“You have to learn the rules of the game. And then you have to play better than anyone else.”
Virginia Workers Compensation Laws
Learn the Virginia Workers Compensation Rules and Use Them to Win Your Case
Filing a workers compensation claim and seeking benefits without understanding the Virginia Workers’ Compensation Rules is a recipe for disaster. Even if you satisfy the substantive legal requirements to receive workers’ compensation benefits, the employer and its insurance carrier may use the Workers’ Compensation Commission’s Rules to find a way to deny your case procedurally.
Don’t let this happen to you. Below is a list of important workers’ compensation rules you should know and understand before starting the workers’ compensation claims process. Click on the links to learn more, or contact workers compensation lawyer Corey Pollard for help winning your case and negotiating a workers compensation settlement. We’ve helped hundreds of disabled workers and their families obtain the compensation and medical treatment they need and deserve under Virginia workers compensation laws.
Rules of the Virginia Workers Compensation Commission
Rule 1. Prehearing Procedures
These workers’ comp rules govern what happens after you, the employer, or insurer file a workers’ compensation claim, but before you attend a workers’ comp hearing presided over by a deputy commissioner.
These rules can be used to help you develop the evidence in your case and get approved for benefits.
Rule 1.1 Employee’s Initial Claim for Benefits
This rule explains what information an employee’s original claim for benefits must include and when it should be filed by. An original claim for benefits is the same as your initial claim for benefits – the first claim you file after your work injury.
For more information on what to include when filing a workers’ comp claim, read our article entitled How to File a Workers Compensation Claim in Virginia.
For more information on the time limits for filing a claim, read our article on the Workers Compensation Statute of Limitation.
Rule 1.2 Employee’s Change in Condition Claim
This rule explains when you can file a subsequent claim for benefits because your physical condition or work status has changed and what information the subsequent claim must include.
The rule also states that the 90-day rule applies to an employee’s claim seeking wage loss benefits on the ground of change in condition.
Read our article, How to Reopen Your Workers Compensation Case When You Have a Change in Condition, for more information.
Rule 1.3 Dismissal Due to Failure to File Supporting Medical Evidence
This rule states that you must file evidence that supports your original claim for benefits or change in condition application within 90 days of the date you filed the claim. If not, the employer can file a motion to dismiss your claim.
This workers compensation rule is why we recommend obtaining supportive medical reports and office visit notes before you file a claim.
Rule 1.4 Employer’s Application for Hearing
This rule explains when an employer or its insurance carrier may file to stop an injured employee’s benefits and what they must do to cut off your wage loss benefits or medical treatment while waiting on a hearing.
Read our article, Employer’s Application for Hearing, for more information on what to do when your benefits are stopped.
Rule 1.5 Acceptance or Rejection of Claim or Employer’s Application for Hearing
This workers’ comp rule explains what the Commission will do after it receives an Employer’s Application for Hearing and how an injured employee may respond.
If the Employer’s Application for Hearing is technically acceptable, then it will be referred to the hearing docket for an evidentiary hearing on the merits.
Rule 1.6 Review of Decision Accepting or Rejecting Claim or Employer’s Application for Hearing
This rule explains what rights the parties to a workers compensation claim have after the Commission rules on whether an Employer’s Application for Hearing is technically acceptable. Both parties have the right to request review of the decision accepting or rejecting the Employer
- Rule 1.7 Workers’ Compensation Settlement
- Rule 1.8 Discovery
- Rule 1.9 Informal Dispute Resolution
- Rule 1.10 Willful Misconduct
- Rule 1.11 Prehearing Statement
- Rule 1.12 Enforcement of the Virginia Workers’ Compensation Act and Commission Rules
Rule 2. Hearing Procedures
- Rule 2.1 On the Record Decision
- Rule 2.2 Evidentiary Hearing
- Rule 2.3 Expedited Hearing
Rule 3. Posthearing Procedures
- Rule 3.1 Request for Review
- Rule 3.2 Written Statements
- Rule 3.3 Additional Testimony
- Rule 3.4 Oral Argument before the Commission
Rule 4 Filing Documents
Rule 4.1 Agreements
Rule 4.2 Medical Reports and Records
Rule 4.2 of the Rules of the Virginia Workers’ Compensation Commission addresses what parties to a work injury claim must do with medical reports received.
Rule 4.2 provides, in part:
Each party shall promptly provide the other parties with copies of any medical records they receive as they receive them. Unless otherwise directed by the Commission or these Rules, the parties shall not file medical records with the Commission until a hearing request is filed. The requesting party shall promptly file medical records supporting the request, if applicable. After a hearing request has been filed, the parties shall file with the Commission only medical records that are related to the hearing request. These records shall be filed upon receipt by the party filing them, and are required reports subject to the provisions of 65.2-902. A party is not required to file copies of medical records that another party has already filed.
Though Rule 4.2 mandates that the insurance carrier should provide the injured worker with copies of medical reports as they receive them, our experience is that this does not always happen when the injured worker is unrepresented by counsel. Be persistent and demand your medical reports from the carrier. These medical reports are often the key to winning your case and getting the benefits you deserve.
Rule 6 Award of Attorney’s Fees under Code Section 65.2-714
- Rule 6.1 Agreement Between Parties
- Rule 6.2 When Parties Fail to Agree on a Fee
Rule 9 Payment of Compensation
- Rule 9.1 Waiting Period
- Rule 9.2 Direct Payment