What Happens After You File for Workers Compensation?

 

You Filed a Claim with the Workers Compensation Commission. Now What?

 

Filing a workers compensation claim and gathering the appropriate documents can be stressful. The weeks following a work accident are a time of uncertainty. And not knowing what to expect from the workers comp claims process can make things worse.

 

This article explains what happens after you file a claim for benefits with the Virginia Workers Compensation Commission.

 

I hope it gives clarity on how your employer’s workers compensation insurance carrier and the Commission will process your claim. By understanding what happens after you file a claim, you’ll know what to look out for and what you can do to give yourself the best chance of receiving workers comp benefits as soon as possible.

 

Keep reading to learn more. Then browse my website for more information on Virginia workers compensation.

 

If you don’t see what you’re looking for, or want to hire a top-rated workers compensation lawyer in Virginia, call me for a free consultation: 804-251-1620 or 757-810-5614. I’ve helped hundreds of injured employees win at trial and negotiate workers compensation settlements. And I want to help you.

 

What Happens After You File the Work Injury Claim?

 

Here is what you should watch for after filing a workers comp claim:

 

Watch For a Follow-Up Email or Letter

 

You should receive a letter or email confirmation from the Workers Compensation Commission after filing your claim. Whether you receive a letter or email depends on whether you have signed up for WebFile, the Commission’s electronic portal system.

 

The letter will acknowledge that you have filed a claim for workers comp. It will state your claim number and the date of injury. Make sure the date of injury is correct. And always write the claim number on correspondence you file with the Commission.

 

Save the confirmation letter. If your employer and its insurance company defend the claim on the basis that you failed to file before the workers compensation statute of limitations expired, you can use this letter to protect your legal rights.

 

Review the Insurance Carrier’s First Report of Injury (FROI)

 

After you report your work accident to your employer, the employer should notify its workers compensation insurance carrier of a potential claim.

 

When the insurance carrier receives notice of the work injury or the filing of a workers compensation claim, it must report it to the Commission electronically. This initial claims report is called the First Report of Injury (FROI).

 

The FROI provides the employer’s version of events regarding how your accident happened, when it was reported, and what body parts were injured.

 

Review the FROI for inaccuracies. Then obtain documentation and other evidence to support your version of events.

 

Watch For the Workers Compensation Commission’s 20-Day Order

 

Within two weeks of filing your claim for benefits, you will receive a letter from the Workers Compensation Commission entitled 20-Day Order. This is one of the Commission’s standard letters.

 

You do not have to respond to the 20-Day Order. Your employer’s insurance carrier does. You will receive a courtesy copy.

 

The insurance carrier has 20 days from the date of this letter to respond to the Commission and to state whether it will accept or deny your claim.

 

Read the Insurance Carrier’s Response to the Commission’s 20-Day Order

 

The 20-Day Order gives the insurance carrier several options.

 

The first option is to accept the claim as compensable.

 

If the insurance carrier accepts your claim, it must state whether all parties have signed agreement forms, whether it mailed agreement forms to you, or whether it is agreeing to a medical award only.

 

The second option is to state the claim is being investigated. Often this is a delay tactic that increases the financial stress that you – the injured worker – are under.

 

The third option is to deny the claim. If the insurance carrier denies the claim it must file all medical records in its possession relating to the claim. The Virginia Workers Compensation Rules require this.

 

What Does It Mean if the Insurance Carrier Accepts Your Claim in Response to the 20-Day Order?

 

The insurance carrier should send you a proposed award agreement form if it accepts your claim.

 

Unfortunately some insurance carriers send award agreement forms that are either incomplete or inaccurate.

 

If the award agreement form is incomplete or inaccurate, do not sign it. Ask the insurance carrier to send an accurate form.

 

If the award agreement form is accurate, sign and return it. And keep a copy for yourself.

 

The Commission will enter an Award Order memorializing your right to benefits after receiving an agreement form that all parties have signed.

 

For more information on what to look for when reviewing the proposed form, read my article entitled Award Agreements under Virginia Workers Compensation.

 

What Does it Mean if the Insurance Carrier Denies Your Claim for Workers Comp?

 

The 20-Day Order asks the insurance carrier to give the reason it denied your claim. This information is useful in deciding how to move forward.

 

Workers compensation claims are denied for many reasons. Some of the most common reasons include: failing to report the injury to your employer within the required time; failing to seek medical treatment; or, not suffering an injury that arose of a specific risk of your employment.

 

What Do You Do if the Insurance Carrier Denies Your Claim or Refuses to Provide All the Benefits Sought?

 

The Workers Compensation Commission makes the final decision whether your employer and its insurance carrier must pay the benefits sought.

 

If your claim is denied, either in part or in full, you should send a letter to the Commission requesting that your claim be scheduled for trial.

 

Then call a workers comp attorney right away to help you conduct discovery, develop evidence, and prepare for trial.

 

What Do You Do if the Insurance Carrier Does Not Respond to the 20-Day Order?

 

Even though it is called an “order,” the Commission will not penalize the insurance carrier for failing to respond to the 20-Day Order.

 

Unlike other states, Virginia does not have a rule or law in place that states a workers comp claim is accepted automatically if the insurance carrier fails to respond within the appropriate time period.

 

If you do not receive a response within the twenty-day period, write the Commission and ask for a trial. Don’t let your claim sit with the Commission for months. The sooner you take action, the sooner you can get the temporary total disability, permanent partial disability, and lifetime medical benefits you need and deserve.

 

Call An Experienced Work Injury Lawyer Today

 

From Bristol to Manassas to Virginia Beach to Richmond, I help injured workers across the state manage the workers comp claims process and get the benefits they deserve.

 

As you can see, the beginning of the workers comp process has many steps. It only gets more complicated once your case is scheduled for trial and you have to develop the evidence, respond to discovery, and present your case to a deputy commissioner.

 

Don’t try to take on the insurance carrier and its attorneys alone. Focus on your health while I focus on winning your case.

 

Call today for a free consultation: 804-251-1620 or 757-810-5614. I look forward to talking with you.

 

Corey Pollard
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