If, however, your injury or disease is serious and results in high medical expenses and significant time off work, you could be in for a fight. Your employer's insurance company, which actually pays workers' comp benefits, is more likely than ever to dispute, delay, or deny your claim in order to save money.
The Basics of Virginia Workers' Compensation
Workers' compensation was first established to eliminate and replace injury-based lawsuits against employers. If you are accidentally hurt in the process of doing your job or develop a disease due to workplace conditions, you generally may not sue your company. Instead, you may file a claim for workers' comp benefits, which include all your medical expenses and two-thirds of the wages you lose due to time off work for treatment and recovery.
Workers' Comp Is No-Fault Coverage
In theory, workers' comp is no-fault insurance. That means you should not have to prove your employer did anything wrong to cause your injury. Even if you're responsible for your own work accident, you may still file a claim, and your boss may not fire you or retaliate against you for doing so. In reality, however, injured workers must work harder and jump through more hoops than ever before to get fair benefits from workers' comp insurers for more expensive injuries and illnesses.
How to Initiate Your Claim
The Virginia Workers' Compensation Commission (VWCC) allows you 30 days to report your accidental injury and two years to file your claim for benefits, but any delay on your part in reporting or filing gives the insurer ammunition to use against you. Report your injury in writing to your supervisor as soon as possible after your accident. Within ten days, your employer should file a First Report of Injury (FROI) with the VWCC. You may then submit a Claim for Benefits Form from the VWCC website's "Injured Workers" page.
Seek prompt medical attention from a doctor on your employer's Panel of Physicians. Follow this doctor's treatment plan to the letter, keeping all appointments and retaining receipts and other documentation of your treatment. Take medication as prescribed and keep a daily journal of your treatment and recovery. If your claim is a simple and inexpensive one, you can hope to receive an Awards Agreement and weekly wage benefits until you reach maximum medical improvement (MMI) and are released to return to work. If your claim is complicated and/or expensive, though, the insurer might:
- Delay or deny your claim
- Be slow to approve treatments
- Force you back to work too early
When the insurance company becomes your adversary, you need an experienced workers' comp lawyer on your side to counter its tactics and stand up to its team of attorneys, whose primary goal is to save money for the company's shareholders.
How Your Lawyer Can Help You to Obtain Fair Benefits
While you're focused on your medical treatment and recovery, your attorney can stand up to a tight-fisted insurer and counter its tactics to delay or deny your claim. Your workers' comp lawyer can:
- Help you complete the filing process correctly and on time
- Handle all paperwork and communications with your employer and the insurer
- Represent you at a conference or meeting with the employer and/or insurance company
- Counter the insurer's delays and speed up the process of your claim
- Take action against your employer for firing you or retaliating against you
- Gather medical evidence and present expert testimony to dispute the insurer's claim that your injury is due to a pre-existing condition
- Present evidence to support your impairment or disability rating
- Request an independent medical exam if you're not satisfied with your physician
- Represent you at a hearing before the VWCC
- Minimize any payment offset if you're receiving Long-Term Disability or Social Security Disability Insurance payments
- Negotiate a lump-sum payment in some cases
- Collect/organize your evidence and appeal your denied claim to the VWCC or the Virginia Court of Appeals
- Help you to file a claim against any third party that contributed to your accidental injury
Gathering medical and non-medical evidence to support your claim, deposing eyewitnesses or vocational specialists, and advising you regarding your statements in the benefits process are all jobs best left to your lawyer while you recover from your injuries.