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If you’re hurt in the course of performing your job duties in Virginia, you are entitled to file a claim for workers’ comp. Workers’ comp is no-fault insurance that covers the medical expenses and lost wages of employees who suffer work-related injuries. Nearly every Virginia business with three or more workers on the payroll is required by law to carry workers’ comp insurance.
To file a claim for benefits, you do not have to prove employer negligence. Even if you caused the accident, you can still file a claim, and your employer may not retaliate against you for doing so. You must, however, be sure that you meet all deadlines and procedural requirements in the claims process.
The Virginia Workers’ Comp Claims Process
The workers’ comp claims process can be difficult and tedious, especially when you’re trying to recover from your injury or illness. A workers’ comp attorney can help you by making sure you follow all the steps below correctly and in a timely manner.
Report Your Injury and File a Claim
If you’re hurt or become sick as a result of carrying out your job duties, you should report your injury, in writing, to your immediate supervisor as soon as possible. Include details of when, where, and how you were injured, along with names of any witnesses to your accident. The Virginia Workers’ Compensation Commission (VWCC) allows you 30 days to make your report, but doing so immediately increases your chance of a successful claim. After receiving your report, your employer should file a First Report of Injury (FROI) with the VWCC.
The next step in the process is to submit a Claim for Benefits form from the VWCC website’s “Injured Workers” page. While you do have two years to file your claim, you should do so as soon as you can. If you wait, your employer’s insurance company, which actually pays workers’ comp benefits, can cite your delay as proof that you’re not badly hurt or that your injury is not work-related. It’s important to remember that the insurer is in business to earn profits by paying out as little as possible in claims.
See an Approved Doctor and Keep Medical Records
Your employer’s insurer may give you a choice of three physicians to see for medical care. If this does not happen, you should seek prompt care from a doctor of your choice, but it’s a good idea for you or your attorney to stay in touch with the insurer about this to make sure your choice of physician does not jeopardize your claim. If you’re not satisfied with the doctor recommended by the insurer, your lawyer can work to get you an independent medical exam from a different physician.
No matter which doctor you see, keep all scheduled medical appointments, follow all the doctor’s advice, and take your medications as they’re prescribed. Keep receipts and other records of treatment, and maintain a daily journal of your recovery process, paying particular attention to the physical activities that will be required by your job when you return to work.
If Your Claim Is Allowed
The VWCC will notify you with an Awards Agreement if your claim is accepted. You should start receiving lost wage benefits equal to two-thirds of your normal salary within a couple of weeks, and medical bills from all your health care providers may be submitted to the insurance company. When you’ve completed treatment and reached the stage of maximum medical improvement (MMI), your doctor should release you to return to your job.
Your claim is most likely to be allowed if your injury is minor, your medical expenses are low, and you require little time off work. In such a case, your claim will not be expensive for the insurer, and you might be able to handle the claims process successfully without a lawyer.
What to Do About Complex and Expensive Claims
Some workers’ comp claims are not as simple as those described above. If, after reaching MMI, you’re left with a temporary or permanent disability, you could be given job restrictions and an impairment rating that allow you to perform only a “light-duty” job for some period of time or for the long term. In such a case, you’re entitled to benefits equal to two-thirds of the difference between your old and new salaries. If your employer cannot offer a light-duty job or if you’re unable to return to work at all, your claim becomes complicated for all concerned and potentially expensive for the insurance company.
There could be disagreement among you, your employer, the insurer, and your doctor regarding your ability to go back to work. You might be required to undergo a functional capacity evaluation (FCE) to determine what job duties you can and cannot perform. Your percentage of lost function in one or more body parts would determine the number of weeks for which you may receive benefits, according to a complicated schedule set forth by the Virginia Workers’ Compensation Act. The insurer might be slow to approve expensive treatments, or your claim could be denied. If this happens, you have to request a hearing before the VWCC or even file an appeal in civil court to continue seeking fair benefits. In order to avoid the stress, tedium, and delays that result from long-term back-and-forth negotiations with the insurer, you might want to consider the alternative settlement options that are available to you.
Types of Workers’ Comp Settlements
You and your attorney might decide that one of the four workers’ comp settlement plans outlined below is better for you than the standard weekly lost-wage benefit process that most claimants go through. It is a good idea to consult a lawyer to help you choose the option that’s best for you.
Full and Final Settlement
The insurance company simply offers you one lump-sum payment, rather than a specified number of weeks of benefits, to compensate you for your injury. This is the most common type of workers’ comp settlement. It fulfills the insurer’s obligation to you, and you may not claim any further benefits resulting from your current work-related injury.
Structured Settlement
You receive a number of payments for a specified amount over a specified number of years. The insurer fulfills its obligation to you in this way and owes you nothing more in the future.
Lump-Sum Payment for Indemnity With Open Medical Benefits
You receive a single payment for lost-wage benefits resulting from your disability, but the insurer agrees to pay future medical bills resulting from your work-related injury. With this agreement, you give up your right to workers’ comp disability benefits and vocational retraining.
Full and Final Settlement with a Workers’ Compensation Medicare Set Aside (WCMSA)
If you have Medicare coverage at the time of your injury, your employer’s insurer pays you a lump settlement and funds a WCMSA for your future medical expenses. The WCMSA funds will be used to pay future medical bills related to your injury before Medicare kicks in to pay the balance. Such a settlement plan might have to be approved by the Center for Medicare and Medicaid Services (CMS).
