present evidence supporting their defenses.
Judicial Opinion Rendered
You will receive the deputy commissioner’s written decision, called a Judicial Opinion, within 30 to 60 days of the hearing.
Appeal to the Full Commission
A party has 30 days to appeal the Judicial Opinion to the Full Virginia Workers Compensation Commission.
Usually, the Full Commission decides the case based on the evidentiary record developed at the hearing and written briefs. However, the Full Commission may schedule oral arguments.
Appeal to the Court of Appeals
A party has thirty days from the publication date of the Full Commission’s opinion to appeal to the Virginia Court of Appeals.
Appeal to the Supreme Court of Virginia
Either party can file a petition for appeal with the Virginia Supreme Court.
The Virginia Supreme Court rarely grants petitions in workers compensation cases.
Your Attorney for Every Step of the Workers Comp Process
Understanding the workers comp claim process and your next steps are vital to winning your claim or negotiating a top-dollar settlement.
Contact us today for help with the process.
You pay nothing unless we obtain benefits or a lump sum for you.
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.
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