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Workers' Compensation in Virginia provides no-fault insurance coverage for employees' accidental work-related injuries and occupational diseases. Most Virginia employers are required by law to carry workers' comp. You can't be fired for filing a claim, and you don't have to prove that your employer did anything wrong to cause your accident. If your claim is accepted by the Virginia Workers' Compensation Commission (VWCC) and your employer's insurance company, workers' comp should pay all your medical bills and replace approximately two-thirds of lost wages while you're off work.
Qualifying for Virginia Workers' Comp Coverage
Accidental work-related injuries and occupational illnesses must arise in the course of your employment and meet specific criteria to be covered by Virginia workers' comp.
Accidental Injuries
A compensable injury by accident must:
- Be caused by a particular work activity
- Happen at work or during a work-related event
- Occur suddenly at a specific time
Examples of compensable injuries include broken bones, sprained joints, cuts, burns, back injuries, and brain injuries. Repetitive motion injuries such as carpal tunnel syndrome are generally not compensable in Virginia.
Occupational Illnesses
A compensable occupational illness must:
- Arise from a job-specific activity
- Not be a condition of the back, neck, or spinal column
Examples of occupational illnesses covered by workers' comp include respiratory problems from exposure to toxic materials, skin conditions, heat stroke, cardiovascular issues, and some types of cancer.
Ordinary Diseases Are Not Covered
An ordinary disease of life that you might contract regardless of your work is not compensable unless you can prove that it resulted from some condition specific to your job. Doing so to the satisfaction of the VWCC and your employer's insurance company generally requires the help of a workers' comp attorney.
Benefits Available Under Virginia Workers' Compensation
Benefits available to workers whose injuries or illnesses meet the criteria above are eligible for payment of all medical expenses and wage reimbursement.
Medical Benefits
Workers' comp medical benefits cover:
- Emergency care
- Hospitalization
- Doctor's appointments
- Prescribed drugs
- Medical testing
- Physical therapy and rehabilitation
- Assistive equipment
- Mileage reimbursement
Wage Reimbursement Benefits
If you're off work for seven days or less, workers' comp does not replace your lost wages. Starting on your eighth day off, however, it replaces two-thirds of your average weekly earnings until you return to work. If you're off for 21 days or more, your wage replacement is retroactive to your first day off. In most cases, you'll receive wage benefits until you reach maximum medical improvement (MMI) and your doctor clears you to return to your regular job. If you're left with a temporary or permanent disability after reaching MMI, your claim will fall into one of four categories:
- Temporary Partial Disability (TPD). If your doctor gives you temporary work restrictions that require you to accept a "light duty" position rather than your previous job, you may receive benefits to make up two-thirds of the difference between your old salary and your new one until you can resume your old job. You must attempt to perform the light-duty job to the best of your ability. Failure to do so could damage your claim.
- Permanent Partial Disability (PPD). If your doctor does not expect your condition to improve any further, you might receive an impairment rating that reflects your lost percentage of use of a particular body part. In such a case, VWCC guidelines specify how long you may receive wage benefits depending on the body part that's impaired. Workers' comp covers vocational re-training in some cases.
- Temporary Total Disability (TTD). If you're unable to perform even a light-duty job or your employer has no such position to offer, you're eligible to continue receiving your wage-loss benefits for a period of time determined by VWCC guidelines according to your particular disability.
- Permanent Total Disability (PTD). If your doctor determines that your disability is permanent and you're not expected to return to work at any time in the future, you may continue receiving two-thirds of your previous earnings for a period of time set forth in the Virginia Workers' Compensation Act.
- Death benefits. If you lose a loved one in a work-related accident, you may apply for workers' comp death benefits, which pay up to $10,000 for funeral expenses and $1,000 for related travel (in 2023).
When You Need an Attorney
In disability cases, the services of a workers' comp lawyer are highly recommended to help you seek fair compensation as you face an uncertain future without your previous income. Very thorough medical documentation is required, and the insurer is likely to fight you over an expensive long-term disability claim. You're probably no match for the insurance company's lawyers and adjusters unless you have your own attorney to level the playing field.